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WOMEN'S HEALTH > DISORDERS OF THE VULVA & VAGINA > Flashcards

DISORDERS OF THE VULVA & VAGINA Flashcards

1
Q

TYPES OF VAGINITIS

A
  • bacterial vaginosis
  • trichomoniasis
  • candidiasis
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2
Q

VULVA is made up of ______________ squamous cell epithelium

A

keratinized

hair follicles
sebaceous glands
sweat glands
apocrine glands

– Occasionally contains breast tissue….may swell and become tender after delivery

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3
Q

VAGINA is made up of ______________ squamous cell epithelium

A

nonkeratinized

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4
Q

vaginal pH

A

3.5 - 4.5

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5
Q

vaginal flora is made up of

A

lactobacillus & other aerobic and anaerobic bacteria

normal vaginal secretions have NO ODOR

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6
Q

SYMPTOMS OF VAGINITIS

A 
A change in the volume, color, or odor of vaginal discharge
Pruritus
Burning
Dyspareunia
Dysuria
Spotting
Erythema
Pelvic discomfort
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7
Q

WHY IS IT IMPORTANT TO FIND THE ETIOLOGY OF VAGINITIS

A

It is important that laboratory documentation of the etiology of vaginitis be determined

Symptoms are very nonspecific

One CANNOT determine etiology from history and PE alone and may mistreat the condition

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8
Q

be careful with physical exam of vaginitis, because with bacterial vaginitis, the vulva ______________

A

APPEARS NORMAL

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9
Q

if erythema, lesions or fissures are present = may suggest vulvar

A

dermatitis

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10
Q

PHYSICAL EXAM FOR VAGINITIS

A

Begin with careful external examination of the vulva:

  • In bacterial vaginitis the vulva appears normal
  • Erythema, lesions or fissures may suggest a dermatitis of the vulva
  • Changes suggesting chronic inflammation?

May detect a foreign body

Note characteristics of vaginal discharge even though classic examples are not always the case

Check the cervix for erythema and discharge

Check for vaginal trauma

Bimanual exam to check for cervical motion tenderness and uterine tenderness

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11
Q

pH testing for vaginitis - technique

A

swab with a pH swab or dry swab the WALL of the vagina, not pooled secretions

Use narrow range pH paper or swab (jen says to use pH paper of 4.0 - 5.0)

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12
Q

pH of premenopausal women

A

3.5 - 4.5 (jen says 3.8 - 4.5)

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13
Q

pH of bacterial vaginosis

A

> 4.5

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14
Q

pH of trichomoniasis

A

5.0 - 6.0

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15
Q

pH of candidiasis

A

4.0 - 4.5

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16
Q

in pregnancy, what does the amniotic fluid do to the pH of the vagina

A

amniotic fluid raises the pH

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17
Q

bacterial cultures of the vagina

A

ARE NOT HELPFUL

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18
Q

Saline wet mount for vaginitis

A
  • evaluate within 20 minutes

Clue cells—bacterial vaginosis (BV)
Trichomonads
Increased PMNs—cervicitis

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19
Q

clue cells on saline wet mount indicate

A

BV - bacterial vaginosis

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20
Q

increased PMNs on saline wet mount indicate

A

cervicitis

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21
Q

KOH prep for vaginitis

A

to determine if fungal

see hyphae & budding yeast

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22
Q

what is the amine test

A

smelling the slide immediately after adding KOH for the “fishy” smell of BV or trichomonas

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23
Q

a positive amine test is indicative of

A

bacterial vaginitis

“fishy” odor after adding KOH to secretions = could be either BV or trichomonas

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24
Q

Most common cause of discharge of women of childbearing age (40-50%)

A

BV - BACTERIAL VAGINOSIS

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25
Q

Will be less lactobacilli present in conditions such as

A

yeast & bacterial vaginosis

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26
Q

Thin, white/gray discharge

A

bacterial vaginosis

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27
Q

what is bacterial vaginosis

A

Abnormality of the normal vaginal flora:

  • Decrease in hydrogen-peroxidase lactobacilli
  • Increase in primarily gram negative rods
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28
Q

bacterial vaginosis has a decrease in _________________ and an increase in __________

