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Myth Busters- A Randomized Control Trial on Laser Therapy in Lichen Sclerosus The Vulva Diaries

March 6, 2021

Dr. Selk interviews Dr. Andrew Goldstein, an obstetrician and gynecologist and the director of the Center for Vulvovaginal Disorders in New York City and Washington DC, about his new randomized control trial studying laser therapy in lichen sclerosus (LS). Topics covered include reasons behind conducting the trial, methodology of the study, results of the study, how to counsel patients about laser for LS, previous research and other evidence on laser for LS, importance of unbiased study design, differences based on type of laser used, and the ethics of counselling patients about treatment.

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Desquamative Inflammatory Vaginitis

February 20, 2021

In this week's episode Dr. Selk interviews Dr. Claire Danby, who is an obstetrician gynecologist at Maine Medical Center with a dedicated vulvovaginal clinic and a clinical assistant professor at Tufts University. Today they discuss desquamative inflammatory vaginitis (DIV). Topics covered include the definition of DIV, presentation, diagnostic criteria, etiology, demographics, prevalence, a systematic approach to diagnosis, treatment, treatment changes based on menopausal status, other conditions that get confused with DIV, and cure rate of DIV.

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Estrogen in Post-menopausal Vulvar Pain

February 06, 2021

Dr. Selk interviews Dr. Martha Goetsch who is a long-term researcher and clinician specializing in vulvar conditions at the Oregan Health and Sciences Unit. In this week's episode they discuss some of her recent research on estrogen in vulvar pain. Topics covered include the background and reasons for exploring this area, theories behind the cause of vulvar pain, methods studied to reduce vulvar pain, and results after implementing these methods in post-menopausal women. They also discuss estrogen regimens in post-menopausal patients, differentiating between atrophy/dryness and pain, systemic absorption of topical estrogens, how long to treat with estrogen post-menopause, reassuring patients about estrogen use, the utility and importance of using lidocaine in these patients and what concentration of lidocaine to use.

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Terminology of Vulvodynia

January 16, 2021

This week Dr. Selk interviews Dr. Jacob Bornstein in his second episode with "The Vulva Diaries"! Dr. Bornstein is a professor of Obstetrics and Gynecology in Israel, past president of the ISSVD and chair of the terminology committee, with extensive publications in vulvar disease. In this episode they discuss the terminology of vulvodynia. Topics covered include history behind the terminology of vulvodynia, potential etiologies of vulvodynia, the process behind updating terminology, key elements that factor into determining the terminology of vulvodynia, importance of ascertaining the main associated cause of a patient's vulvodynia, evidence behind treatments for vulvodynia, and the story of the emergence of vulvodynia into the research spotlight.

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Vestibulectomy

December 5, 2020

In today's episode Dr. Selk interviews Dr. Jacob Bornstein, a professor of Obstetrics and Gynecology in Israel, past president of the ISSVD and chair of the terminology committee, with extensive publications in vulvar disease. Today we are covering vestibulectomies -- what a vestibulectomy is, the history behind it's development, indications, it's success rate in treating vulvodynia, and at what point to offer vestibulectomy. Other topics discussed include complications associated with vestibulectomy and the rate at which they occur, answers to questions commonly asked by patients (what will it look like? and will it prevent vaginal delivery?), how long to follow patients post-operatively, which patient populations are less likely to be cured, extensive versus minimal surgical techniques, and post-operative recovery.

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Lichen Sclerosus and Lichen Planus in Pregnancy

October 24, 2020

In this week’s episode Dr. Selk chats again with Dr. Jennifer Bradford, a gynecologist in Sydney, Australia with a tertiary care practice in vulvovaginal disease and co-author of “The Vulva” handbook. In this second episode covering lichen sclerosus and lichen planus with Dr. Bradford, they discuss how pregnancy can affect these conditions. Topics discussed include how lichen sclerosus (LS) and lichen planus (LP) symptoms change over the course of pregnancy and post-partum, LS and LP treatments during pregnancy, vaginal delivery with LS or LP, managing post-partum LS flares, topical steroid safety in pregnancy (and tips on how to counsel patients about this), elective C-sections, potential effect of breastfeeding on post-partum flares, and tips for motivating patients to improve treatment compliance post-partum.

