BENIGN GYNECOLOGIC LESIONS 1.2 (TB) Flashcards
Which part of the vagina is in close relationship with the urogenital and pelvic diaphragms?
The lower third of the vagina.
What supports the middle third of the vagina?
The levator ani muscles and the lower portion of the cardinal ligaments.
What structures support the upper third of the vagina?
The upper portions of the cardinal ligaments and the parametria.
What is a Gartner’s duct cyst?
A cystic dilation of the embryonic mesonephros, usually present on the lateral wall of the vagina.
Where are Gartner’s duct cysts typically located?
In the lower third of the vagina, present anteriorly.
How can you differentiate a large urethral diverticulum from a Gartner’s duct cyst?
A urethral diverticulum will shrink when the urethra is milked and urine comes out, whereas a Gartner duct cyst does not.
What is the most common periurethral mass in women?
Urethral diverticulum, representing approximately 84% of periurethral masses.
What is a key clinical test for urethral diverticulum?
Insert two fingers and compress towards you; if urine leaks out, it indicates a urethral diverticulum.
What are the common symptoms of a urethral diverticulum?
Urinary urgency, frequency, dysuria (90%), hematuria (15%).
Which imaging modalities can diagnose a urethral diverticulum?
Voiding cystourethrography, cystourethroscopy, MRI, and ultrasonography.
What is the definitive treatment for a urethral diverticulum?
Excisional surgery when the diverticulum is not infected.
What is the recurrence rate of urethral diverticulum after surgery?
10-20% due to incomplete resection.
What are potential complications of urethral diverticulum repair?
Urinary incontinence and urethrovaginal fistula.
What is an inclusion cyst?
A cyst that forms from vaginal epithelium buried beneath the surface following a gynecologic or obstetric procedure.
Where are inclusion cysts commonly found?
In the posterior and lateral walls of the lower third of the vagina.
What is the management of an inclusion cyst with dyspareunia or pain?
Excisional biopsy.
What is a dysontogenic cyst?
A thin-walled, soft cyst of embryonic origin, usually 1-5 cm in diameter, found in the upper half of the vagina.
What are the three types of dysontogenic cysts and their origins?
Gartner duct cyst (mesonephros), Müllerian cyst (paramesonephricum), Vestibular cyst (urogenital sinus).
What is the most common vaginal foreign body?
A forgotten tampon.
What are the symptoms of a forgotten tampon?
Foul-smelling vaginal discharge or spotting.
What serious condition can a forgotten tampon cause?
Toxic shock syndrome due to Staphylococcus aureus.
How do you treat a retained tampon?
Remove the tampon, wash with normal saline and betadine, and prescribe Clindamycin or Metronidazole.
What is the most frequent cause of vaginal trauma in adult females?
Coitus (sexual intercourse, 80%).
What are common causes of vaginal trauma?
Straddle injuries, penetration by foreign materials, sexual assault, vaginismus, and waterskiing accidents.
What is a common predisposing factor for vaginal trauma?
Virginity, postpartum or postmenopausal vaginal epithelium, pregnancy, and prolonged abstinence.
What is the most common type of coital laceration?
Transverse tear of the posterior fornix.
What are the clinical manifestations of post-coital laceration?
Profuse vaginal bleeding, sharp pain during intercourse, and persistent abdominal pain (25%).
What is the most serious complication of vaginal trauma?
Vaginal evisceration, where intestines protrude through a large vaginal tear.
What is the source of vaginal lubrication during intercourse?
A transudate produced by engorgement of the vascular plexuses encircling the vagina.
What is the difference between vaginal and cervical secretions during coitus?
Vaginal secretions are transudates, while cervical secretions are thick and copious.
What is the lower, narrow portion of the uterus called?
Cervix
What is the Latin origin of the word ‘cervix’?
Neck
What is the Greek word for cervix?
Trachelos
What does ‘trachelorrhaphy’ mean?
Repair of the cervix
What is the Greek word for vagina?
Kolpos
What is the shape of the cervix?
Cylindrical to conical
What type of tissue predominantly makes up the cervix?
Fibrous tissue
What are other names for Nabothian cysts?
Mucinous retention cysts, epithelial inclusion cysts
What causes a Nabothian cyst to form?
A cleft of columnar epithelium becomes covered with squamous cells, trapping secretions.
What is the appearance of a Nabothian cyst?
Translucent or opaque whitish or yellow, 2-10 mm or 1 cm
What is the common cause of trauma to the cervix that leads to Nabothian cyst formation?
Minor trauma or childbirth
Are Nabothian cysts considered normal?
Yes, they are a normal feature of the adult cervix.
How are Nabothian cysts diagnosed?
Clinical exam and speculum examination.
What is the management for asymptomatic Nabothian cysts?
No treatment necessary.
What is the treatment for painful Nabothian cysts?
Cryosurgery or ablation using electrosurgery.
What is the most common benign neoplastic growth of the cervix?
Cervical polyp
In which group are endocervical polyps most common?
Multiparous women in their 40s and 50s.
What are the two main types of cervical polyps?
Endocervical (narrow, long pedicle & cherry red) and ectocervical (short, broad base & grayish white).
What is a common symptom of cervical polyps?
Postcoital bleeding or intermenstrual bleeding.
How are cervical polyps diagnosed?
Speculum examination and biopsy.
What is the management of cervical polyps?
Polypectomy, cauterization if needed, or surgical procedures like hysteroscopic polypectomy.
What is the usual number of cervical myomas present?
Usually solitary.
What are symptoms of cervical myoma?
Vaginal bleeding, dysuria, urgency, obstruction, dyspareunia.
How is cervical myoma diagnosed?
Speculum, pelvic examination, biopsy.
What is the management of cervical myoma in reproductive age?
GnRH agonists, excision.
What is the management of cervical myoma in patients with completed family size?
Hysterectomy.
What is the immediate management of acute cervical laceration?
Suturing.
What can happen if a cervical laceration is not repaired?
May lead to cervical incompetence in future pregnancies.
Where is the major arterial supply to the cervix located?
Lateral cervical walls at 3 and 9 o’clock positions.
What type of suture is used to reduce blood loss during cervical procedures?
Deep figure-of-eight suture through vaginal mucosa and cervical stroma at 3 and 9 o’clock.
What is cervical ectropion?
Eversion of the endocervix, exposing columnar epithelium to the vaginal environment.
What is the appearance of cervical ectropion?
Reddish, similar to granulation tissue, may be covered by yellow turbid discharge.
Who commonly has cervical ectropion?
Adolescents, pregnant women, and those taking estrogen-progestin contraceptives.
What is the management of asymptomatic cervical ectropion?
No treatment needed.
What is the first step before treating cervical ectropion?
Rule out malignancy.
What are treatment options for symptomatic cervical ectropion?
Acidifying agent trial or invasive procedures like cryosurgery/electrosurgery.
What is cervical stenosis?
Narrowing or obstruction of the cervix.
What are causes of acquired cervical stenosis?
LEEP, cervical cautery, radiation, infection, neoplasia, atrophic changes.
What are symptoms of cervical stenosis in premenopausal women?
Dysmenorrhea, pelvic pain, amenorrhea, infertility.
What are possible complications of cervical stenosis in postmenopausal women?
Hematometra, hydrometra, pyometra.
How is cervical stenosis diagnosed?
Inability to introduce a 1-2 mm dilator into the uterine cavity.
What is the management of cervical stenosis?
Dilation under ultrasound guidance, stenting to maintain patency.