A

decrease in lactobacilli

increase in primarily gram negative rods

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29
Q

FINDINGS ON EXAM FOR BV

A
  • fishy odor (both during exam & with KOH amine test)
  • positive Clue cells on wet mount
  • thin white/gray discharge
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30
Q

what is the usual complaint of BV

A

malodorous or copious discharge

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31
Q

BV itself does NOT cause symptoms of

A 
Dysuria
Dyspareunia
Pruritis
Burning
Vaginal inflammation
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32
Q
  • Up to 75% of BV infections may be
A

ASYMPTOMATIC

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33
Q

what criteria is used to diagnose BV

A

Amsel criteria

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34
Q

Amsel criteria for diagnosing BV

A
  • need 3/4 of the following criteria to diagnose BV
    1) Homogeneous, thin, grayish-white discharge that smoothly coats the vaginal walls
    2) Vaginal pH > 4.5
    3) Positive whiff-amine test
    4) Clue cells on saline wet mount, comprising at least 20% of epithelial cells
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35
Q

treatment of choice for BV

A

METRONIDAZOLE (FLAGYL)

  • oral = 500mg BID x 7 days (no alcohol)
  • intravaginal gel 5g qd x 5 days
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36
Q

don’t have ________ while on metronidazole (flagyl)

A

alcohol

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37
Q

another treatment option for BV (after metronidazole)

A

CLINDAMYCIN

- oral or intravaginal

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38
Q

2 treatment options for BV

A

1) metronidazole (flagyl)

2) clindamycin

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39
Q

________ may be useful as adjunctive therapy for BV along with antibiotics

A

probiotics

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40
Q

do sexual partners also need to be treated when woman has BV

A

no

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41
Q

recurrence of BV

A

recurrence rates are high
May retreat with same or different regimen

Women who have 3 or more documented cases of BV in 12 months can be offered maintenance therapy:
metronidazole gel for 7-10 days then twice weekly dosing for 4-6 months

NOT clindamycin because of toxicity

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42
Q

women who have 3+ documented cases of BV in 1 year

A

treat with maintenance therapy of metronidazole

metronidazole gel x 7-10 days, then twice weekly x 4-6 months

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43
Q

do NOT give __________ for BV recurrences due to _____________

A

do not give CLINDAMYCIN for BV recurrences, due to toxicity

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44
Q

MOST COMMON STI WORLDWIDE

A

Trichomonas vaginitis

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45
Q

flagellated protozoan

A

trichomonas vaginalis

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46
Q

infects both men & women

A

trichomonas vaginalis

Female infections range from asymptomatic (50%) to acute, severe, inflammatory disease

Males are generally asymptomatic & the infection resolves spontaneously 90% of the time—the remainder get typical urethritis symptoms

Women can acquire the infection from men or other
infected women

men do not acquire it from other men

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47
Q

malodorous, thin, green/yellow vaginal discharge

A

trichomonas

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48
Q

SYMPTOMS OF TRICHOMONAS VAGINALIS

A

Malodorous, thin, green/yellow vaginal discharge (70%)

Burning, dysuria, frequency (urethra commonly involved also)

Pruritus, dyspareunia, pelvic discomfort

Post-coital bleeding

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49
Q

DIAGNOSIS OF TRICHOMONAS

A

On speculum exam MAY see green, malodorous, frothy discharge (<10%)

pH 5-6

Mobile T. vaginalis on wet mount (seen 60-70%)

Can do rapid antigen and nucleic amplification tests (usually available where prevalence is high)

On males…. can do PCR test on urine or a urethral swab…. trying to look for motile trich has VERY LOW yield

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50
Q

“STRAWBERRY CERVIX”

