Benign Disorders of the Female Genital Tract

Question 1

Dx?

All may present with vulvar pruritus.

1. symmetric white, thinned skin in anogenital region; shrinkage and agglutination of labia minora
2. multiple shiny, flat, purpule papules on inner aspects of labia minora, vagina; may cause vaginal adhesions and stenosis
3. thickened, white epithelium; slight scaling that is unilateral and circumscribed
4. red moist lesions, may be scaly; also found in other sebacious gland areas such as face, axilla, groin
5. palpable red glandular spots and patches in the upper third of the vagina on the anterior wall; associated with DES exposure in utero

Answer 1

1. Lichen sclerosis
2. Lichen planus
3. Lichen simplex chronicus
4. Vulvar psoriasis
5. Vaginal adenosis

Question 2

Tx?

• always biopsy!*
  1. Lichen sclerosis
  2. Lichen planus
  3. Lichen simplex chronicus
  4. Vulvar psoriasis

Answer 2

1. Lichen sclerosis
   - -high potency topical steroid
2. Lichen planus
   - -vaginal hydrocortisone suppositories
3. Lichen simplex chronicus
   - -medium potency topical steroids
4. Vulvar psoriasis
   - -UV light; topical steroids

Question 3

Dx?

1) Acute onset; waxing and waning lower abdominal pain and n/v; usually right-sided; risk factors include pregnancy, ovulation induction, ovarian masses
2. Acute onset; lower abdominal pain, n/v; pain begins in periumbilical area, migrates to RLQ; anorexia; bowel complaints
3. Acute onset; lower abdominal pain; usually at mid-cycle; often following physical activity or intercourse; light vaginal bleeding; (-) n/v
4. ovarian enlargement with multiple cysts; fluid shift causing ascites, hypovolemia; follows gonadotropin tx for infertility
5. gradual onset of fever, chills, lower abdominal pain, and vaginal discharge; younger female; multiple sex partners; prior hx of PID

Answer 3

1. Ovarian/Adnexal Torsion
2. Appendicitis
3. Ruptured Ovarian Cyst
4. Ovarian Hyperstimulation Syndrome
5. Tubo-Ovarian Abscess