Xxxxx is 65-year-old female here with complaints that there

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Xxxxx is 65-year-old female here with complaints that there is an area in the vaginal
introitus that has been opening up and bleeding. She thinks it is in the area of the
episiotomy scar from many years ago. She tried using a little Neosporin on this area,
seems to help a little bit but then it opens up again. Does not seem to heal. She has tried
vaginal estrogen but it seems to actually be irritating when she uses this. She is
wondering if she can use some vaginal tablets that she has heard about. It has been
painful to have intercourse with this.
She also wanted to talk about HRT in general. She has gone off hormones as of about
two years ago but still finds it bothersome in particularly with hot flashes. She notes that
her daughter recently was put on some sort of hormone replacement and her gynecologist
had reviewed risks and benefits with her daughter and we reviewed them again here as
well. She does have a family history of breast cancer in her mother who was diagnosed
at roughly age 79. She had her mammogram done last year. She has not done a physical
in a while.
She had a hysterectomy. There was one ovary intact. She notes that when Dr. Trollope
did the colonoscopy with destruction of the polyp from June of last year he also had done
surgery with sigmoid diverticulitis and a left ovarian mass in 9/2003 as well as an
umbilical hernia repair. Apparently the pathology according to Dr. Whang's note showed
a left ovarian cyst and diverticular disease. It was after this removal of the remaining
ovary that she had persistence of the hot flashes.
PHYSICAL EXAM: Well appearing female. Vaginal introitus with a red area at the
introitus.
ASSESSMENT AND PLAN:
1. Nonhealing area in the vaginal introitus. Does not look infected. She is to try the
Neosporin until she gets into gynecology, have them evaluate what can be done to help
this heal. Meanwhile we are going to try the Vagifem tablets one daily for two weeks
and then two or three times per week for atrophic vaginitis since she does not like using
the messy vaginal creams. We talked about HRT but decided it would be best for her to
come back for a complete physical and we could decide on it at that time. She could ask
the gynecologist's opinion as well.
2. Diverticulosis, extensive enough to require colonic resection 2003 along with the
removal of the remaining ovary.
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