This is a much needed book for the patient with vulvovaginal symptomatology too often faces the prospect of an incomplete evaluation and misdirected therapies. There are many reasons for this. Physicians with practice time constraints magnified by an office full of waiting patients too often begin their physical examination with the introduction of the vaginal speculum, bypassing the vulva. In addition, the record of diagnostic accuracy of vaginal infections by physicians shows a high error rate and inaccurate diagnoses lead to inappropriate therapeutic interventions, which only prolong and sometimes intensify patient's symptomatology. Finally, to a large extent, the care of patients with vulvovaginal problems requires dermatologic insights that are too often lacking for many practitioners.
The editors of this book, Miranda A. Farage and Howard I. Maibach, attempt to address these shortcomings and I applaud their efforts. They have selected experts who have both the knowledge and the ability to organize their prose that captures reader attention and accomplishes reader understanding. The underlying philosophy of this book is to provide an in-depth expose of the anatomy and physiology: a basis for the understanding of the pathophysiology and one that sets a goal to achieve with appropriate therapy. This is followed by an exposition of the myriad presentations of patients with vulvovaginal disease, and current scientifically accepted treatment regimens. There is an excellent analysis of the menstrual cycle and the range of health care products that are now available to women. Since medicine is not practiced in a vacuum, the influences of race and societal norms on women are provided in detail. Finally, there is a fascinating section that provides an in-depth review of newer investigational techniques that will influence the future care of women.
This is a book for all readers. For me, it is a cover-to-cover joy to read. For others, it will be a valuable office reference to be opened every day to address problems of individual patient care. My congratulations to both the editors and the authors. Obviously, it is a labor of love that hits the mark.
William J. Ledger, M.D. Professor and Chairman Emeritus Department of Obstetrics and Gynecology New York Presbyterian Hospital-Cornell Medical Center
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