Lab tests should include a wet mount, “which is absolutely essential”; cultures for speciation and sensitivity; tests for gonorrhea, chlamydia, and herpes simplex virus types 1 and 2; and serum tests of estradiol, total and free testosterone, and sex hormone–binding globulin.
“I'm a big proponent of vulvar punch biopsies,” Dr. Goldstein added. “I always send my punch biopsies with a differential diagnosis to a dermatopathologist, and I always close the biopsy with one or two interrupted Vicryl sutures.”
Atrophic vulvovaginitis is the most common cause of dyspareunia in menopausal women, he said, followed by pelvic floor dysfunction and vulvar dermatoses. Less common causes include vulvar granuloma fissuratum, desquamative inflammatory vaginitis, and interstitial cystitis.
He said he believes the addition of low-dose testosterone to estradiol helps to treat atrophy at the vulvar vestibule, but he acknowledged that this belief is based on his clinical experience and lacks evidence-based studies.
Dr. Goldstein disclosed that he serves on the advisory boards of Boehringer Ingelheim Pharmaceuticals Inc. and Wyeth. He has also received research funding from Novartis.
Postmenopausal women 'expect to have sex later in life.'
Source Dr. Goldstein