Disorders of the vulva and vagina Flashcards
What is lichen planus?
It’s a common disease which can affect skin on any part of the body, but particularly mucous membranes such as the mouth and vulva.
It presents with flat, papular, purplish lesions.
Painful.
Affects all ages, not linked to hormones.
What is the treatment for lichen planus?
High potency steroid creams
What is lichen sclerosis?
The vulval epithelium is thin with collagen loss.
Appearance of pink-white papules, which coalesce to form a parchment-like skin and fissures.
What are the symptoms of lichen sclerosis? How does it progress?
Severe pruritis.
Severe scratching –> trauma and bleeding. Skin splitting.
Inflammatory adhesions can form, potentially causing fusion of the labia and narrowing the introitus.
What is a consequence of lichen sclerosis?
5% go on to develop carcinoma
What is the treatment of lichen sclerosis?
Ultra-potent topical steroids.
What is the treatment for vulvar dysaesthesia?
Gabapentin or amitriptyline
Who is more likely to have candidiasis?
Diabetics, the obese, in pregnancy, when antibiotics have been used or when immunity is compromised.
What causes a Bartholin’s gland cyst?
Blockage of the duct.
What causes a Bartholin’s gland abscess?
An infected cyst by staphylococcus or E. Coli
What is vaginal adenosis?
When columnar epithelium is found in the normally squamous epithelium of the vagina.
It commonly occurs in those whose mother’s took DES during pregnancy.
What are the two types of vulval intraepithelial neoplasia (VIN)?
Usual type VIN - associated with HPV, immunosuppression and smoking. Can be warty, basaloid or mixed. It is associated with warty or basaloid squamous cell carcinoma.
Differentiated type VIN - rarer, associated with lichen sclerosis, unifocal.
What is the gold standard for VIN?
Local surgical excision to relieve symptoms, confirm histology and exclude invasive disease.
Which type is the most common carcinoma of the vulva?
Squamous cell
What is vulval squamous cell carcinoma associated with?
Smoking, lichen sclerosis, Paget’s disease of the vulva, immunosuppression. It can arise de novo or as a consequence of VIN.
