Benign pathology of the vagina and vulva Flashcards
What are some infectious pathologies of the vulva?
Candida
Vulvar warts
Bartholin’s gland abscess
What are some non-neoplastic epithelial disorders of the vulva?
Lichen sclerosis
Other dermatoses
What is atrophic vaginitis
Dryness and atrophy of the vaginal mucosa
Describe the pathophysiology of atrophic vaginitis
Menopause causes falling oestrogen levels
This causes thinning, dryness and reduced elasticity of the vaginal mucosa making it more prone to inflammation and infection (pH and microbiome changes)
What are some other problems that may be caused by reduced oestrogen levels?
Pelvic organ prolapse and stress incontinence due to connective tissue atrophy
How does atrophic vaginitis present?
Itching
Dryness
Dyspareunia
Bleeding
What will examination of the labia and vagina show in atrophic vaginitis?
- Pale mucosa
- Thin skin
- Reduced skin folds
- Erythema and inflammation
- Dryness
- Sparse pubic hair
What is the main treatment of atrophic vaginitis?
Topical oestrogen
Vaginal lubricants
What are some forms of topical oestrogen?
- Estriol cream, applied using an applicator (syringe) at bedtime
- Estriol pessaries, inserted at bedtime
- Estradiol tablets(Vagifem), once daily
- Estradiol ring(Estring), replaced every three months
What are some contraindications for topical oestrogen?
Breast cancer
Angina
VTE
What is the function of he Bartholin’s glands
Produce mucus to help with vaginal lubrication
What are Bartholin’s cysts
Swellings of the Bartholin’s glands due to blocking of the ducts causing mucus buildup
How do Bartholin’s cysts present?
Unilateral, fluid filled cyst between 1-4cm
What is a Bartholin’s abscess?
Infection of a Bartholin’s cyst
How does Bartholin’s abscess present?
Hot , tender, red, pus-draining Bartholin’s cyst
What are some conservative management options for Bartholin’s cysts
Good hygiene
Analgesia
Warm compress
How are Bartholin’s abscesses managed?
Swab, culturing and antibiotics
Possibly surgery
What surgical options may be required in Bartholin’s abscesses
Word catheter (Gland balloon) - Tube inserted to allow constant drainage
Marsupialisation - Gland sutured open to allow constant drainage
What is lichen sclerosus?
A chronic inflammatory skin condition causing patches of porcelain-white skin
What are some common regions for lichen sclerosus?
Labia, perineum, perianal skin
Axilla and thighs
Foreskin and glans (Men)
What causes lichen sclerosus
Thought to be autoimmune, associated with T1DM, alopecia, hypothyroid and vitiligo
What is lichen simplex
Lichen simplexis chronic inflammation and irritation caused by repeated scratching and rubbing of an area of skin. This presents with excoriations, plaques, scaling and thickened skin.
What is lichen planus
Lichen planusis an autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas with white lines across the surface calledWickham’s striae.
Typical lichen planus patient
45-60 woman complaining of vulval itching and skin changes
What are some symptoms of lichen sclerosus?
- Itching
- Soreness and pain possibly worse at night
- Skin tightness
- Painful sex (superficial dyspareunia)
- Erosions
- Fissures
What is the koebner phenomenon
New skin lesions occur at areas of mild trauma
Describe the appearance of lichen sclerosus
- “Porcelain-white” in colour
- Shiny
- Tight
- Thin
- Slightly raised
- There may be papules or plaques
- Possible fissures or erosions
How is lichen sclerosus managed (Not cured)
Clobetasol propionate 0.05% (Dermovate)
(Potent topical steroid)
Emollients
What are some complications of lichen sclerosus?
- 5% risk of SCC formation
- Pain and discomfort
- Sexual dysfunction
- Bleeding
- Narrowing of the vaginal or urethral openings
What is vulvodynia?
Chronic vulval discomfort, most often described as a burning pain, occuring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disoder
Describe the aetiology of vulvodynia
Usually in vulnerable individuals
Usually has a trigger
Associated with other chronic pain conditions such as fibromyalgia
Symptoms of vulvodynia
Vulval burning, stinging, irritation or rawness
Can be generalised or localised
Can be provoked or unprovoked
What are some investigations used in vulvodynia?
Diagnosis of exclusion
Vaginal swab to rule out infection
Management of vulvodynia
- Information
- Genital skin care advice and emollients
- Localised provoked pain - lidocaine 5% ointment, vaginal trainers, physiotherapy
- Unprovoked pain - tricyclics, gabapentin/pregabalin
- Psychosexual interventions
