Disorders of the vulva and vagina Flashcards
What are the most common vulval symptoms?
Pruritus (itching), soreness, burning and superficial dyspareunia (pain during sex)
In general, what are the different vulval conditions?
Infection, dermatological, malignancy and premalignant diseases and vulval pain syndromes
What is lichen simplex?
Women with sensitive skin, dermatitis or eczema can present with vulval symptoms, which can result in lichen simplex, a chronic inflammatory skin conditions
How does lichen simplex present?
Severe intractable pruritis, especially at night
What happens to the area affected by lichen simplex?
The area, typically the labia majora, is inflamed and thickened with hyper- and hypo pigmentation.
What can exacerbate the symptoms of lichen simplex?
Chemical or contact dermatitis and sometimes are linked to stress or low body iron stored.
How do you treat lichen simplex?
Irritants such as soap should be avoided; emollients, moderately potent steroid creams and antihistamines are used with the aim of breaking the itch-scratch cycle.
What is lichen planus?
A common disease which may affect skin anywhere on the body, but particularly mucosal surfaces such as in the mouth and genital region.
How does lichen planus present?
Flat, papular, purplish lesions. It is more commonly associated with pain than with pruritus.
Who does lichen planus affect?
It can affect all ages and is not linked to hormonal stastus.
How do you treat lichen planus?
High-potency steroid creams; surgery should be avoided
What is lichen sclerosus?
The vulval epithelium is thin with loss of collagen.
What is lichen sclerosus potentially linked with?
It may have an autoimmune basis and thyroid disease and vitiligo may coexist. Around 40% of women have or go on to develop another autoimmune condition.
What age does lichen sclerosus most often present?
The typical patient is postmenopausal but much younger women are occasionally affected.
What are the symptoms are lichen sclerosus?
It causes severe pruritus, which may be worse at night. Uncontrollable scratching may cause trauma with bleeding and skin splitting and symptoms of discomfort, pain and pareunia.
How does lichen sclerosus appear?
Pink-white papule, which coalesce to form parchment-like skin with fissures. Inflammatory adhesions can form potentially fusing of the labia and narrowing of the introitis
In how many women does lichen schlerosus develop into vulval cancer?
5%
How do you treat lichen sclerosus?
Treatment is with ultra-potent topical steroids.
What is Bartholin’s gland cyst and abscess?
The two glands behind the labia minora secrete lubricating mucus for coitus. Blockage of the duct causes cyst formation. If infection occurs, an abscess forms.
What bacteria often causes infection in Bartholin’s gland abscess?
Staphylococcus and E.coli
How do you treat Bartholin’s gland abscess?
Incision and drainage, and marsupialisation, whereby the incision is sutured open to reduce the risk of re-formation.
What is intraoital damage?
Often after childbirth. Overtightening, incorrect apposition at perineal repair or extensive scar tissue.
How does intraoital damage present?
Often presents with superficial dyspareunia.
How do you treat intraoital damage?
Symptoms are often self-limiting. If the introits is too tight, vaginal dilators or surgery are used.
What is the appearance of vaginal cysts?
They have a smooth white appearance, can be as large as a golf ball, and are often mistaken for a prolapse.
How do you treat vaginal cysts?
They are often asymptomatic, but if there is dyspareunia they should be excised.
What is vulval intraepithelial neoplasia?
The presence of atypical cells in the vulval epithelium.
How is VIN characterised?
The usual type or the differentiated type
What age is usual type VIN most common?
35-55
What is the usual type VIN associated with?
HPV, CIN, cigarette smoking and chronic immunosuppression
How does usual type VIN present?
Clinically it may be multifocal and appearances vary widely: red, white or pigmented; plaques, papules or patches; erosions, nodules, warty or hyperkeratosis. Pruritus or pain are common.
What is differentiated type VIN associated with?
Is can be associated with lichen sclerosis and is seen in older women
How does differentiated type VIN present?
The lesion is usually univocal in the form of an ulcer or plaque and is linked to keratinising squamous cell carcinomas of the vulva. Pruritus or pain are common.
How would you treat VIN?
Emollients or a mild topical steroid may help. The gold standard is local surgical excision to relieve symptoms, confirm histology and exclude invasive disease.
What is the epidemiology of vulval cancer?
It accounts for 5% of genital tract cancers, with up to 1200 new cases each year in the UK and 400 deaths.
At what age is vulval cancer most common?
After the ago of 60 years
What type of carcinoma are most vulval cancers?
95% are squamous cell carcinoma. Melanomas, basal cell carcinomas, adenocarcinomas and a variety of others, including sarcomas, account for the rest.
What is vulval cancer associated with?
Lichen sclerosis, immunosuppression, smoking and Paget’s disease of the vulva
What are the clinical features of vulval cancer?
Pruritus, bleeding or discharge, or may find a mass, but malignancy often presents late due to embarrassment or aren’t noticed.
What would you find on examination in vulval cancer?
An ulcer or mass, most commonly in the labia major or clitoris. The inguinal lymph nodes may be enlarged, hard or immobile.
How is vulval cancer staged?
Surgical and histologically (after surgery)
How would you treat vulval cancer?
Stage 1 - wide local excision.
All other stages - wide local excision and groin lymphadenectomy through separate ‘skin sparing’ incisions
What is the prognosis of vulval cancer?
Most die with not due to. Stage 1 at 5 years - >90% survival. Stages 3/4 at 5 years - 40%
Is most vaginal cancer primary or secondary?
Secondary
What is secondary vaginal cancer?
It is common and arises from local infiltration from cervix, endometrium or vulva, or from metastatic spread from cervix, endometrium or GI tumours
What age is primary vaginal cancer most common?
Older women
How does vaginal cancer present?
Bleeding or discharge, a mass or ulcer is evident.
How would you treat vaginal cancer?
Intravaginal radiotherapy or, occasionally, radical surgery
What is the prognosis of vaginal cancer?
The average survival at 5 years is 50%
