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Abstract: The patient in this case is a 48-year-old woman with pelvic floor dysfunction caused by multiple pregnancies and deliveries, resulting in urinary leakage. Due to urinary leakage, the patient often used sanitary napkins that were not breathable, and with the infiltration of urine, she developed vulvar pain, itching, burning sensation, and finally vulvar epidermal rupture, so she came to our hospital and was finally diagnosed with vulvodynia, and was given sitz bath + medication before her condition was controlled and her symptoms relieved.
Basic Information】Female, 48 years old
Disease Type】Vulvodynia
Hospital】Guangxi Zhuang Autonomous Region Jiangbin Hospital
Date of consultation】July 2021
Treatment plan】Sitz bath (1:5000 potassium permanganate solution) + medication (recombinant bovine basic fibroblast growth factor gel + gentamycin hydrochloride ointment)
Treatment period】10 days of outpatient treatment
Treatment effect】The condition was controlled and the burning sensation and pain of vulva was relieved.
I. Initial consultation
Patient’s description: She had 3 normal births and 2 abortions in the past. In the last month, the leakage has worsened and she needs sanitary napkins to go out. Due to the hot weather and the influence of the sanitary napkins soaked with urine, the patient experienced a burning sensation and itching in her vulva, and inadvertently scratched and damaged part of the skin, resulting in vulvar ulceration and pain. In recent days, she felt unbearable and visited our outpatient clinic on July 5, 2021. Gynecological examination: the vulva was flushed, the labia majora and minora were enlarged, part of the epidermis was broken, the vagina was open, there was not much discharge, the uterus was normal in size, there was no pressure pain, and no abnormality was palpated in both adnexal areas.
(Outpatient medical record on July 5)
II. Treatment history
The patient was given potassium permanganate disinfection tablets and instructed to take a daily sitz bath at home diluted to 1:5000 potassium permanganate solution. After the sitz bath, recombinant bovine basic fibroblast growth factor gel and aureomycin hydrochloride ointment were applied to the vulva alternately, which has a bactericidal effect and promotes the healing of broken skin. This has an antiseptic effect and promotes the healing of broken skin. At the same time, patients are instructed not to use sanitary napkins, to rest as much as possible at home, to avoid excessive activities leading to friction on the affected side of the vulva, to choose cotton, loose, breathable pants, and to avoid sexual intercourse.
Third, the effect of treatment
After 5 days of treatment, the patient went to the outpatient clinic for a follow-up consultation, and the vulva was still mildly flushed, but it was significantly less flushed than before, and the broken epidermis had also healed. The surface of the wound was crusted and healed, indicating that the treatment was effective. The patient was recommended to refer to the pelvic floor rehabilitation center for pelvic floor rehabilitation treatment to relieve the symptoms of vulvodynia.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we still need to remind the patient of some matters that should be noted in daily life.
1.Patients are advised to continue to keep the vulva dry and clean in order to facilitate the debridement of ulcerated wounds, reduce activities, choose loose and comfortable pants and avoid excessive rubbing of the vulva.
2, to develop good eating habits, less fishy and spicy and easily triggered allergies, fire food, more fresh fruits and vegetables, more conducive to reduce the recurrence of vulvodynia.
3. Long-term leakage and recurrent episodes of vulvodynia can easily have a negative impact on a woman’s physical and mental health, even significantly reducing her activities and social life, for which her family should be more understanding and encourage patients to actively pursue treatment.
4. It is recommended to go to a pelvic floor rehabilitation center to assess the function of the pelvic floor and develop an individualized rehabilitation program to relieve the symptoms of urinary leakage and to remove the triggering factors of vulvodynia.
V. Personal insight
There are many causes of vulvodynia, but for older patients, urine leakage is also a common cause of vulvodynia, so frequent and repeated urine leakage should be taken seriously. This can lead to pain, itching, burning and scratching, which can lead to erosion and ulceration, and can be physically and mentally harmful to the patient. Because urine leakage is the trigger, patients should undergo pelvic floor rehabilitation as early as possible to relieve the symptoms of bladder bulge, which is helpful to reduce urine leakage.