Accuracy of Vaginal pH Testing Before and After Addition of Sterile Saline.

OBJECTIVE: Complaints of vaginal discharge are common, and vaginal pH is important diagnostically. Vaginal pH is measured either directly using pH paper or after wet mount analysis. This study aims to analyze whether a significant change in vaginal pH after saline addition exists. METHODS: This prospective, diagnostic accuracy study included 97 persons with a vagina between the ages of 18-80 years who received care at an academic center. Two samples of vaginal discharge were collected, with pH measured by direct application to pH paper and after wet prep analysis. Outcome measurements included pH measurements and demographic variables collected from electronic medical records. A Wilcoxon signed-rank test was performed, with a p value less than .05 considered significant. It was hypothesized that addition of saline to vaginal discharge increases pH artificially. RESULTS: Primary outcome included pH difference between both samples. Sixty four (66%) of the subjects had a pH difference of 0.50 and 3 (3%) had a difference of 1.0. Twenty nine (30%) of the subjects had no difference. One subject (1%) had a decrease of 0.50 in pH after saline. Reproductive age and nonuse of vaginal medications were significantly associated with a pH difference of 0.50 or higher after saline addition. Of the demographic variables, reproductive age and nonuse of vaginal medications within the past week or the day of collection were associated with a significant pH difference after saline addition (79%, p = .025; 79%, p = .001; 76%, p = .002, respectively). CONCLUSIONS: It may be reasonable to subtract 0.50 from final pH reading in patients of reproductive age and in those who have not used vaginal medications recently.

Vulvar Concerns in Women With a History of Abdominoplasty: A Case Series.

OBJECTIVES: The aim of the study was to present a series of women with a history of traditional abdominoplasty or circumferential abdominoplasty (belt lipectomy) with vulvar concerns and anatomic changes. METHODS: We describe 5 women with a history of abdominoplasty who were referred with symptoms of vulvar pain, dyspareunia, lower urinary tract symptoms, and/or lesion/mass. Physical examination revealed elevation of the clitoris on the pubic symphysis with or without retraction of the clitoral hood in each. RESULTS: Abdominoplasty can result in anatomic changes to the female pubic region after elevation of the mons pubis and consequent elevation of the clitoris with or without retraction of the clitoral hood. Although causation cannot be confirmed from this series, a temporal association of vulvar/clitoral pain, pelvic floor dysfunction, and anatomic alterations with or without lesions after abdominoplasty was present in each case. CONCLUSIONS: Awareness regarding potential sequelae from anatomic alteration may lead to improved patient counseling and modified surgical techniques to avoid significant elevation of the mons pubis and vulvar commissure.

Botryomycosis of the vulva: a case report.

OBJECTIVE: Vulvar ulcers may be caused by various etiologies including infection, trauma, dermatosis, and cancer. We report a case of a vulvar ulcer caused by botryomycosis. CASE: An 85-year-old woman presented with vulvar itching, pain, bleeding, and ulcerations suspicious for cancer. Biopsies of the ulcers returned without dysplasia or malignancy. She was referred to the tertiary care vulvar vaginal disease clinic. Dermatopathologic reevaluation of pathologic slides diagnosed lichen sclerosus and botryomycosis. The patient was treated with ciprofloxacin for 7 weeks with complete resolution of vulvar ulcerations. CONCLUSION: Botryomycosis should be included in the differential diagnosis of infectious etiology of vulvar ulcers.

Langerhans' cell histiocytosis of the vulva: the Iowa experience.

BACKGROUND: Vulvar presentation of Langerhans' cell histiocytosis (histiocytosis X) is rare. Symptoms and signs at the time of presentation can include pruritus, pain, dyspareunia, burning, discharge and presence of a discrete lesion and/or generalized ulceration. Once a diagnosis of Langerhans' cell histiocytosis is made, there is no formal treatment protocol. This report highlights 2 clinical cases diagnosed and treated at a tertiary care center. CASES: We report the case histories of 2 women who presented to the Vulva/Vaginal Disease Clinic at the University of Iowa. The first patient, a 76-year-old woman, had a 1-year history of vulvar pruritus. The second patient, a 39-year-old woman, had a 3-month history of a clitoral growth. CONCLUSION: Presentation of Langerhans' cell histiocytosis as a vulvar primary condition is rare and probably underdiagnosed as its clinical presentation can vary. Such patients often have been treated for recurrent yeast or presumed herpes simplex virus infections. Langerhans' cell histiocytosis should be considered as a differential diagnosis in females who present with chronic pruritus, pain, ulcerations or intermittent rashes.