Tuesday4 - sammy08

[ArchivalUser]

A 54 year old white female comes to the office for evaluation of vaginal irritation and discharge. She says that she has dysuria and increased frequency of urination. these problems started 3 months ago but are increasing day by day. she is not taking any medication currently and she underwent hysterectomy for fibroid uterus 6 years ago. on examination, clear watery discharge is noted at the introitus and generalised vulvular erythema of the vagina is noted. Sterile speculum examination shows a pale vaginal epithelum with patches of erythema. The PH of the discharge is 5.5. pap smear prepration of the discharge reveals numerous basal epithelial cells. Urine dip stick test is normal What is the best initial treatment for this patient?

A. TMP- SMX for one week
B. Metronidazole
C. Vaginal ablation
D. Combined estrogen and progesterone replacement
E. Estrogen replacement

[ArchivalUser]

e

[ArchivalUser]

E

[ArchivalUser]

e.

[ArchivalUser]

diagnosis ?

[ArchivalUser]

a.

[ArchivalUser]

This is atrophic vaginitis. The diagnosis itself wasn't the issue here. The point to be stressed is that had she not underwent that hyterectomy, we would have gone for combined estrogen and progesterone treatment rather than estrogen alone