Benign disorders of the lower genital tract Flashcards
what causes labial fusion?
excess androgens
what can cause excess androgens?
excess androgen exposure, or enzyme def’y (21-hydroxylase def’y most common)
CP of congenital adrenal hyperplasia
adrenal crisis - salt wasting, hypotension, hyperK+, hypoG
elevated 17-alpha-hydroxyprogesterone
tx of CAH
cortisol (provides - fdbk to inh ACTH sec’n)
fludrocortisone to replace aldosterone
CP of imperforate hymen:
primary amenorrhea w/cyclic pelvic pain
may have persistent pelvic pain due to accuml’n of menstrual flow behind hymen
increasing ab’l girth
hematocolpos (blood buildup behind hymen)
tx of imperforate hymen
surg
how does a transverse vaginal septum form?
mullerian tubercle doesn’t completely cannulize
CP of transverse vaginal septum
same as imperforate hymen, but septum is deeper & thicker, and a normal hymen can be seen distal to it.
tx of transverse vaginal septum
surgery
what is vaginal atresia?
when UG sinus fails to form lower part of vagina, gets replaced w/fibrous tissue instead, no introitus seen. Same CP as imperforate hymen.
what is vaginal agenesis?
seen in androgen insensitivity syndrome and Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.
CP of MRKH pts
genetically female
normal ovarian fct
normal secondary sex char’ics
No proximal vagina, cervix, uterus, tubes
CP of AI pts
genetically male, pht’lly female
no proximal vagina or uterus or tubes
undescended testis
what is lichen sclerosis
atrophy of vulvar skin. maybe due to immunologic or hrm’l mech. Seen in post-menopausal women
CP of lichen sclerosis
symmetric, white, thinned labial skin, may extend to perineum or anal sphincter. Pruritis. Dypareunia. Atrophy of labial epithelium.
tx of lichen sclerosis
topical high-potency steroids
what is squamous cell hyperplasia?
vulvar eczema/dermatitis. Thickened skin from edema. Chronic pruritis.
tx of squamous cell hyperplasia
medium potency topical steroids
what is lichen planus?
atrophic inflamm’y eruption of multiple shiny, flat, purple papules on inner aspects of labia minora, vagina, vestibule. C/b erosive. C/b drug-induced or spontaneous.
tx of lichen planus?
hydrocortisone vag suppositories. May need surgical excision or vag dilators for vag adhesions. Vag estrogens for pts w/vaginal atrophy.
what is lichen simplex chronicus
chronic inflam => scratching => thick white epith with scaling. Unilateral. Circumscribed. Pruritic.
tx for lichen simplex chronicus?
medium-potency topical steroids
what is vaginal adenosis?
red grandular spots & patches that are palpable on vaginal wall. Related to DES exposure. Epith contains multiple cell types (endocervix, endometrium, tubes). C/b premalignant so always bx it.
dx’c approach to vulvar lesions?
all s/b bx’d b/c need histo’c dx. Esp if ulcerated or unifocal.
approach to tx of vulvar lesions?
hygeine
avoid tight-fitting clothes/panties, bubble baths, douches, pwoders
clobetasol (high-potency steroid cream) for lichen planus or sclerosis
low-to-medium potency steroids for other dermatoses
what is role of topical ES or TS in vaginal/vulvar lesions?
none!
what is the most common tumor of the vulva?
epidermal inclusion cyst (occluded pilosebaceous duct or hair follicle)
when to incise & drain a cyst?
if its infected or sx’c
what is a skene’s gland cyst?
cyst in paraurethral glands
what is a urethral caruncle?
small, red, fleshy tumors of distal urethral meatus, seen in post-menopausal women 2/2 vaginal atrophy
mgt of urethral caruncle?
usually none needed. If spotting, short course of systemic or topical ES. Rarely, surgical excision.
what are the most common benign solid tumors of vulva & vagina
lipoma
hemangioma
urethral caruncle
mgt of Bartholin’s duct cysts:
if small and asx’c, nothing.
Sitz baths
if first presentation is in a pt over age 40, need to bx to r/o bartholin’s gland carcinoma.
If abscess forms, need to drain using Word catheter w/balloon tip or marsupialization.
if cx of drainage grows N. gonorrhoeae, or if concommittant cellulitis, give abx
what is word catheter?
insert it into cyst, inflate balloon, leave it in for 4-6 weeks, allow it to re-epithelialize
what is marsupialization
done for recurrent bartholin’s duct cysts or abscesses. Incise and sew open the gland
what is a nabothian cyst?
dilated retention cyst on the cervix, 2/2 blockage of an endocervical gland. Usually asx’c
what is a mesonephric cyst?
cyst forms in remnants of mesonephric (wolffian) duct. Lie on external surface of cervix, deep in cervical stroma
char’ics of a cervical polyp:
pedunculated or broad-based (sessile)
post-coital spotting
intermenstrual spotting
mgt of cervical polyps:
usually are benign and don’t need t/b removed, but are b/c there’s a chance they could be pedunculated endometrial polyps and :. premalignant
mgt of cervical fibroids:
bx to r/o cervical cancer.
can excise if sx’c or if likely to cause problems in pg’y (obstruction)
causes of cervical stenosis:
congenital
scarring s/p surgery or rad
obstruction w/cancer or polyp or fibroid
mgt of cervical stenosis:
if asx’c, none.
if its blocking uterine outflow during menses, needs excision.
If stenosis is due to scarring, gentle dilation.