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A Hairy Situation: Vulvar Hair Removal

September 13, 2020

In her second feature on "The Vulva Diaries," Dr. Selk interviews Dr. Melissa Mauskar, a dermatologist at UT Southwestern Medial Center in Dallas, Texas, about issues that can occur with vulvar hair removal. Topics covered include hair removal methods, side effects from shaving, prevention of these side effects, reasons for vulvar hair removal, side effects from hair removal creams and waxing and prevention of these side effects, managing burns from waxing, laser hair removal, issues with permanent hair removal, how to approach providing patient education about vulvar hair removal, and vulvovaginal disease patients that should not engage in hair removal.

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Lichen Sclerosus and Vulvar Cancer: A Patient's Journey and Advocacy Mission

August 1, 2020

This is our first patient interview episode! In this episode Dr. Selk interviews Clare Baumhauer, who is a patient with lichen sclerosus and vulvar cancer, a patient advocate for these conditions, and the co-founder of the UK Vulvar Cancer Awareness Group. Topics covered include Clare's patient journey, including her long road to diagnosis, reasons for lack of patient and healthcare provider awareness about vulvovaginal diseases, difficulties with finding knowledgable practitioners, the story behind her amazing campaign, importance of correcting misinformation about steroid use for treating lichen sclerosus, advice for vulvovaginal disease patients, messages to healthcare providers about lichen sclerosus and vulvar cancer, and the importance of patient support groups.

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Genital Warts

June 20, 2020

Dr. Selk interviews Dr. Debra Birenbaum, an obstetrician-gynecologist at Dartmouth-Hitchcock Medical Center in New Hampshire, about genital warts. Topics covered include prevalence, diagnosis, treatment options and specific treatment methods, treating resistant bulky disease, when to biopsy, vaccination, treating warts in pregnancy, and treating immunocompromised patients.

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Steroid Therapy Part 2

January 02, 2021

This week is part 2 of our two episode series on steroid therapy with Dr. Gayle Fischer. Dr. Fischer is a professor of Dermatology at the University of Sydney in Australia, and has written books and has many years of research experience in the area of vulvar dermatology and lichen sclerosus (LS). In this episode, Dr. Selk and Dr. Fischer discuss steroid therapy in pregnancy, whether prescribed steroid strength depends on a patient's age, how often to follow-up with patients, natural remedies and how to advise patients about this, how to optimize steroid treatment, whether steroids can ever be stopped, and whether steroid treatment can prevent complications of LS..

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If It Ain't Broke Don't Fix It: Evidence Behind New LS Treatments

November 21, 2020

Dr. Selk interviews Dr. Gayle Fischer, a dermatologist at the University of Sydney in Australia and an expert in lichen sclerosus (LS), about new LS treatments. Topics covered include steroid treatment and why patients seek different treatments, new ancillary treatments and evidence behind them, patient counselling tips, post-procedural steroid use, dangers of calcineurin inhibitors in LS, and benefits of topical steroid treatment.

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Surgery for Lichen Planus and Lichen Sclerosus

October 10, 2020

Dr. Selk interviews Dr. Jennifer Bradford, who is a gynecologist in Sydney, Australia with an exclusive vulvovaginal practice and the co-author of the clinical handbook "The Vulva." This episode covers surgeries for scarring secondary to lichen planus and lichen sclerosus. Topics discussed include types of surgeries, pre-operative requirements, anesthetics, surgical techniques, who to operate on, treating vaginal agglutination in lichen planus, and post-operative management.

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Graft Versus Host Disease

August 29, 2020

Dr. Selk interviews Dr. Michelle Jacobson, a gynecologist in Toronto, about graft versus host disease (GVHD). Topics covered include the definition of GVHD, counselling of stem cell transplant patients, assessing for genital GVHD, patient presentation, detecting GVHD in the context of menopause, physical features of genital GVHD, when to treat with surgery, recurrence risk, medical therapies and other treatments, vaginal creams versus ointments, treating post-menopausal women with vaginal steroids, the role of biopsy in diagnosis, and important information to communicate to your pathologist.

