Ashley Fuller, MD

A v***ar biopsy sounds scary. But knowing what to expect can make it a whole lot less intimidating.

The part that usually hurts the most? The injection of numbing medicine—and that discomfort is typically brief. If you’re nervous about it, you can ask your clinician to use topical numbing medication BEFORE the injection.

Once you’re numb, you may feel pressure or pulling, but you shouldn’t feel sharp pain.

Your clinician may use a small punch biopsy or remove a tiny piece of tissue with scissors. Depending on the size and location, they may place a dissolvable stitch or use a chemical agent to stop the bleeding.

Most v***ar biopsies heal within about 1–2 weeks.

And remember: you’re allowed to ask questions. You’re allowed to ask for more numbing. You’re allowed to tell us if something hurts.

A tiny piece of tissue can give us incredibly valuable information—and sometimes finally give you the right diagnosis. 💗

***arHealth ***arBiopsy

Vaginitis is often treated like a quick visit.

Swab → result → prescription → done.

But for patients with persistent or recurrent symptoms, it can take over their lives.

And here’s the thing: a positive test doesn’t always explain the symptoms. A negative test doesn’t mean nothing is wrong. And not everything that feels like “vaginitis” is actually vaginitis.

A good history matters. A careful exam matters. Clinical context matters.

Vaginitis deserves more than a swab and a MyChart message. And our patients deserve to feel like we understand how much this can affect their lives.

***arHealth

How big is the v***ar vestibule, really?

Not very big.

But this tiny area of tissue can cause a VERY big amount of trouble.

Burning. Rawness. Pain with pe*******on. Pain with tampons. Pain with touch. Pain that makes someone dread s*x—or stop having it altogether.

The vestibule is small, highly innervated, hormonally responsive, and vulnerable to a number of different pain processes.

And yet, it’s an area that often gets barely examined—or gets lumped in with “the va**na.”

Small piece of anatomy. Huge potential impact on quality of life.

Never underestimate the vestibule. 🔎

***arHealth ***arVestibule

Call me old fashioned, but this v***ar specialist still loves a good old-fashioned yeast culture. 🧫

PCR panels are fast. They’re convenient. They can detect a LOT.

But sometimes I don’t just want to know whether Candida DNA is hanging around.

I want to know: Is yeast actually growing? What species is it? And if treatment keeps failing, what is it susceptible to?

A culture can help answer those questions—especially when symptoms are persistent, recurrent, atypical, or just not following the script.

Because a positive molecular test doesn’t always tell the whole clinical story. And neither does a negative one.

The best test isn’t always the newest test.

Sometimes you need to examine the patient, look at the discharge, use your microscope—and send a good old-fashioned culture.

Yes, I will die on this Petri dish. 🧫😂

***arHealth

Your v***ar vestibule is NOT just the entrance to your va**na. 👀

In fact, embryologically, it has more in common with the urethra than it does with the va**na.

Why does that matter?

Because when we lump the v***a, vestibule, and va**na together as one interchangeable body part, we miss things. We misunderstand symptoms. And sometimes, we treat the wrong tissue.

The vestibule is its own distinct, hormonally responsive, highly innervated tissue—and it deserves to be examined and understood that way.

Anatomy isn’t just trivia. It changes how we diagnose and treat vulvova**nal symptoms.

So please: look before you treat. 🔎

***arHealth ***a ***arVestibule

Ferry ➡️ talk about s*x ➡️ try to look like I’m not nervous ➡️ ferry home. 😂⛴️🎤

Not a bad day at the office.

Yeast infections are common. But that doesn’t mean they’re always simple. 🍞😬

A few things I wish everyone knew:

✨ Not every itch is yeast.
Irritation, dermatitis, BV, v***ar skin conditions, low estrogen, and other causes can feel a whole lot like a yeast infection.

🔬 The species matters.
Not all Candida behaves the same way—and not every species responds to the same treatment.

🔥 Sometimes you need to treat the inflammation, too.
Even when the yeast is being treated, irritated v***ar tissue may need some extra attention.

🧐 Recurrent yeast? Ask WHY.
If it keeps coming back, it’s worth confirming the diagnosis and thinking about what might be contributing rather than just repeating the same prescription over and over.

💊 And fluconazole isn’t the right answer for every yeast infection.
Sometimes you need a different medication, a different duration, or a different diagnosis altogether. It can also interact with other medications, so “just take a Diflucan” isn’t always as simple as it sounds.

Bottom line: Your v***a is not a sourdough starter. If the “yeast infection” keeps coming back, it deserves a closer look. 😂

Save this one for the next time things get itchy—and send it to someone who has a standing Diflucan prescription in their medicine cabinet. 👀

***arHealth

Fluconazole isn’t the right answer for every yeast infection. 👏

Not every yeast infection is the same. And not every patient with itching, burning, or discharge even has yeast.

Before you automatically reach for another dose of Diflucan, it’s worth asking:

🧫 Is it actually yeast?
🔬 What species is it?
💊 Could it be resistant?
🔁 Is this recurrent — and if so, why?
⚠️ Could fluconazole interact with another medication they’re taking?
👀 Could something else be causing the symptoms?

Non-albicans Candida may respond differently to treatment. Azole resistance is real. And fluconazole isn’t a completely benign medication just because we prescribe it all the time.

It has clinically important drug interactions. Fluconazole inhibits CYP enzymes and can affect the levels of other medications — including some statins, anticoagulants, certain psychiatric medications, and other drugs that can prolong the QT interval.

That doesn’t mean fluconazole is a “bad” drug. It means we should make sure it’s the right drug for the right patient.

And BV, contact dermatitis, lichen simplex chronicus, DIV, GSM, vulvodynia and other v***ar conditions can all get mislabeled as “another yeast infection.”

Sometimes fluconazole is exactly the right answer.

Sometimes you need a culture, speciation, a different treatment — or an entirely different diagnosis.

The answer to every itchy v***a is not “here’s another Diflucan.”

***arHealth

One of the most common things I hear is:

“My doctor said everything looked normal.”

A thorough v***ar exam is much more than a quick glance.

I’m evaluating the skin, looking for subtle signs of inflammation, examining the cl****is and cl****al hood, assessing the vestibule (one of the most common sources of pain), and checking the pelvic floor muscles.

Sometimes the diagnosis comes from one tiny detail that most people would never think to look for.

Your symptoms deserve more than “it looks fine.”

***aspecialist ***apain *xualpain ***aexam