Benign Conditions of the vagina and vulva Flashcards
Name the following 3 glands of the external female genital tract:
What are potnetial causes for vulval pruritus?
- Infections
- Candidiasis
- Trichomonas vaginalis
- Skin conditions:
- Lichen sclerosis
- Eczema
- VIN
- Contact dermatitis
What are potential causes for vulval pain?
- Infections:
- Candidiasis
- Skin conditions:
- Lichen sclerosis
- Eczema
- VIN
- Vuvlodynia (idiopathic pain lasting for >3 months)
- Bartholin gland inflammation
What are possible causes of superficial dyspareunia?
- Skin conditions:
- lichen sclerosis (can cause vulval splitting)
- Volvodynia
- Vulval fissures
- Skin bridges of the vulva (i.e. abnormal skin connections)
What is a useful support group you might point woman with vulval conditions towards?
The Vulval Pain Society (vulvalpainsociety.org)
What general advice can you give woman with vulval skin conditions?
- Don’t use soap/vaginal douching
- Use cotton, organic sanitary pads
- Use sensitive-skin washing detergent
What is lichen planus?
How would you manage it?
- Lichen planis is an autoimmune condition affecting the skin, genitalia and oral/GI mucosa.
- Symptoms are pruritus + superficial dyspareunia
Management:
- High-doese topical steroids
- manual dilation if vaginal stenosis
What is lichen sclerosus?
How is it managed?
- Lichen sclerosus is an inflammatory skin condition of presumed autoimmune origin
- Lesions can present in the anogenital area as well as the rest of the body
- Sympotms are itch/pain
Managment:
- Good skin care
- strong topical steroids
- Biopsy if not resolved with steroids (associated with vulval cancer)
What is the most likely diagnosis?
Briefly descrive pathophysiology and investigation/management options.
- This is a Bartholian cyst. Itdevelops if the long duct of the Bartholian gland becomes blocked. If infected, this can lead to a Bartholian abscess.
Investigations:
- In those >40 exclude cancer so consider biopsy
- Consider M,C&S of cyst/abscess contents
Management:
- Conservative:
- SitzBaths
- Warm Compresses
- Catheter drainage. Incision and drainage, balloon catheter left in situ for 5-6 weeks (if no catheter very high risk of recurrence). Under local anaesthetic. Give painkillers and Abx
- Marsipulation: suturing internal aspect of the cyst to outside. under GA. Give painkillers and Abx
- Silver nitrate cauterisation
- A Bartholin’s abscess can be managed by drainage of the abscess as well as broad spectrum antibiotics (usually trimethoprim).
What is dspareunia?
How can it be classified?
What are important Ix and DDx?
Dyspareunia describes pain during sex. This can be superficial or deep.
Ix:
- Examination (pelvic, abdominal)
- Superficial: Bx of lower genital tract + swabs
- Deep: TVUSS, swabs
DDx:
- Female genital mutilation
- PID, endometriosis
- Vaginal atrophy
- Psychosexual factors (e.g. previous assault)
What is vaginismus?
Vaginismus describes the involuntary contractions of muscles around the opening of the vagina. This makes any activity that involves penetration painful or impossible.
This often has a hige psychological impact on a woman and her relationship.
They require skilled psychosexual management approaches (surger is usually not the answer).
Name the different types of female genital mutilation.
There are four types of FGM:
- Clitoridectomy: partial or total removal of the clitoris, or of the prepuce.
- Excision: partial or total removal of the clitoris and the labia minora =/- the labia majora
- Infibulation: narrowing of the vaginal opening
- Other all other non-medical procedures for non-medical purposes.
What are the consequences of FGM?
Short-term complications of FGM include bleeding, infection and urinary retention.
Long-term consequences of FGM include:
- Genital scarring
- Urinary tract complications
- Dyspareunia, apareunia and impaired sexual function,
- Psychological sequelae
- Menstrual difficulties (haematocolpos)
- Genital infectionand pelvic inflammatory disease
- Infertility
- HIV and Hep B infection
- Obstetric complications
Describe the management of FGM
If the female is under 18 and you suspect or someone discloses they may have had FGM, follow local safeguarding procedures and report to social care services. Police and social care services will take immediate action and multi-agency safeguarding meeting will be convened.
If the female is under 18 and you found clinical evidence or the child herself has disclosed FGM you have the mandatory duty to report this to the police by dialling 101. They will ask the name, DoB and address and well as your contact details. You must also alert social care services and follow local safeguarding procedures.
If the woman is over 18:
- Report the woman via the green proforma case. This is not done anonymously.
- Offer referral to FGM clinic
- Offer referral to psychological services.
