The pelvic complaints discussed in this section concern devices placed (or misplaced) in the vaginal area, such as pessaries or tampons, and vaginal discharge and lesions. Often when a patient has complaints in this region, they are vague and overlapping. Careful questioning is needed to determine the true nature of the complaint.
Far too many vulvar and vaginal infections are managed over the telephone. The reasons are patients often have symptoms they’ve had before and are self-diagnosing, providers have only so much time and many such complaints are dismissed as minor, and there are a host of available over-the-counter products worth trying. In reality, it is hard not to treat these complaints via telephone for the sake of convenience alone.
However, there are compelling reasons to delay such treatment. Serious infections, some of them communicable, can be missed. Patient symptoms may be exacerbated by inappropriate treatments. Superinfection with simple and common body bacteria may occur. It can be better to offer patients some comfort measures for relief until they can be seen and their conditions adequately diagnosed. Your clinic or office practice philosophy often dictates what direction you take.
The biggest challenge in this arena is not letting a potential sexually transmitted infection (STI
) go undiagnosed and thus missing an opportunity for proper treatment at a critical time. It is important to determine patients who may be at greatest risk for STIs. This also is a good opportunity to educate them about the signs and symptoms of potential problems. A chart of STI
presenting symptoms, incubation periods, usual course of the disease, and important facts and implications are included here.
It is important to remember that urinary symptoms and vulvovaginitis symptoms may overlap. Yeast infections can affect the urethra and bladder, causing the familiar triad of dysuria, urgency, and frequency. Patients also may mistake the discomfort of urine irritating a vulvar lesion as symptoms of abnormal urination.
Some tried and true remedies may keep patients comfortable until they can be adequately evaluated. Some suggestions of common home remedies are zinc oxide, oatmeal bath products, cold compresses, bags of frozen vegetables secured in an outer wrapper, and even vegetable shortening! You should discuss with the providers with whom you work what comfort measures will be suggested to patients until they can be seen.
Comfort measures we recommend in our clinic/office are:
______________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________.
Also included in this section are protocols for evaluating patients who have had common outpatient procedures who may call with common related complaints. Detailed information to answer questions regarding Pap smears is also provided. (Note: Zika and other emerging diseases that may be transmitted sexually are not included yet in the STI
chart.) Information on these diseases may be found in Chapter 5
, Table 5-1
: Exposure to Selected Communicable Diseases in Pregnancy.