A Note from the Editor-in-Chief
Lawrence D. Devoe, M.D.
Welcome to the February 2007 Editor-in-Chief’s page. This issue continues a selection of articles related to a recent international symposium, the XVIIIth World Congress of the International Society for the Study of Vulvovaginal Disease (ISSVD). While there are a number of important contributions in this issue, I would like to highlight the following:
In This Issue:
Training in the Diagnosis and Management of Vulvovaginal Diseases
A major factor that contributes to difficulties in treating patients with vulvovaginal diseases is deficient training of providers who care for this population. Murphy conducted a questionnaire survey of ISSVD members that covered the past, present and future scope of how best to accomplish improvements in clinical education. While the survey respondents were mainly United Kingdom clinicians, the recommendations made in this report may be generalized to other nations. In essence, given the acknowledgment that specific training in vulvovaginal diseases should be improved, the concept of postgraduate fellowship training seems worthy of consideration. Given the plethora of required curricular elements for basic training in obstetrics and gynecology in North America, this suggestion, if implemented, would allow the development of a cadre of experts who would provide better patient care.
An Evaluation of Gabapentin in the Treatment of Generalized Vulvodynia, Unprovoked
G. Harris, B. Horowitz and A. Borgida
The authors addressed the possible efficacy of the use of gabapentin in the treatment of vulvodynia. Gabapentin has been well studied as an anticonvulsant. Although its mechanism of action is unclear, it has also been used successfully as a palliative agent for neuropathic pain. In this retrospective analysis, it appears that patients treated for more than 2 years had significant improvement in most instances (80%) and with a very low incidence of side effects. Those patients who received treatment early in their disease experienced better results than did those whose disease history was protracted. Though the group size was relatively small and the design lacked the power of a prospective, randomized trial, it provides encouraging support for use of this therapeutic option in properly selected patients.
Expansion of Altered Vaginal Flora States in Vaginitis to Include a Spectrum of Microflora
R. S. Fowler
The author reviewed a large sample of vaginal wet preparations in patients presenting with symptomatic vulvovaginal conditions. As one considers the patterns described in this thoughtful review, one recognizes that there is a good case made here for reclassifying them with respect to the microfloral categorization suggested in the article. This type of approach would have the benefits of making clinical studies and tests of new therapies more practical for both clinicians and the manufacturers of antimicrobials.