Abnormalities Of Female Genitalia ✅ Flashcards
What can abnormalities of the female genitalia be split into?
- Internal or external
- Acquired or congenital
Give 3 examples of congenital abnormalities of the female external genitalia?
- Imperforate hymen
- Vaginal agenesis
- Congenital adrenal hyperplasia
What is the most common presentation of imperforate hymen?
Bulging introital mass as neonate
What are the lour common presentations of imperforate hymen?
Primary amennorhoea or urinary retention in post-pubertal girls
How may imperforate hymen be first identified?
On routine antenatal scans
How is imperforate hymen treated?
Surgical incision of the imperforate hymen
What is vaginal agenesis also known as?
Mayer-Rokitansky syndrome
Does vaginal agenesis occur alone or in conjunction with other abnormalities?
May occur alone but most commonly seen with other abnormalities
What does vaginal agenesis usually occur as part of?
A spectrum of abnormalities resulting from failure of organogenesis of the mesonephric and the paramesonephric duct structures
How much of the vagina is absent in vaginal agenesis?
Classically, upper 2/3 is absent bur may be completely absent or manifest as a dimple in the perineum
How common is vaginal agenesis as a cause of primary amennorhoea?
It is the most common cause
Give 2 acquired causes of abnormalities of female external genitalia?
- Labial adhesions
- Vaginal discharge
How do labial adhesions appear?
The labia minora becomes fused together to give a ‘blank’ appearance of the perineum
Who are labial adhesions most common in?
2-6 year olds
What causes labial adhesions?
Thought to be response to inflammation e.g. vulvovaginitis
What problems result from labial adhesions?
Rarely cause problems but can sometimes cause obstruction or deviation in normal urinary stream
What are the management options for labial adhesions?
- Conservative management
- Surgical management
- Treatment with oestrogen creams
Why is conservative management an option in labial adhesions?
The natural history of labial adhesions is that they’ll revolve spontaneously
What is the limitation of oestrogen creams in the management of labial adhesions?
In pre-pubertal girls the lack of circulating oestrogens means they often reform on stopping topical oestrogens
When might surgical management of labial adhesionbe indicated?
In severely symptomatic cases, eg severe disruption of urine flow
How severe can the disruption of urine flow be in labial adhesions?
Stream from urethra can be directed upwards by dense adhesions
What is the problem with severe disruption of urine flow in labial adhesions?
Can be difficult to keep flow of urine diverted to toilet or potty
Is vaginal discharge common in prepubertal girls?
No, is uncommon
Is vulvovaginitis common in prepubertal girls?
Yes
When does a potentially serious underlying cause of vaginal discharge need to be considered?
If persistent or severe
Give 4 causes of vaginal discharge
- Vaginal foreign body
- Bacterial infections (including STIs)
- Sexual abuse
- Genitourinary malignancies
Give an example of genitourinary malignancy that can cause vaginal discharge?
Rhabdomyosarcoma
What investigations may be used in vaginal discharge?
- Pelvic USS
- microbiology swabs
- Examination under anaesthesia, including cyystoscopy and vaginoscopy
What might vulvovaginitis be associated with?
Occasional spotting of blood on the undergarments
What is the importance of frank vaginal bleeding?
It is rare and serious in prepubertal girls
What is an important diagnosis to exclude in frank vaginal bleeding?
Vaginal rhabdomyosarcoma
What are the most common causes of pre-pubertal vaginal bleeding?
- Trauma
- Foreign bodies
What are some other causes of prepubertal frank vaginal bleeding?
- Vascular malformations
- Precocious puberty
- Sexual abuse
What investigations may be helpful in frank vaginal bleeding?
- Ultrasound of pelvis
- Examination under anaesthesia
What abnormality of the female internal genitalia can be diagnosed antenatally?
Ovarian cystic lesions
What is usually true of ovarian cystic lesions?
They are simple cysts, which are benign follicular cysts
What is considered to be a small to medium size ovarian cystic lesion?
<5cm in diameter
How are small to medium ovarian cystic lesions managed?
Conservative management
What is the risk of conservative management of ovarian cystic lesions?
Risk of torsion
When should ovarian cystic lesions be referred for specialist management?
Larger and more complex cysts
What is the standard surgical management for large simple ovarian cysts?
Laparoscopic deroofing and marsupilisation, with ovarian and Fallopian tube preservation
What should be done before surgery for large simple ovarian cysts?
Thorough assessment to ensure little risk of malignancy (ovarian teratomas)
What constitutes a more complex ovarian cyst?
Septation, or incorporating solid elements
How are more complex ovarian cysts managed?
- Tumour markers sent pre-operatively
- Patients managed alongside paediatric oncology
