Benign Condition of Lower Genital Tract

Question 1

What is Lichen Planus?

Answer 1

AI disorder affecting skin , genitalia, oral, GI mucosa

Question 2

How does Lichen Planus present?

Answer 2

Pruritus 
Dyspareunia 
mouth lesions 
Longitutinal nailed ridging 
Genital lesions (longitudinal, annular, ulcerative)

Question 3

What is management for lichen planus?

Answer 3

High dose topical steroids

Question 4

What are possible vulval cysts?

Answer 4

Bartholin’s cyst > abscess

Skene gland cyst

Question 5

Hoe fo you treat Bartholin’s abscess?

Answer 5

Incision and drainage

Marsupialisation of. cyst

Question 6

What is vaginismus?

Answer 6

Involuntary contraction of vaginal muscles upon penetration

Question 7

What causes vaginismus=?

Answer 7

Psychological influences and anxiety

Question 8

How many types of FGM are there?

Answer 8

4

Question 9

What is FGM type 1?

Answer 9

CLITORIDECTOMY (removing part or all of the clitoris)

Question 10

FGM Type 2

Answer 10

EXCISION

• removal of clitoris
• partial / total removal of labia minor

Question 11

FGM Type 3

Answer 11

INFIBULATION

• removal of part or all of external genitalia
• stitchhing / narrowing the vagina

Question 12

FGM Type 4

Answer 12

Other harmful procedures

e.g. piercing the clitoris, during it off, insertion of corrosive substances

Question 13

What are causes of vulval itching?

Answer 13

Vulval dermatitis (allergic reaction to washing with soaps / detergents)

Candida infection

Recurrent use of antifungals

Low ferritin

Question 14

How do you treat vaginal candidiasis?

Answer 14

CLOTRIMAZOLE:
- cream 5g, 1 dose (insert 1 applicatorful into vagina at night)
OR
- pessary 200mg for 3 nights

OR

FLUCONAZOLE 150mg PO once

Question 15

What do you perform if you suspect vulval malignancy?

Answer 15

Keyes punch biopsy

Question 16

What is lichen sclerosus?

Answer 16

Destructive chronic inflammatory skin disease

Possibly AI aetiology

Question 17

What are symptoms of lichen sclerosus?

Answer 17

Itching, erosion, fissuring
Pain, dyspareunia
Soreness
Hypopigmentation, white atrophic patches
Loss of anatomy, external genitalia fuse together due to increased inflammation
e.g. clitoral hood fuses, loss of vaginal opening
Vaginal stenosis and cracking

Question 18

What malignancy is lichen sclerosis associated with?

Answer 18

Vulval cancer (SCC)

Question 19

What is a Bartholin’s abscess?

Answer 19

Infected bartholin’s gland (> cyst > abscess)

Question 20

Bow do you treat Baltholin’s abscess/cyst?

Answer 20

Conservative: analgesia, warm compress
Medical: Antibiotics
Surgical: Word catheter (4/6 weeks) OR incision and drainage + marupialisation

Question 21

What must you differentiate in a patient presenting with dyspareunia?

Answer 21

Is it DEEP (within pelvis) or SUPERFICIAL (vagina, clitoris, labia problem)

Question 22

What are causes of dysparaeunia?

Answer 22

Pathological:

• Suspected PID
• Endometriosis

Physiological:

• Peri/postmenopausal
• Depression, anxiety, history of sexual assault

OTHER:
- FGM

Question 23

What must you do if you discover FGM in minors=

Answer 23

Document case (legal obligation)
Report case through safeguarding team
Involve social services and the police
This is CHILD SEXUAL ABUSE