Benign Gynaecological Conditions

Question 1

Aetiology and presentation of Bartholin abscess and cyst

Answer 1

• Abscess
  
  • Acute infection of the Bartholin gland duct by bacteria
  • Painful
• Cyst
  
  • Chronic swelling after previous acute infection
  • Painless

Question 2

Management of Bartholin abscess and cyst

Answer 2

• BS antibiotics
• Marsupialisation with GA or word catheter with LA

Question 3

Aetiology of lichen sclerosus

Answer 3

• Autoimune condition
• More common in post-menopausal women

Question 4

Presentation of lichen sclerosus

Answer 4

• Itching
• Excoriation (pain, dyspareunia)
• Whitening of vulval skin
• Loss of labial and clitoral contours
• Narrowing of entry to the vagina

Question 5

Diagnosis and management of lichen sclerosus

Answer 5

• Usually diagnoses clinically - can biopsy
• Topical steroids to treat (i.e. clobetasol - dermovate)

Question 6

Aetilogy of cervical etopy

Answer 6

• Columnar cells from canal everted into cervix (ectropion)

Question 7

Presentation of cervical etopy

Answer 7

• Usually asymptomatic
• Sometimes chronic discharge/post-coital bleeding

Question 8

Diagnosis and management of cervical etopy

Answer 8

• Clinical diagnosis
• Treat only if symptomatic with cautery/cryotherapy/AgNO3

Question 9

Presentation of cervical polyps

Answer 9

• Usually none
• Maybe PCB or PMB
• Only seen if symptomatic - vast majority are benign

Question 10

Diagnosis and management of cervical polyps

Answer 10

• Clinical diagnosis
• Only treat if symptomatic with avulsion

Question 11

Aetiology of fibroids

Answer 11

• Benign tumours of myometrium
• Commonest in Afro-Carribean women
• Oestrogen-dependent
  
  • Grow during pregnancy
  • Shrink after menopause
• Malignancy is rare

Question 12

Presentation of fibroids

Answer 12

• Heavy menstrual bleeding
• Abdominal swelling
• Pressure symptoms
• Subfertility
• Miscarriage
• Pain (rare)
• Abdominal or pelvic masses

Question 13

Diagnosis and management of fibroids

Answer 13

• Clinical diagnosis confirmed by ultrasound
• MRI to plan management
• Conservative in most cases
• Medical
  
  • Control symptoms
  • GnRH analogues and ulipristal acetate prior to surgery
• Surgical
  
  • Hysterectomy (easier, usually STAH)
  • Myomectomy (fertility sparing)
• Uterine artery embolization (UAE)
  
  • Minimally invasive

Question 14

Presentation, diagnosis and managment of endometrial polyps

Answer 14

• Present with PMB, IMB or HMB
• Suspected by TVU, hysteroscopy and histology to diagnose
• Usually treated with hysteroscopy and polypectomy

Question 15

Aetiology of PID

Answer 15

• Ascending infection from cervix
• Not always STD (chlamydia, GC, E. coli, anaerobes)
• Risk of tubal blockage and subfertility

Question 16

Presentation of PID

Answer 16

• Symptomless in 65%
• Anorexia
• General malaise
• Lower abdominal pain (bilateral)
• Deep dyspareunia
• Variable discharge (often purulent)
• PCB or IMB
• Pyrexia
• Abdominal distension and tenderness

Question 17

Investigation of PID

Answer 17

• Pregnancy test (PID rare with pregnancy)
• FBC and CRP raised
• MSU to exlude UTI
• Swabs
• Transvaginal ultrasound (tubo-ovarian abscess)
• Laparoscopy if diagnosis uncertain

Question 18

Management of PID

Answer 18

• Empirical antibiotics (don’t wait for swabs)
  
  • Ceftriaxone, doxycycline and metronidazole
  • Oral ofloxacin and metronidazole
• Pain relief
• Refer to GU medicine

Question 19

Presentation, diagnosis and managment of hydrosalpinx

Answer 19

• Usually no suymptoms after infective phase - pelvic pain and subfertility/infertility
• Diagnosis by TVU, laparoscopy and hysterosalpingogram (HSG)
• Treatment conservative if symptom free but can have bilateral salpingectomy if pelvic pain - IVF for infertility

Question 20

Types of ovarian cysts

Answer 20

• Functional cysts
  
  • Follicular or luteal
  • Related to menstrual cycle
  • Resolve in 6-12 weeks
• Dermoid cysts
  
  • Account for 10% of ovarian neoplasms
  • Variable size
  • Surgical management
• Epithelial cysts
  
  • Serous or mucinous cystadenomas
  • Managed surgically
• Endometriotic cysts

Question 21

Presentation, diagnosis and management of ovarian cysts

Answer 21

• Usually no symptoms - can have pain and abdominal swelling
• Diagnosed using US, CT or MRI alongside CA125, CEA, aFP and hCG
• If symptom free and <6cm then conservative management, ovarian cystectomy or oopherectomy if >6cm
• Histology essential

Question 22

Aetiology of endometriosis

Answer 22

• Oestrogen-dependent benign inflammatory disease characterised by ectopic endometrium - often accompanied by cysts and fibrosis
• Uncertain cause
• Three types:
  
  • Supericial peritoneal lesions (minimal and mild)
  • Deep infiltrating lesions (moderate and severe)
  • Ovarian cysts (endometriomas)

Question 23

Presentation and diagnosis of endometriosis

Answer 23

• Presentation
  
  • Dysmenorrhoea
  • Dyspareunia
  • Pelvic pain
  • Subfertility
  • Fixed tender retroverted uterus
• Diagnosis
  
  • Suspected from Hx and VE
  • TVU helpful
  • CA125 often raised
  • Laparoscopy and biopsy gold standard

Question 24

Management of endometriosis

Answer 24

• Conservative if symptom free
• Medical
  
  • NSAIDs
  • Progestogens, COCP Mirena
  • GnRH prior to surgery
• Surgical is definitive
  
  • Cautary if mild
  • Ovarian cystectomy if endometrioma
• IVF for infertility

Question 25

Aetiology and management of vulvodynia

Answer 25

• Sensation of vulval burning and soreness with no obvious skin problem - no itch
• Hypersensitivity of vulval nerve fibres
• Treat with low dose TCAs, lubricants and vulval care advice

Question 26

Chronic pelvic pain

Answer 26

• No discernible cause
• Rule out gynaecological causes and consider other
• Analgesia