Disorders of the Vulva Flashcards
What is the Vulva
The external Vagina
what is the anterior border of the vagina
bladder/urethra
what is the posterior border of the vagina
upper 1/3, pouch of douglas (retrouterine pouch)
lower 2/3 rectum
what are the most common symptoms of vulval pathology
pruitis
soreness
burning
superficial dyspareunia
what are some causes of pruitis vulvae
candidiasis vulval warts pubic lice psoriasis eczema contact dermatitis lichen planus lichen simplex lichen sclerosis carcinoma premalignant disease (VIN)
what is another name for lichen simplex infection of the vulva
chronic vulval dermatitis
who commonly gets lichen simplex
contact dermatitis patients
patients with eczema
patients with sensitive skin
what part of the vulva is most affected by vulval lichen simplex
labia majora
what is the common feature of vulval lichen simplex
severe intractible pruitis - worse at night
what systemic conditions are associated with vulval lichen simplex
low iron
stress
how do you treat vulval lichen SIMPLEX
emmolients + moderate potency steroids + antihistamines
if diagnosis in doubt biopsy
what does lichen planus infection look like
purple patches/plaques with hypopigmented scaling
what are features of vulval lichen planus
pruitis +/- pain
how do you treat vulval lichen planus
high potency steroids
what does lichen sclerosis look like
pink-white papules, sometimes linking to form hypopigmented patches of skin with fissures
what are features of lichen sclerosis
severe pruitis - especially at night
sometimes adhesions may develop
what do 40% of women with lichen sclerosis also have `
another autoimmune condition
what is the risk of cancer progression from lichen sclerosus
5%
what is the treatment for lichen sclerosus
ultra potent topical steroids
what are examples of vulval pain syndromes
vulvar dysthaesia/vulvodynia
what are vulval pain syndromes associated with
contraceptive use
burning vulvar pain
superficial dyspareunia
how do you treat vulval pain syndromes
gabapentin/amitryptalline
what infections commonly affect the vulva
herpes simplex
vulval warts
syphilis
donovanosis
what is vulval candidiasis more common in
diabetes
immunosuppression
antibiotic use
pregnancy
how do you treat vulval candidiasis
Topical Itraconazole
what is a bartholins cyst
blockage of the serous gland used for vaginal lubrication
what can happen with bartholins cyst’s if they go untreated
infection by e-coli/staph causing an abscess
how do you treat a bartholins abscess
incision and drainage
marsupialisation may also be done (suturing open so it doesnt block again
what are features of vaginal cysts
congenital asymptomatic lesions, appear smooth and white
what is vaginal adenosis
columnar epithelium in the vagina
what medication is commonly associated with vaginal adenosis
diethylstilboestrol in pregnancy (type of oestrogen)
what is the natural progression of vaginal adenosis
normally spontaneously resolve but very ocasionally may turn malignant (clear cell cancer)
what % of all genital cancers do vulval carcinomas account for
5%
what is the most common age range for vulval carcinoma
> 60
what are the vast majority (95%) of vulval carcinomas
SCCs
what are risk factors for vulval carcinoma development
lichen sclerosis
immunosuppression
smoking
pagets disease of the vulva
what is the presentation for vulval carcinomas
pruitis
bleeding
discharge
what stage do 50% of patients with vulval carcinoma present at
1
how is vulval carcinoma staged
Stage 1 tends to be whether it is contained in the perieum or not, there is a 1a and 1b referring to size and degree of stromal invasion , lymph nodes have to be negative
Stage 2 Is any local spread outside the perineum with negative lymph nods
Stage 3 is a tumour of any size with positive nodes
Stage 4a is any invasion into urethra/bone/bladder/rectum
Stage 4b is distant metastases
how do you treat vulval carcinoma
Stage 1
Wide local excision without a lympadenectomy
Other stages
If <4cm or no clinical suspicion of lymph node spread = Sentinel node biopsy
If SNB is -ve inguinofemoral lymphadenectomy is considered
If SNB is +ve or not indicated a wide local excision with groin lymphadenectomy is done (e.g. triple incision radical vulvectomy)
what are the complications of a radical vulvectomy
wound breakdown infection sexual and body image issues lymphedema of the leg lymphoblast formation
what is the prognosis of a radical vulvectomy (5 year survival)
5 year survival stage 1: >90%
3-4 = 40%
