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Dr. Rajal C. Patel, a gynecologist at Northwestern Medicine, discusses the challenges in diagnosing and treating rare vulvar and vaginal disorders. Her insights highlight the importance of looking beyond common pathogens when addressing recurrent vaginitis and emphasize the need for a multidisciplinary approach to patient care. Dr. Patel’s expertise provides additional insight on conditions that are often overlooked in routine gynecological examinations and standard diagnostic procedures.
Key Points:
- Rare vulvar and vaginal disorders include lichen sclerosis, lichen planus, vulvar psoriasis, squamous intraepithelial lesions, hidradenitis suppurativa, Langerhans cell histiocytosis, and sebaceous hyperplasia.
- Standard vaginitis panels test for yeast, bacterial vaginosis, and trichomoniasis, but may miss conditions like cytolytic vaginosis, desquamative inflammatory vaginitis, or ureaplasma and mycoplasma infections.
- Positive tests for common pathogens may sometimes indicate an “innocent bystander” rather than the root cause of symptoms, which could be an underlying dermatosis or neuropathic pain.
- Open-ended questions about vulvar and vaginal concerns during routine exams can help identify issues patients may not voluntarily disclose.
- Northwestern Medicine’s multidisciplinary approach includes specialized physical therapists, sex therapists, pelvic medicine specialists, and interventional radiologists.
- Unique treatments offered include intralesional injections, laser surgery, and vestibulectomy.
- Dr. Patel advocates for expanding medical education to include more comprehensive coverage of vulvar and vaginal health, menopause, and sexual medicine.
“The problem with vulvar and vaginal problems is many patients don’t talk about it, and it’s not as part of a routine exam to ask the patient about these areas.”
– Rajal C. Patel, MD, Obstetrics-Gynecology, Northwestern Medicine
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