ABSTRACT

Improved Pelvic care begins with the acknowledgment by its providers that vulvovaginal problems are not trivial but are important and require attention. The starting point in the care of the patient with vulvovaginal symptoms is a history designed to capture the salient points needed for an accurate diagnosis. This specifically requires a sympathetic physician to ask directed questions of the patient. An error that many physicians make is to begin the pelvic examination with the insertion of the vaginal speculum. For the woman whose chief complaint is burning, itching, or the inability to have intercourse because of vulvar pain, this premature use of the speculum eliminates the possibility of recognizing vestibulodynia. Nonculture analysis of the bacterial flora of the vagina in healthy women and in disease states provides more complete information of the composition of the microbial microbiome. Patients can be symptomatic due to an allergic vaginal or vulvar inflammation.