Benign Disorders of vulva & vagina

Question 1

What is Lichen Simplex?

• Description of presentation
• Causes
• Treatments

Answer 1

aka Chronic vulval dermatitis

• Severe intractable [nocturnal] pruritus, inflamed labia majora with hyper/popigmentation
• Causes: Irritant or Allergic contact dermatitis
• Treatment:
  
  • Avoid irritants/ allergens
  • Replenish IRON
  • Emollients + steroid creams [break itch-scratch cycle]

Question 2

What is Lichen Planus?

• Clinical presentation
• Cause
• Treatment

Answer 2

• Affects mucosal surfaces: mouth/ genitals
• Symptoms: Painful +/- pruritis
• O/E: Papular, purplish, erosive lesion
• Cause: Unknown (autoimmune?)
• Treatment: high-potency steroid cream

Question 3

What is Lichen Sclerosis?

• Pathology
• Aetiology
• Clinical presentation
• Investigations?
• Treatment

Answer 3

• Vulva epithelium thin with loss of colagen
• Aetiology: autoimmune? thyroid/ vitiligo coexist? Postmenopausal women
• Symptoms: Pruritis
• O/E: Pink-white papules & thin skin
• Biopsy: Vulva carcinoma develops in 5%
• Treatment: Topical steroids

Question 4

What is Vulvodynia/ Vulval Pain Syndromes

• Definition
• Cause
• Classifications/ subgroups

Answer 4

• Chronic disorder of vulval pain [Dx of exclusion]
• Cause known, multifactorial
• Vulvodynia’s subgroups;
  
  • Vestibulitis [dyspareunia]
  • Dysaestheisa [postmenopausal]
  • Cyclical vulvovaginitis [most common, cyclical]
  • Vulval dermatoses

Question 5

Outline common infections of the vulva and vestibule

Answer 5

• Herpes simplex virus
• Vulval warts (condylomata acuminata) [caused by HPV]
  
  • Resolve with trichoroacetic acid/ poldophyllin
• Syphilis (condyloma lata) [SDT caused by spirochete]
  
  • Repond to penicillin
• Donavanosis [bacteria Klebsiella granulomatis]
• Candidiasis [aka Thrush, fungus Candida]

Question 6

Outline Bartholin’s gland cyst & abscess

• What are Bartholin’s glands
• Outline cyst & abscess formation
• Treatment

Answer 6

• 2 glands behind labia minora screte lubricating mucus for coitus
• Blockage of duct causes cyst
• Abscess if infection: Staphylococcus or Escherichia coli
• Treatment: incision + drainage + marsupialization [cutting slit]

Question 7

What is Vaginal Adenosis?

• Description
• Causes
• Prognosis

Answer 7

• Collumnar epithelium found in normally squamous epithelium of vagina
• Cause: women whose mothers received diethylstilboestrol (DES) in pregnancy
• Prognosis: spontaneously resolves normally, may form clear cell carcinoma of vagina

Question 8

What is Vaginismus?

• Description
• Clinical Presentation
• Treatment

Answer 8

Involuntary contraction of vaginal musculature interfering with intercourse

Presents with unsuccessful attempts at intercourse

Vaginal dilators may help