Dr. Chapa’s OBGYN Clinical Pearls

Lichen Planus is a chronic inflammatory mucocutaneous disorder that can affect the mouth, vulva, vagina, and anus. Wickham’s Striae are characteristic of mucosal involvement. Biopsy is often needed to confirm the diagnosis and rule out other neoplastic conditions. The more afflicting type of Lichen Planus is erosive lichen planus. In this session, we will review the presentation, pathophysiology, diagnosis, and treatment of vulvar Lichen Planus. (Reference: ACOG expert series CME edition on vulvar skin dermatoses; 2018)

Vulvar Lichen Simplex Chronicus is a non-scarring, chronic inflammatory disease of the skin characterized by intense itching. 65% to 75% of patients have a history of allergic conditions including asthma or childhood dermatitis. In this session, we will review the presentation, diagnosis, and medical care of vulvar Lichen Simplex Chronicus. (Reference: ACOG clinical expert series, CME edition, “Diagnosis and Treatment of Vulvar Dermatosis“ ; 2018)

Vulvar Lichen Sclerosus is a chronic inflammatory vulvar dermatosis. There is an association between this condition and various systemic autoimmune conditions (e.g., thyroid dysfunction, vitiligo). Additionally, patients with this condition have a 4-5% risk of vulvar cancer in the future! In this session, we will discuss the pathophysiology, diagnosis, and management options for this condition. (Reference: CME Series on “Diagnosis and Treatment of Vulvar Dermatosis”, 2018; Obstet Gynecol)

The etonogestrel contraceptive implant is a type of LARC with proven high efficacy. Yet, similar to all progestin only contraception, abnormal bleeding can become bothersome to the patient- especially in the first 3 to 6 months of use. Ulipristal, a progesterone receptor modulator, has shown promise as a new medical agent to help relieve bothersome bleeding in these patients. In this podcast, we will review the latest data from a randomized controlled trial (Oct 2018) on ulipristal for bleeding control in Nexplanon users.

On December 15, 2018, the ACOG released a Practice Update regarding subcutaneous use of 17OHP rather than IM 17OHP for preterm birth prevention. Weekly IM injections of 17OHP were endorsed by the ACOG after the 2003 MEIS MFM Network clinical study demonstrated a reduced risk of preterm birth in women with prior preterm birth, with its use. In this podcast, we will review the ACOG practice update regarding subcutaneous rather than IM 17 OHP for preterm birth prevention.

Nipple discharge is a common breast symptom. Keys and clues to stratify patients as either low risk or high-risk include: the patient’s age, unilateral or bilateral discharge, single duct or multi duct, whether a mass is also present in the breast, and the color of the discharge. Most nipple discharge thankfully is benign, but some require more attention. In this session, we will review the ACOG practice bulletin number 164 regarding nipple discharge.

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Pregnant women and their partners often ask whether or not sex is allowed in pregnancy and what possible consequences may occur. Does sex cause preterm labor? Is PID possible during pregnancy? Is oral sex allowed? Does sex induced labor? Let’s take a look at these questions... and provide answers!

Premature Ovarian Insufficiency (POI) has replaced the previous term of “premature ovarian failure” or “premature menopause”. POI is a stressful and emotional taxing diagnosis for any woman, especially the adolescent and young patient. Other endocrinopathies may be present in patients with POI including thyroid abnormalities and adrenal insufficiency. In this session, we will review the last ACOG Committee Opinion on POI in adolescents and young women (CO 605).

Progestin only contraceptive options include the subdermal implant, Injection, IUS, and pills. Progestin based LARCs provide HIGHLY effective contraception. A common perception in the public community is that these options may result in depression! Do they? Let’s take a look at a systematic review from 2018 on the subject.