A

trichomonas

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51
Q

do partners of those infected with trichomonas need to be treated

A

yes

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52
Q

trichomonas treatment for men & non-pregnant women

A

Tinadozole (Tindamax)
2g x 2 days

or

Metronidazole (Flagyl) -
500mg bid x 7 day or 2g single dose

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53
Q

trichomonas treatment for pregnant women

A

metronidazole 2g single dose

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54
Q

trichomonas treatment for nursing women

A

2 g dose of Flagyl

BUT need to pump & dump x 24 hours after taking it

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55
Q

recurrent trichomonas infections are usually due to

A

Usually due to return to sexual activity too soon and reinfection

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56
Q

how to treat recurrent trichomonas infections

A

⦁ may treat recurrent infections with Metronidazole 2g dose again or use 7 day course of 500mg BID of either Metronidazole or Tinadazole
⦁ If the above fails, can treat with 2g qd x 5 days
⦁ if still refractory - culture to see if strain is resistant

  • in general, there is not a second line antibiotic
  • desensitization is recommended if the patient is allergic
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57
Q

trichomonas treatment for HIV+ patients

A

⦁ 7 day course of either Tinadazole or Metronidazole

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58
Q

prolapsed bladder

A

cystocele

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59
Q

bladder bulges into the vagina

A

cystocele

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60
Q

why does a cystocele occur

A

This occurs when the supportive tissues & muscles between the bladder and the vagina weaken and stretch => bladder bulges into the vagina

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61
Q

Causes of Cystocele

A 
⦁	childbirth
⦁	repetitive straining for bowel movements
⦁	constipation
⦁	chronic or violent coughing
⦁	heavy lifting
⦁	obesity
62
Q

cystocele treatment

A
  • watchful waiting!
  • avoid heavy lifting or straining
  • Pelvic floor (Kegel) exercises can be done to strengthen the pelvic muscles
  • Pessary = a silicone medical device placed in the vagina that supports the vaginal wall and holds the bladder in place
  • Anterior vaginal wall repair (Colporrhaphy)
63
Q

Pessary

A

a silicone medical device placed in the vagina that supports the vaginal wall and holds the bladder in place

64
Q

lichen sclerosis etiology may be linked to _________ or _________

A

genetics or autoimmune

65
Q

pathophysiology of lichen sclerosis

A

intense inflammatory reaction

66
Q

peaks of lichen sclerosis

A

⦁ pre-pubertal girls

⦁ post-menopausal women

67
Q

diagnosis of lichen sclerosis

A

BIOPSY

68
Q

SYMPTOMS OF LICHEN SCLEROSIS

A 
⦁	Hallmark** = Vulvar Pruritus - may be so intense as to interfere with sleep
⦁	Pruritus ani
⦁	Painful defecation
⦁	anal fissures
⦁	dyspareunia
69
Q

hallmark symptom of lichen sclerosis

A

vulvar pruritus - may be so intense as to interfere with sleep

70
Q

lichen sclerosis exam

A
  • chronic inflammation
  • well-demarcated white, finely wrinkled, atrophic patches
  • the labia minora often shrinks & adhesions of the labia majora may cover the clitoris
71
Q
  • well-demarcated white, finely wrinkled, atrophic patches
A

lichen sclerosis

72
Q
  • the labia minora often shrinks & adhesions of the labia majora may cover the clitoris
A

lichen sclerosis

73
Q

treatment for lichen sclerosis

A

⦁ Clobetasol proprionate 0.05% cream x 6-12 weeks (topical steroid)
⦁ then use for maintenance therapy (1-3x/week)

74
Q

2nd most common cause of vaginitis symptoms

A

vulvovaginal candidiasis

75
Q

is vulvovaginal candidiasis an STI?

A

NO

76
Q

primary etiologic agent of vulvovaginal candidiasis

A

Candida Albicans

Candida glabrata = accounts for the rest

77
Q

PATHOGENESIS OF CANDIDIASIS

A
  • the organism can migrate from the anus to the vagina & colonize there
  • less common cause = sexual or relapse from reservoir in the vagina
  • Infection occurs when there is an overgrowth of candida
78
Q

