Disorders of the Vulva & Vagina Flashcards
Vagina ?
Muscular tube which extends from upwards & backwards from the vulva to the uterus
what would be the length from vulva to the uterus ?
Approximately 7-10cm
How many walls does the vagina have ?
Anterior and Posterior
Explain the structure of vagina ?
Upper end is pierced by the cervix
& the upper half lies above the pelvic floor whereas the lower half lies within the perineum
What is Vagina lined by ?
Squamous epithelium
What is Hymen ?
It is a small, thin piece of tissue located at the opening of the vagina. It is formed by fragments of tissues left over the fetal development & it is unique to each individual
What is the arterial supply of the vagina ?
Vaginal artery & drained by vaginal vein
Explain the lymphatic drainage ?
- Upper third drains to internal & external illiac nodes
- Middle third drains to the internal nodes only
- Lower third drains to the superficial inguinal nodes
What is the nerve supply of the vagina ?
it’s from inferior hypogastric plexus
What is Vaginitis?
Inflammation of the vagina is due to the infection such as ( bacterial vaginosis,candidiasis, STI including trichomoniasis).
irritants
Hormonal deficiency ( atropic vaginitis)
What is included in the history ?
Painful Urination
Vaginal discharge
Pruititis Valvae (itchy)
Dyspareunia
Vaginal dryness
Vilvodynia ( pain around the vaginal openieng)
Dysuria
Vaginal Bleeding
Abdominal pain
PMH of previous episodes
Some risk factors
What are the risk factors?
Douching ( washing / cleansing the vagina )
Poor or excessive hygiene
Poor personal hygeine ( wiping from back to front)
Antibiotic use
Change in feminine hygiene products/ soap
HIV infection
Diabetes
Black women
IUD
OCP use
Latex condom/ diaphragm
Reproductive age
Menopause
Multiple/ new sexual partners
Smoking
Increased frequency of intercourse
Pregnancy
what do you look for in the examination ?
Erythema
Pale, shiny epithelium with decreased elasticity (atrophic changes)
Vaginal discharge
Discharge adherent to vaginal mucosa
Vaginal bleeding
Strawberry cervix ( trichomonas infection )
and possibly fever if it’s infected
What is the cause of vaginitis ?
Bacterial vaginosis ( thin, fishy odour, discharge)
Candida ( thick, white, cottage cheese like discharge)
Atrophic vaginitis
Trichomonas vaginalis
What investigation would you take it forward?
The primary investigation would be Triple or dual swab & consider referring them to medicine clinic especially if suspecting any sexually transmitted disease.
What are the investigation would be carried out in the GUM clinic ?
Vaginal pH
Amine “whiff” test
Wet mount microscopy
Gram staining
HIV test
NAAT test
VDRL
Serum rapid antigen reagin test
Rapid enzyme tests
What is the management of the vaginitis ?
If the cause is infection - treat the infection.
If it is not infection - use vaginal moisturisers
If it is atopic vaginitis - use vaginal moisturiser, advise the ladies to use Lubricants during intercourse, topical oestrogen creams and HRT
What is Toxic Shock Syndrome ?
Rare but life threatening conditions
Cause of TSS?
Assoc with range of infections such as staph and strep which decreases the toxins then sets off multi system inflammatory response.
causes can be both menstrual and non menstrual
can also be caused by respiratory tract infections, skeletal infections such as osteomyelitis and septic arthritis
Causes of Menstrual TSS ?
Tampon associated
and
Non- tampon associated
Causes of Non tampon TSS ?
assoc with contraceptive use
assoc with septic abortion
gynae surgery
termination of pregnancy
puerperium ( time after childbirth)
Causes of Skin or soft tissue infections include ?
Primary staphylococcus infection
What would be the treatment for TSS ?
- Identification and decontamination of the site of toxin production
- Aggressive fluid resuscitation
- Antibiotics
- General supportive care
- Pooled human immunoglobulin in refractory cases
What abx would you give it for pts with TSS?
Penicillinase-resistant penicillin, cephalosporin, vancomycin WITH clindamycin or linezolid
What is the prevention of TSS ?
Treat wounds and burns quickly and get medical advice if you notice signs of an infection, such as swelling, redness and increasing pain
Always use a tampon with the lowest absorbency suitable for your period
Alternate between tampons and a sanitary towel or panty liner during your period
Wash your hands before and after inserting a tampon
Change tampons regularly – as often as directed on the pack (usually at least every 4 to 8 hours)
Never have more than one tampon in your vagina at a time
When using a tampon at night, insert a fresh tampon before going to bed and remove it when you wake up
Remove a tampon at the end ofyour period
Whenusingfemale barrier contraception, follow the manufacturer’s instructions about how long you can leave it in
It’s a good idea to avoid using tampons orfemale barrier contraception if you’ve had TSS before.
Case study
refer to the ppt
What does the examination show ?
Temperature of 37.9 C
Inguinal Lymphadenopathy
What is the Differential Diagnosis ?
Bartholin’s cyst abscess
What is Bartholin’s cyst ?
- Non-infectious occlusion of the distal Bartholin’s duct with resultant retention of secretions
- Usually unilateral
- May be asymptomatic if small
- Typically presents as a vulval mass
Inferior aspect labia majora
Posterior introitus
5 or 7 o’clock position
Crossed by labium minus
What is Bartholin’s abscess?
Primary
From bartholinitis
Secondary
From infection of Bartholin’s cyst
E Coli
Polymicrobial (non-STI)
- Rapidly Increasing pain ++
- Fever in approx. one third of pts
- May spontaneously rupture
What are the risk factors of bartholin’s cyst?
Women of reproductive age
Previous Bartholin’s cyst/ abscess
Sexual activity
Rarely occur following direct trauma/ surgery
What are the differentials for Bartholin’s cyst?
Mucous cyst of the vestibule
Vulval haematoma
Vulval fibroma
Vulval lipoma
Cyst of the canal of Nuck
Epidermal inclusion cyst
Skene’s duct
