Disorders of the Vulva and Vagina Flashcards
Vulva may contain?
Breast tissue
Can become swollen after delivery
Vaginitis
Inflammation or infection of the vagina.
Change of volume, color, odor of discharge
Normal vaginal pH
3.5 - 4.5
Trich infection pH
5.0 - 6.0
Bacterial Vaginosis pH
> 4.5
Candidial infxn pH
4.0 - 4.5
Clue cells on saline wet mount
Bacterial Vaginosis
KOH Prep
Reveals hyphae and budding of yeast
Bacterial vaginosis usually only causes
Malodorous or copious discharge
Does not cause painful urination or inflammation
BV Tx
Flagyl 500mg BID x 7 days
BV Tx for pregnant and nursing
Clindamycin
Candidiasis
Thick, white cottage cheese discharge
Usually colonize from anus
Rarly transmitted sexually
Candidiasis prevention
Keep external area clean and dry
Avoid douches, irritating soaps
Change tampons frequently
Wear loose underwear
uncomplicated yeast infxn tx
Fluconazole (Diflucan) 150mg x 1 dose
OTC intravaginal ointments
Complicated infxn tx
Floconazole (diflucan) 150mg 2-3 doses 72 hrs apart.
Topical therapy
Intravaginal boric acid tablets for 2 wks
Flucytosine cream qHS for 2 wks
Intravaginal boric acid is …
Fatal if swallowed
Most common STI in the world
Trichomonas Vaginitis
Trichomonas Vaginitis
Flagellated protozoan
Infects both males and females
Males generally asymptomatic
Trich presentation
Malodorous, thin green/yellow d/c
Burning, dysuria, frequency
Pruritis, painful sex, post-coital bleeding
Trich dx
pH 5-6
Mobile organisms on wet mount
Rapid antigen test
Strawberry cervix
Trich tx
For everyone: 2 g flagyl one dose
For HIV: 7 day course BID
Genital Herpes
Painful ulcers and itching
Dysuria
Tender inguinal lymphadenopathy
Constitutional sx
Herpes Tx
Treat within 72 hrs
Acyclovir (zovirax) 400mg TID for 7-10 days
Most common viral STD in the US
Condylomata Acuminata
Anogenital Warts
Anogenital Warts
Condylomata Acuminata
women 67% of pop
HPV 6 and 11
Warts tx
Chemical destruction
Immunologic
Surgery
Molluscum Contagiosum
Painless domes
Can be sexually transmitted
Atrophic vaginitis
Caused by decreased estrogen (menopause)
Dryness, burning itching
Decreased lubrication during sex
Bleeding, discharge
Atrophic vaginitis tx
Moisturizers, lubricants
Estrogen therapy
Lichen sclerosis
Intense inflammatory rxn in non-child-bearing pop.
Painful pruritis and itching - may interfere w/ sleep
Lichen sclerosis PE
Chronic inflammation
Well demarcated white atrophic patches
Labia minora shrinks and clitorous may be lost
Lichen sclerosis tx
Clobetasol propionate .05% cream for 6-12 weeks
then
Maintenance therapy 1-3 x/wk
Bartholin glands
2-3% of women develop cysts or abscesses Most common large cyst of vulva Mostly asymptomatic Must exclude carcinoma in women over 40 No tx for women under 40
Bartholin abscess s/s
Swelling and exquisite pain
Erythematous and warm
Polymicrobial
Bartholin abscess tx
I&D
Word catheter for 4 wks
Cystocele
Bladder prolapse into vagina
Pagets Dz
Intraepithelial carcinoma of genital, perianal and axillary areas.
Red, scaly velvety esions
Itching, burning and bleeding
Excise.
Vulvar CA
4th most common GYN CA
Pruritis most common complaint
Many pts are asymptomatic
Mostly squamous cell
Vaginal Intraepithelial Neoplasia (VAIN)
Caused by HPV 6 and 11