RISK FACTORS FOR CANDIDIASIS

A

⦁ DM
⦁ Increased Estrogen levels (OCP, Pregnancy)
⦁ Immunosuppression
⦁ ***Antibiotic use

up to 1/3 of women develop yeast infxns from abx use

79
Q

DIAGNOSIS OF CANDIDIASIS

A

o Speculum exam
⦁ thick, white, sometimes “cottage cheese” discharge
⦁ in severe cases = gray membrane
⦁ pH = 4.0 - 4.5

o KOH wet mount slide (up to 50% are negative) - but would see hyphae & budding yeast

o In rare cases, cultures for candida are indicated
⦁ multiple, recurrent, or persistent cases that are not responding to treatment (may have a resistant pathogen)
⦁ women with a normal pH, and no visible pathogen on wet mount

80
Q

SPECULUM EXAM OF CANDIDIASIS

A

⦁ thick, white, sometimes “cottage cheese” discharge
⦁ in severe cases = gray membrane
⦁ pH = 4.0 - 4.5

81
Q

“cottage cheese” discharge

A

vulvovaginal candidiasis

82
Q

in what rare cases are cultures indicated for candidiasis

A

⦁ multiple, recurrent, or persistent cases that are not responding to treatment (may have a resistant pathogen)

⦁ women with a normal pH, and no visible pathogen on wet mount

83
Q

PREVENTION/EDUCATION FOR CANDIDIASIS

A
  • Keep the external genital area clean & dry
  • avoid irritating soaps (including bubble bath), vaginal sprays & douches
  • change tampons / sanitary napkins frequently
  • wear loose cotton (rather than nylon) underwear that doesn’t trap moisture
  • take antibiotics only when prescribed, and never take them for longer than necessary
84
Q

what classifies uncomplicated candidiasis

A

mild to mod signs/symptoms
probable Candida albicans infection
healthy & not pregnant

85
Q

treatment of uncomplicated candidiasis

A

⦁ many OTC intravaginal treatments are available & highly effective

⦁ RX = Fluconazole (Diflucan) 150mg x 1 dose

	- stays in vaginal secretions x 72 hrs
	- can interact with many drugs**
86
Q

treatment of complicated candidiasis

A

⦁ Fluconazole 150mg: 2-3 doses 72 hours apart

⦁ topical therapy with Clotrimazole/ miconazole/ terconazole x 7-14 days

⦁ Intravaginal boric acid tablets x 2 weeks (fatal if swallowed***)

⦁ Flucytosine cream intravaginally qhs x 2 weeks

87
Q

intravaginal boric acid tablets x 2 weeks; risk =

A

fatal if swallowed!!!

88
Q

what constitutes complicated candidiasis

A

severe signs/symptoms
Infection not due to C. albicans (usually C. glabrata)pregnant
DM
immunosuppression
debilitation
hx of recurrent verified (> 4 infxns/yr) candidal infections

89
Q

herpes outbreak: primary vs recurrent

A

The primary outbreak = the worst episode; recurrent outbreaks are generally less severe

90
Q

GENITAL HSV SYMPTOMS

A 
⦁	painful genital ulcers
⦁	itching
⦁	dysuria
⦁	tender inguinal lymphadenopathy
⦁	may have systemic symptoms: Headache, Malaise, Fever
91
Q

DIAGNOSIS OF HSV

A

o EXAM

  • “multiple vesicles on an erythematous base”
  • vulvar swelling
  • lymphadenopathy
  • confirmation of diagnosis = by viral cell culture or PCR
92
Q

“multiple vesicles on an erythematous base”

A

GENITAL HSV

93
Q

DIAGNOSIS OF HSV SHOULD BE CONFIRMED BY

A

by viral cell culture or PCR

94
Q

treatment for HSV

A
  • the treatment for a PRIMARY infection needs to be started within 72 hrs
  • treatment = 7-10 days
    ⦁ acyclovir (zovirax) - 400mg TID x 7-10 days
    ⦁ famcyclovir (famvir) - 250mg TID x 7-10 days
    ⦁ valacyclovir (valtrex) - 1000mg BID x 7-10 days
  • for RECURRENT infections
    ⦁ acyclovir 800mg BID x 3 days
    ⦁ famcyclovir 1000mg BID x 1 day
    ⦁ valacyclovir 500mg BID x 3 days
  • SUPPRESSIVE therapy
    ⦁ acyclovir 400mg BID
    ⦁ famcyclovir 250mg BID
    ⦁ valacyclovir 500mg QD
95
Q

MOST COMMON VIRAL STD IN THE US

A

condylomata acuminate (genital warts)

96
Q

etiologic agent of condylomata acuminate (anogenital warts)

A

HPV

97
Q

SIGNS/SYMPTOMS OF GENITAL WARTS

A

⦁ pruritus, burning, pain
⦁ bleeding, vaginal discharge
⦁ may have no symptoms!

