Benign condition of vagina + vulva

Question 1

DDx of vaginal pruritus

Answer 1

Infection
Skin problem (lichen sclerosus, eczema, vaginal intraepithelial neoplasia

Question 2

DDx of vulval pain

Answer 2

Infection
Skin condition
Vulvodynia
Infected bartholin’s gland

Question 3

DDx of superficial vulvodynia

Answer 3

skin conditions
vulvodynia
vulval fissure
skin bridges of vulva

Question 4

Mx of vulval pruritus

Answer 4

Advice - use emollients avoid water and soap. Avoid wet wipes, perfumes, tight clothing.
Sort out cause:
contact dermatitis ( vulval dermatitis has correlation w/ atopy - can suggest hydrocortisone cream)
Lichen simplex (potent corticosteroid for 14 days)
Antifungal use (recurrent use can cause itchiness)
Fix ferritin (low ferritin can cause itchiness)
If cause unknown 1% hydrocortisone cream and antihistamine + refer

Question 5

What does lichen planus affect

Answer 5

AI disease affecting mucosa of skin, GI + oral mucosa

Question 6

What is lichen sclerosus associated with

Answer 6

AI disease and vulval cancer

Question 7

Types of vulval cyst

Answer 7

Bartholin’s gland cyst
Skene gland cyst
mucous inclusion cyst

Question 8

RF for dyspareunia

Answer 8

peri/post menopausal
FGM 
PID
endometriosis
Hx of sexual assault
depression + anxiety

Question 9

Psychosexual dysfunction

Answer 9

Primary - pain arising from psychosomatic problems

Secondary - pain arising from emotional problems

Question 10

Types of FGM

Answer 10

Type 1 - excision of clitoral hood and/or clitoris
Type 2 - excision of clitoris and labia minora
Type 3 - excision of part of all external genitalia (clitoris, labia minora+majora) + stitching of infundibulum
Type 4. - anything else (piercing, cauterising)

Question 11

Mx of lichen sclerosus

Answer 11

Good skin care, use emollients, soap substitutes
Strong steroids for 3 months
biopsy if unresolved

Question 12

What is lichen sclerosus

Answer 12

Believed to be AI condition that leads to hyalinastion of skin and white parchment paper appearance

Question 13

What is lichen planus

Answer 13

AI disease that affects skin, genitals, eyes and oral mucosa

Question 14

Symptoms of lichen planus

Answer 14

Pruritus
superficial dyspareunia
oral lesions

Question 15

Mx of bartholin’s cyst/abscess

Answer 15

Small and asymptomatic - conservative (warm bath’s help)
Large and symptomatic - catheter (4-6wks) or surgical marsupialisation and can also give broad spectrum Abx
Abscess - could either be conservative or incision and drainage but give broad spectrum Abx

NB - recommend STI screen in these pt

Question 16

Mx of FGM

Answer 16

Report to police and social services if <18
if >18 don’t have to
Check to see if there are young girls in family at risk
De-infibulation