Acute Vulval Pain Flashcards
What causes acute vulval pain
Barhtholin's abscess Thrush Ulceration Haematoma Lichen sclerosus Vulval cancer Atrophic vagintiis
What can cause vulval ulceration
Syphillis
Herpes - painful
Malignancy
What should you do if someone presents with vulval mass
Always investigate
Speculum - cervix / vagina
Associated bleeding or discharge
What is important in the Hx
Sexual
Drug
How do you treat acute vulval pain
Analgesia
Treat cause
What is risk
Urinary retention
If someone has abdominal pain what should you always think of
Bladder / urinary
What makes it less likely gynae
If not related to period or sex
How do you test if gynae pain
Give GnRH analogue to induce menopause as test for cure
What is Batholin’s gland
2 mucous secreting vestibular glands responsible for secreting vagina and lubricant
Only palpable in disease or infection
Where are they found
Labia minora
4+8 position
What causes an abscess
Duct blocked = cyst which may be tender
Cyst becomes infected if doesn’t resolve
What are common organisms
C+G Trachomatis E.coli S>aureus C. perfrinigens
What are symptoms of Bartholins abscess
Swelling Pain in perinea area Unable to sit down Fever May drain pus
What should you consider if recurs in middle aged women
Bartholin adenocarcinoma
How do you investigate Bartholin’s abscess and how do you Rx
C+G test Take swab of any discharge Ax Marsupialisation = 1st line Surgical incision and drainage if doesn't respond
What should you do for any vulval lump post menopause
Refer to exclude malignancy
What suggest malignancy
Irregular
Nodular
Hard
Fixed
How do you treat vulval cyst
Marsupialisation = gold standard
Incision + drainage
When do you give Ax
If surrounding cellulitis
What are complications
Infection
Bleeding
Haematoma
Recurrence if not excised
When are haematoma common
Post delivery
After epiostomy
How does someone with haematoma present
Pain
Swelling
Shcok if large
How do you investigate
ABCDE
FBC, coag
Group and save
Examine to find out site
How do you treat
Analegisa
Catheter
Incision and drainage
What are complications of haematoma
Urinary retention
Pressure necrosis
Sepsis
Haemorrhage
What causes vaginal atrophy
Decreasing levels of oestrogen
Womb becomes thinner and dryer
What are symptoms of vaginal atrophy
Dry Itch Pain with intercourse UTI Chaffing PFM weaker Incontinence Light bleeding Persistent smelly discharge Vaginal pain Pain on urination
Why UTI
Higher pH
What may improve symptoms
Sexually active
Increased blood flow
What should you do if PV bleed
Endometrial / cervical cancer investigation
Exclude vulval cancer
How do you Dx vaginal atopy
Dx of exclusion
Exclude malignancy
Speculum will show
What is conservative Rx
Natural underwear Loose underwear No damp clothes Non-perfumed wash No hygiene spray Avoid shaving Plain water to wash Quit smoking
What is medical Rx
Cool wash or compress of bicarb + water Moistuerser Lubricant Natural oil Vitamin E
What can be prescribed
Vaginal oestrogen
HRT
How is vaginal oestrogen prescribed
Tablet
Pessary
Cream
What are SE of vaginal oestrogen
Breast pain
Bleeding
What are long term risk of HRT
VTE
IHD if 10 years post menopause
Breast cancer
Endometrial cancer if E only