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The Role of the Psychologist

July 18, 2020

Dr. Selk interviews Dr. Sophie Bergeron, a professor of psychology at the University of Montreal, about the role of a psychologist in treating vulvovaginal disease patients. Topics covered include how psychologists can help vulvovaginal disease patients, what kind of therapy is used for these conditions, the evidence behind CBT for vulvar pain disorders, strategies for emphasizing the importance of seeing a psychologist to patients, how to find a good therapist, different kinds of sex therapists, if patients require referrals, average cost of treatment, average number of sessions required, and couples therapy.

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Hidradenitis Suppurativa

June 6, 2020

In Dr. Kristen Stewart's second episode, she and Dr. Selk discuss hidradenitis suppurativa (HS). Dr. Stewart is a dermatologist in Jacksonville, Florida. Topics covered include prevalence, diagnosis (and why it takes so long for patients to get diagnosed with this condition), clinical presentation, common symptoms and patient complaints, causes of HS, treatments (including lifestyle modifications, medical treatments and surgery), staging of HS, patient support, comorbidities, and differentiating between HS and cutaneous Crohn's disease.

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Steroid Therapy Part 1

December 19, 2020

Dr. Selk interviews Dr. Gayle Fischer in part 1 of our 2 episode series on steroid therapy. Dr. Fischer is a professor of Dermatology at the University of Sydney in Australia, and has written books and has many years of research experience in the area of vulvar dermatology and lichen sclerosus (LS). Topics covered include the importance of using long-term steroids in certain vulvar conditions, how to respond to patient fears about steroids, studies assessing side effects of steroid use in these conditions, matching the strength of the steroid to the severity of disease, providing instructions to patients, importance of raising awareness about vulvar diseases, long-term steroid use in pediatric vulvar disease, and psychosocial implications of pediatric LS.

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Pigmented Vulvar Lesions

November 7, 2020

In another episode with Dr. Melissa Mauskar, a dermatologist from UT Southwestern Medical Center in Dallas, Texas, her and Dr. Selk discuss pigmented vulvar lesions. Topics covered include types of vulvar pigmented lesions, mimickers of pigmented lesions, when to biopsy, vulvar melanoma, specific ways to biopsy melanomas, post-inflammatory hyperpigmentation, treatments, and symptoms associated with pigmented lesions.

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Cosmetic Gynecology

September 26,2020

Dr. Selk interviews Dr. Sofia Torres, a gynecologist in Buenos Aires, Argentina, about cosmetic gynecology. Topics covered include types of cosmetic gynecologic procedures (surgical and non-surgical), why they've become more popular, who offers these procedures, evaluating patient motivations for undergoing these procedures, resources for patient education, patient counselling recommendations, assessing for organic anatomic issues, post-operative complications, and laser procedures.

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Vulvar Cancer

August 15, 2020

Dr. Selk interviews Dr. Mario Preti, a gynecologist and oncologist in Torino, Italy and the past President of the International Society for the Study of Vulvovaginal Disease (ISSVD), about vulvar cancer. Topics covered include prevalence, demographics, types of vulvar cancer, risk factors and causes, how vulvar cancer patients present, what is seen on physical exam, diagnosis, how to biopsy a suspicious lesion, treatment, impact of lymph node metastases, inguinal lymph node removal and sentinel node dissection, treating advanced vulvar cancer, when to recommend radiation therapy, prognosis, recurrence, treating recurrent disease, prevention of vulvar cancer, supportive care and the importance of patient awareness.

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Lichen Planus

July 4, 2020

Dr. Selk interviews Dr. Melissa Mauskar, a dermatologist at UT Southwestern Medical Center in Dallas Texas, about lichen planus. Topics covered include the definition of lichen planus, the different forms of lichen planus, prevalence, typical presentation, what to look for on exam, when and how to biopsy, and steps to take after you get a non-specific biopsy result. They also discuss different treatments, depending on whether the patient has localized vulvar disease or disease in different areas of the body, treating the patient that's not getting better, which systemic therapies work best, how to treat patients with vaginal involvement, use of dilators, treating post-menopausal patients on topical estrogen therapy, which topical steroids to use, counselling patients on steroid application, and the impact of lichen planus on patients' quality of life.

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