98
Q

INDICATIONS FOR GENITAL WARTS TX

A
  • alleviation of bothersome symptoms
  • cosmetic
  • obstruction, dyspareunia, psychological distress
  • decrease risk of transmission
99
Q

recommend biopsy for genital warts if:

A

⦁ diagnosis is uncertain
⦁ lesion has suspicious features (irregular or unusual pigmentation)
⦁ patient is postmenopausal or immunocompromised
⦁ lesion is refractory to medical therapy

100
Q

TREATMENT FOR GENITAL WARTS

A

o Chemical Destruction
⦁ Podophyllin (DO NOT USE if pregnant)
⦁ Trichloroacetic acid (highly caustic - can be used during pregnancy)
⦁ 5-FU gel - injected into lesions

o Immunologic
⦁ Imiquimod (Aldara) cream
⦁ Interpheron alpha - systemic therapy

o Surgery
⦁ cryotherapy - LN2 or probe cooled with nitrous oxide
⦁ Laser therapy - in operating room with anesthesia
⦁ Excisional - knife or scissors, requires anesthesia

101
Q

TREATMENT FOR GENITAL WARTS:
- chemical destruction

__________ can’t be used if pregnant

_________ can be used if pregnant

A

podophyllin - DON’T use if pregnant

trichloroacetic acid = can be used if pregnant

102
Q

GENITAL WARTS & PREGNANCY - can transmission occur?

A

YES

  • vertical transmission CAN occur
    ⦁ either through bloodstream prior to birth
    ⦁ or at the time of birth - as infant passes through infected birth canal
103
Q

HPV can manifest in young children as:

A

⦁ mucosal, conjunctival, or laryngeal disease

⦁ juvenile onset respiratory papillomatosis (JRP) - severe, but rare

104
Q

Dome shaped with central dimple (umbilicated)

A

molluscum contagiosum

105
Q

MOLLUSCUM CONTAGIOSUM

A
  • multiple 1-2mm raised, painless lesions
  • **Dome shaped with central dimple (umbilicated)
  • contain cheesy-white material
  • can be sexually transmitted
106
Q

treatment for molluscum

A
  • cryosurgery
  • bichloracetic acid
  • dermal curette
107
Q

atrophic vaginitis can occur in

A

women of any age who experience a decrease in estrogenic stimulation of urogenital tissue

108
Q

the effect of estrogen stimulation on urogenital system

A
  • maintains a well-epithelialized vaginal vault
  • estrogen acts on receptors in the vagina, vulva, urethra & trigone of the bladder
  • estrogen maintains the collagen content of epithelium
  • keeps epithelial surfaces moist
  • maintains optimal genital blood flow
  • maintains acidic vaginal pH (without estrogen, pH > 5)
109
Q

RISK FACTORS FOR ATROPHIC VAGINITIS

A

⦁ natural menopause
⦁ bilateral oophorectomy
⦁ spontaneous premature ovarian failure
⦁ ovarian failure due to radiation, chemo or surgery
⦁ premenopausal meds with anti-estrogenic effects
⦁ post-partum reduction in estrogen production during lactation
⦁ prolactin elevation
⦁ amenorrhea secondary to suppression of the hypothalamic-pituitary axis due to chronic treatment with glucocorticoids

110
Q

SYMPTOMS OF ATROPHIC VAGINITIS

A

⦁ vaginal dryness, burning or itching
⦁ decreased lubrication during sex
⦁ dyspareunia
⦁ vulvar or vaginal bleeding (postcoital bleeding)
⦁ vaginal discharge
⦁ pelvic pressure or vaginal bulge
⦁ Urinary tract symptoms (frequency, dysuria, hematuria)

