Disorders of the Vulva and Vagina

Question 1

What are the causes of pruritus vulvae?

Answer 1

1. Candidiasis (+/- vaginal discharge)
2. Vulval warts (condylomata acuminate)
3. Pubic lice, scabies
4. Any dermatological disease - eczema, psoriasis, lichen simplex/planus/sclerosus
5. Carcinoma
6. Premalignant disease (vulval intraepithelial neoplasia - VIN)

Question 2

What is this describing?

Blocked duct in glands under labia minora. Painless.

Answer 2

Bartholin’s cyst

Question 3

What is this describing?

Blocked duct in glands under labia minora that has become infected. Painful. Struggle to sit, hot, swollen, red labia.

Answer 3

Bartholin’s abscess

Question 4

What is the management for a Bartholin’s abscess?

Answer 4

1. Incision and drainage

2. Marsupialisation - incision sutured open to reduce risk of reformation

Question 5

What is this describing?

Gynaecological cancer, rare, squamous cell carcinoma, occurs in the elderly (70-80 years).

Answer 5

Vulval cancer

Question 6

What causes vulval cancer?

Answer 6

Can arise from vulval intraepithelial neoplasia as a premalignant stage or de novo.

Question 7

What is vulval intraepithelial neoplasia associated with?

Answer 7

HPV, CIN, smoking, chronic immunosuppression.

Question 8

Where should you check for cancer upon finding vulval intraepithelial neoplasia?

Answer 8

Vulva, cervix, anal canal, nasal cleft

Question 9

What is the treatment for vulval intraepithelial neoplasia?

Answer 9

Local surgical excision

Question 10

What is this a presentation of?
Pruritus, bleeding, discharge. May be a mass or ulcer on labia majora or clitoris. Inguinal nodes may be enlarged. Elderly patient (70-80).

Answer 10

Vulval cancer

Question 11

How is vulval cancer investigated and treated?

Answer 11

1. Biopsy, sentinel node biopsy

2. Wide local excision + node dissection, bilateral unless >2cm from midline.