Benign Disorders of Vulva and Vagina Flashcards
Name some benign disorders of the vulva and vagina?
- Lichen simplex
- Lichen planus
- Lichen sclerosus
- Vulodynia (or the vulval pain syndromes)
- Infections of the vulva and vestibule
- Bartholin’s gland cyst and abscess
- Introital damage
- Vaginal cysts
- Vaginal adenosis
What are the most common vulval Sx?
- Pruritus (itching)
- Soreness
- Burning
- Superficial dyspareunia
What is lichen simplex?
Chronic inflammatory skin condition
How does lichen simplex present?
Intractable pruritus
Labia majora are inflamed and thickened with hyper and hypo pigmentation
Tx of lichen simplex?
Avoid irritants like soap
Emollients, moderately potent steroid creams and antihistamines to break itch-scratch cycle
How does lichen planus present?
Flat, papular, purplish lesions.
Pain rather than pruritus normally
Tx of lichen planus?
High potency steroid creams (avoid surgery)
What is lichen sclerosus?
A chronic inflammatory condition (lympocyte mediated)
What happens in lichen sclerosus?
The vulval epithelium is thin with loss of collagen
What is the autoimmune basis of lichen sclerosus?
It is thought to have an autoimmune basis
Associated with other autoimmune diseases in 20-34%; thyroid disease, diabetes, vitiligo, pernicious anaemia
What age group does lichen sclerosus affect?
Postmenopausal usually, but much younger women can be affected too
Sx of lichen sclerosus?
- Burning pain
- Pruritus
- Scratching can cause trauma with bleeding and skin splitting and Sx of discomfort
- Superficial dyspareunia
Appearance of lichen sclerosus?
White, shiny, wrinkly, atrophic appearance (‘like tissue paper’);
White patches, purpura
Hyperkeratosis and lichenification (constant scratching)
Risks with untreated lichen sclerosus?
- Over time, can develop loss and fusion of labia minora, narrowing of introitus (causing problems with intercourse and micturition)
- Inflammatory adhesions can form
- Vulval carcinoma can occur in 5% of cases
Ix of lichen sclerosus?
- Biopsy for diagnosis, if not responding to Tx
- Biopsy suspicious lesions
- Check ferritin levels and treat if low
- Screen for autoimmune conditions (FBC, TFTs, glucose, serum iron, autoimmune antibodies, intrinsic factor and vitamin B12)
