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OBGYN > Disorders of the Vulva and Vagina > Flashcards

Disorders of the Vulva and Vagina Flashcards

1
Q

General Vaginitis

  • sx
  • PE
  • Dx
A

Sx:

  • change in volume, color, or odor of vaginal discharge
  • pruritus
  • burning
  • dyspareunia
  • dysuria
  • spotting
  • erythema
  • pelvic discomfort

PE:

  • depending upon cause, may see erythema, lesions, fissures, FB
  • bimanual exam

Dx:

  • pH
  • saline wet mount
  • KOH prep
  • Whiff test
  • PCR
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2
Q

Bacterial Vaginosis

  • cause
  • PE findings
  • sx
  • dx criteria
  • tx
A

cause: abnormality of the normal vaginal flora, decrease in hydrogen-peroxidase lactobacilli

PE findings:

  • fishy odor
  • clue cells
  • thin, white/gray, fishy smelling discharge.

Sx:

  • usually complain is that of malodorous or copious discharge
  • asymptomatic
  • BV alone does not cause dysuria, dyspareunia, prurritis, burning, vaginal inflamm..
Dx: 
Amsel Criteria: requires 3 of 4; 
-thin, gray-white discharge that smoothly coats vaginal walls 
-vaginal pH greater than 4.5
-positive whiff-amine test 
-clue cells on saline wet mount

Tx:

  • metronidazole** PO (no alcohol) or intravaginal.
  • clindamycin 2nd line PO or intravaginal

*probiotics as an adjunctive therapy

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3
Q

Vulvovaginal Candidiasis:

  • cause
  • pathogenesis
  • risk factors
  • dx
  • tx
A

Cause: candida albicans

pathogenesis:
- organism migrates from anus to vagina
- infection occurs when there is overgrowth of candida

Risk factors:
-DM, increased estrogen levels, immunosuppression, abx use

Dx:
-speculum exam: thick white “cottage cheese” discharge

  • severe cases gray membrane
  • KOH wet mounts (50% are negative)
  • pH: 4.0-4.5 (normal)
  • rarely cultures are used.

Tx:
-uncomplicaated: OTC intravaginal tx OR Diflucan x1 dose.

-complicated: Diflucan 2-3doses, topical clotrimazole/miconizole 7-14d

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4
Q

What is the MC STI worldwide!!??

What is the MC VIRAL STI in the US?

A

Trichomonas Vaginitis

MC viral STI in US is Anogenital warts (HPV)

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5
Q

Trichomonas Vaginitis:

  • sx
  • dx
  • tx
A

Sx:

  • females range from asymptomatic to acute, severe, inflamm dz
  • males generally asymptomatic & infection resolves spontaneously 90% of the time.
  • burning, dysuria, frequency, pruritus, dyspareunia, pelvic discomfort
  • post-coital bleeding

Dx:

  • malodorous, thin, frothy green/yellow vaginal discharge
  • pH 5-6
  • mobile on wet mount (flagella)
  • PCR (on males do PCR on urine or urethral swab, females swab the cervix and vaginal wall)
  • strawberry cervix

Tx:

  • all women even if asymptomatic should be treated if there is evidence of infection.
  • Treat both partners*
  • Flagyl*
  • HIV pts: 7d course of flagyl
  • must sustain from sex while being treated otherwise may get recurrent infection.
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6
Q

Genital Herpes

  • cause
  • sx
  • dx
  • tx
A

Cause: HSV 1 and 2

Sx:

  • painful genital ulcers and itching
  • dysuria
  • tender inguinal lymphadenopathy

Dx:

  • multiple vesicles on erythematous base
  • vulvar swelling
  • lymphadenopathy
  • dx confirmed by vial culture (Tzanck Smear) or PCR

Tx:

  • Primary infection needs to be started within 72hrs
  • Acyclovir (5x/day) for 7-10d
  • Famcyclovir (TID)
  • Valocyclovir (BID)
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7
Q

Codylomata Acuminata

  • aka
  • cause
  • sx
  • tx
A

aka: anogenital warts

Cause: HPV 6 & 11

Sx

  • itching, burning, pain
  • bleeding, vaginal discharge
  • may have no sx
  • when very large can interfere with defication & coitus
Tx: 
Chemical
-Podophyyllin (NOT IN PG) 
-Richloroacetic acid (OK PG) 
-5-FU (Efudex)

Immunologic:

  • Imiquimod
  • interferon alpha

Surgery:

  • cryotherapy
  • laster therapy
  • excisional
  • clearance of warts is 35-100% but the latent HPV can still exist and 20-30% recurrence

*vertical transmission

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8
Q

Mulloscum Contagiosum

  • describe that lesion!
  • tx
A

Lesion

  • 1-2mm papules w/ central dimple
  • painless lesions
  • contain cheesy-white material

Tx:

  • crysurgery
  • bichloracetic acid
  • dermal curette
  • can clear on their own
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9
Q

Atrophic Vaginitis:

  • cause
  • functions of estrogen
  • risk factors
  • clinical manifestations
  • PE
  • Tx
A

Cause:
-decrease in estrogenic stimulation of urogenital tissue

Functions:

  • maintains well epithelialized vaginal vault
  • maintaines collagen content of epithelium
  • keeps epithelial surfaces moist
  • maintains optimal genital blood flow
  • maintains acidic vaginal pH

Risk factors:

  • natural menopause
  • bilateral oophorectomy

Manifestations:

  • vaginal dryness, burning, itching
  • decreased lubrication during sex
  • dyspareunia
  • vulvar or vaginal bleeding (post coital)
  • vaginal discharge
  • pelvic pressure or vaginal bulge
  • irritative voiding

PE findings:

  • pale, smooth or shiny vaginal epithelium
  • loss of elasticity
  • sparsity of pubic hair
  • introital(opening of vagina) narrowing
  • lack of moisture
  • fusion or resorption of labia minora
  • unrugaed epithelium of vagina
  • shorten, narrowed, and poorly distensible vaginal vault.

Tx: treat vaginal dryness

  • Vaginal lubricants:Vagisil, K-Y jelly
  • sexual activity may improve vaginal function
  • Vaginal estrogen therapy (cream, tablet, ring)
  • might get systemic therapy*
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10
Q

Lichen Scerosis

  • cause
  • when does this occur?
  • dx
  • sx
  • PE
  • Tx
A

Cause: genetic or autoimmune

-two peaks: prepubertal girls and postmenopausal women

Dx: punch bx

Sx:

  • vulvar pruritus, may be so severe as to interfere with sleep
  • pruritus ani, painful defication, anal fissures, dyspareunia

PE:

  • chronic inflammation
  • well-demarcated white, finely wrinkles, atrophic patches
  • labia minor often shrink & adhesion of the labia major may cover clitoris

Tx:
-clobetasol proprionate 0.05% cream

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11
Q

Cyst of Bartholin Glands:

  • sx
  • tx
A

Sx: most are asymptomatic

Tx:
-not necessary in women less than 40 unless infected or symptomatic

  • in women older than 40 bx & drainage is performed to exclude carcinoma
  • if large and not resolving can be tx as though its an abscess
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12
Q

Bartholin Duct Abscess

  • sx
  • Tx
A

Sx:

  • exquisite pain
  • red, warm, tender, fluctuant
  • may be surrounding cellulitis

Tx:

  • I&D lanced at or behind the hymenal ring
  • Word catheter into the cavity- left for at least 4wks
  • marsupialization: incision in the abscess and suture the cyst open to ensure drainage.
  • reserved for pts who fail 1-2 placements of word catheter.
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13
Q

Cystocele

  • aka
  • what is this?
  • cause
  • tx
A

aka: prolapsed bladder

What: bulging of bladder into the vagina

Cause: occurs when the supportive tissues and muscles between the bladder and the vagina weaken and stretch

  • childbirth
  • repetitive straining for bowel movements
  • constipation
  • chronic cough
  • heavy lifting
  • obesity

Tx:

  • watchful waiting
  • kegal exercises
  • Pessary: silicone medical device placed in vagina that supports vaginal wall and holds bladder in place.
  • anterior vaginal wall repair (colporrhaphy)
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14
Q

Pagets Disease:

  • what is this?
  • describe that lesion
  • sx
  • tx
A

What: intraepithelial adenocarcinoma. Extramammary dz may involve genital, perianal, and axillary areas.

Lesion: brick red, scaly, velvety, eczematoid plaque with sharp border.

Sx: itching, burning, bleeding

Tx:

  • excison with greater than 3mm border
  • radiotherapy
  • laser
  • photodynamic therapy
  • 5-FU
  • Imiquimod
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15
Q

Vulvar Cancer:

  • Risk factors
  • clinical manifestations
  • histological types
  • Mode of spread
A

Risk:

  • HPV
  • cigarette smoking
  • lichen sclerosis
  • vulvar or cervical intraepithelial neoplasia
  • immunodeficiency syndromes
  • PMHx surgica CA

Manifestations:

  • unifocal(single site) vulvar plaque, ulcer, or mass
  • pruritis
  • often asymptomatic**

Histologic typeS:

  • Squamous cell (90%)-warty appearance since association with HPV.
  • Melanoma
  • Basal cell
  • extramammary paget dz

Mode of spread:

  • direct extension to adjacent structures
  • lymphatic
  • hematogenous
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16
Q

Vaginal Intraepithelial Neoplasia

  • cause
  • tx
A

Caus: HPV 6&11
*this is a reason to continue PAP smears after hysterectomy

Tx:

  • laser ablation
  • local excision
  • 5-FU
  • Vaginectomy and skin graft

OBGYN (7 decks)

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