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Obstetrics and Gynaecology > Disorders of the vulva and vagina > Flashcards

Disorders of the vulva and vagina Flashcards

1
Q

What are the most common vulval symptoms?

A

Pruritus (itching), soreness, burning and superficial dyspareunia (pain during sex)

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2
Q

In general, what are the different vulval conditions?

A

Infection, dermatological, malignancy and premalignant diseases and vulval pain syndromes

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3
Q

What is lichen simplex?

A

Women with sensitive skin, dermatitis or eczema can present with vulval symptoms, which can result in lichen simplex, a chronic inflammatory skin condition

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4
Q

How does lichen simplex present?

A

Severe intractable pruritis, especially at night

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5
Q

What happens to the area affected by lichen simplex?

A

The area, typically the labia majora, is inflamed and thickened with hyper- and hypo pigmentation.

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6
Q

What can exacerbate the symptoms of lichen simplex?

A

Chemical or contact dermatitis and sometimes are linked to stress or low body iron stored.

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7
Q

How do you treat lichen simplex?

A

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.

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8
Q

What is lichen planus?

A

A common disease which may affect skin anywhere on the body, but particularly mucosal surfaces such as in the mouth and genital region.

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9
Q

How does lichen planus present?

A

Flat, papular, purplish lesions. It is more commonly associated with pain than with pruritus.

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10
Q

Who does lichen planus affect?

A

It can affect all ages and is not linked to hormonal stastus.

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11
Q

How do you treat lichen planus?

A

High-potency steroid creams; surgery should be avoided

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12
Q

What is lichen sclerosus?

A

The vulval epithelium is thin with loss of collagen.

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13
Q

What is lichen sclerosus potentially linked with?

A

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.

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14
Q

What age does lichen sclerosus most often present?

A

The typical patient is postmenopausal but much younger women are occasionally affected.

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15
Q

What are the symptoms are lichen sclerosus?

A

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.

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16
Q

How does lichen sclerosus appear?

A

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

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17
Q

In how many women does lichen sclerosus develop into vulval cancer?

A

5%

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18
Q

How do you treat lichen sclerosus?

A

Treatment is with ultra-potent topical steroids.

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19
Q

What is Bartholin’s gland cyst and abscess?

A

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.

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20
Q

What bacteria often causes infection in Bartholin’s gland abscess?

A

Staphylococcus and E.coli

21
Q

How do you treat Bartholin’s gland abscess?

A

Incision and drainage, and marsupialisation, whereby the incision is sutured open to reduce the risk of re-formation.

22
Q

What is intraoital damage?

A

Often after childbirth. Overtightening, incorrect apposition at perineal repair or extensive scar tissue.

23
Q

How does introital damage present?

A

Often presents with superficial dyspareunia.

24
Q

How do you treat introital damage?

A

Symptoms are often self-limiting. If the introitus is too tight, vaginal dilators or surgery are used.

25
Q

What is the appearance of vaginal cysts?

A

They have a smooth white appearance, can be as large as a golf ball, and are often mistaken for a prolapse.

26
Q

How do you treat vaginal cysts?

A

They are often asymptomatic, but if there is dyspareunia they should be excised.

27
Q

What is vulval intraepithelial neoplasia?

A

The presence of atypical cells in the vulval epithelium.

28
Q

How is VIN characterised?

A

The usual type or the differentiated type

29
Q

What age is usual type VIN most common?

A

35-55

30
Q

What is the usual type VIN associated with?

A

HPV, CIN, cigarette smoking and chronic immunosuppression

31
Q

How does usual type VIN present?

A

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.

32
Q

What is differentiated type VIN associated with?

A

Is can be associated with lichen sclerosis and is seen in older women

33
Q

How does differentiated type VIN present?

A

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.

34
Q

How would you treat VIN?

A

Emollients or a mild topical steroid may help. The gold standard is local surgical excision to relieve symptoms, confirm histology and exclude invasive disease.

35
Q

What is the epidemiology of vulval cancer?

A

It accounts for 5% of genital tract cancers, with up to 1200 new cases each year in the UK and 400 deaths.

36
Q

At what age is vulval cancer most common?

A

After the ago of 60 years

37
Q

What type of carcinoma are most vulval cancers?

A

95% are squamous cell carcinoma. Melanomas, basal cell carcinomas, adenocarcinomas and a variety of others, including sarcomas, account for the rest.

38
Q

What is vulval cancer associated with?

A

Lichen sclerosis, immunosuppression, smoking and Paget’s disease of the vulva

39
Q

What are the clinical features of vulval cancer?

A

Pruritus, bleeding or discharge, or may find a mass, but malignancy often presents late due to embarrassment or aren’t noticed.

40
Q

What would you find on examination in vulval cancer?

A

An ulcer or mass, most commonly in the labia major or clitoris. The inguinal lymph nodes may be enlarged, hard or immobile.

41
Q

How is vulval cancer staged?

A

Surgical and histologically (after surgery)

42
Q

How would you treat vulval cancer?

A

Stage 1 - wide local excision.

All other stages - wide local excision and groin lymphadenectomy through separate ‘skin sparing’ incisions

43
Q

What is the prognosis of vulval cancer?

A

Most die from other diseases related to their age. Stage 1 at 5 years - >90% survival. Stages 3/4 at 5 years - 40%

44
Q

Is most vaginal cancer primary or secondary?

A

Secondary

45
Q

What is secondary vaginal cancer?

A

It is common and arises from local infiltration from cervix, endometrium or vulva, or from metastatic spread from cervix, endometrium or GI tumours

46
Q

What age is primary vaginal cancer most common?

A

Older women

47
Q

How does vaginal cancer present?

A

Bleeding or discharge, a mass or ulcer is evident.

48
Q

How would you treat vaginal cancer?

A

Intravaginal radiotherapy or, occasionally, radical surgery

49
Q

What is the prognosis of vaginal cancer?

A

The average survival at 5 years is 50%

Obstetrics and Gynaecology (27 decks)

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