111
Q

PHYSICAL EXAM FINDINGS OF ATROPHIC VAGINITS

A

⦁ pale, smooth or shiny vaginal epithelium
⦁ loss of elasticity
⦁ sparsity of pubic hair
⦁ introital narrowing
⦁ lack of moisture
⦁ fusion or resorption of the labia minora
⦁ friable, unrugated epithelium of the vagina
⦁ shortened, narrowed, and poorly distensible vaginal vaults

112
Q

TREATMENT OF ATROPHIC VAGINITIS

A

o for Vaginal dryness
- Vaginal moisturizers (Replens, Vagisil, K-Y) - use 1+ times/week
- Use vaginal lubricants at the time of coitus
⦁ water soluble products = astroglide, K-Y jelly
⦁ silicone based products = pjur eros, ID millennium
⦁ oil based = Elegance women’s lubricant

  • sexual activity itself may improve vaginal function

o Vaginal estrogen therapy = MOST EFFECTIVE TREATMENT
- contraindications = a woman with estrogen-dependent tumor
- associated with urinary tract benefits
- usually start with vaginal estrogen therapy (cream, tablet or ring)
⦁ SE = vaginal irritation, bleeding or breast tenderness
- some women need systemic therapy
⦁ SERM - selective estrogen receptor modulator = Ospemifene oral tabs (Osphena)
⦁ SE = hot flashes, thromboembolism, endometrial cancer

113
Q

most effective therapy for atrophic vaginitis

A

estrogen therapy

usually start with vaginal estrogen therapy (cream, tablet or ring)

some women need systemic therapy

114
Q

SERM (selective estrogen receptor modulator) for atrophic vaginitis treatment in women who need systemic estrogen therapy (vaginal estrogen therapy not enough)

A

Ospemifene oral tablets (Osphena)

115
Q

contraindications to estrogen therapy for atrophic vaginitis

A

woman with an estrogen-dependent tumors

116
Q

SE to vaginal estrogen therapy (cream, ring, tablet)

A

vaginal irritation, bleeding, breast tenderness

117
Q

SE to SERM (Osphena/Ospemifene) systemic treatment of estrogen therapy for atrophic vaginitis

A

hot flashes
thromboembolism
endometrial cancer

118
Q

Many vaginal & vulvar lesions mimic

A

Bartholin gland disorders

119
Q

Most common large cyst of the vulva

A

Bartholin duct cyst

120
Q

treatment of Bartholin’s duct cysts

A
  • treatment not necessary in women < 40 unless they become infected or symptomatic
  • if the cyst is large & not resolving = can then treat with the same technqiues you would use for an abscess
121
Q

most Bartholin’s duct cysts are

A

asymptomatic

122
Q

symptoms of Bartholin duct abscess

A
  • swelling of the Bartholin gland with exquisite pain
  • on exam = erythematous, warm, tender and usually fluctuant (can push around)
  • there may be surrounding cellulitis
123
Q

INFECTION of Bartholin duct abscess

A

usually polymicrobial

STIs are LESS likely - but still test pt if they are at high risk for STIs

There has been a rise in MRSA as etiologic agent

124
Q

treatment of Bartholin’s duct cyst or abscess

A

I&D - lance at or behind the hymenal ring

  • place a wick to continue drainage;
  • place a word catheter into the cavity and leave it in for at least 4 weeks
125
Q

Marsupialization of Bartholin duct cyst/abscess

A
  • longer procedure done under local anesthesia
  • reserved for patients who fail 1-2 placements of a word catheter
  • procedure = cut slit into cyst/abscess and suture down edges - makes recurrence less likely
  • Complications = hematoma, scarring, dyspareunia
126
Q

Marsupialization of Bartholin’s duct is reserved for patients who

A

failed 1-2 placements of a word catheter

127
Q

complications of marsupialization procedure

A

scarring
hematoma
dyspareunia (painful sex)

128
Q

SIGNS/SYMPTOMS OF PAGET’S DISEASE

A
  • itching
  • burning
  • bleeding
129
Q

PAGET’S DISEASE LESIONS

A

Lesions are brick red, scaly, velvety, eczematoid plaques with sharp borders

130
Q

Paget’s disease May be an indication of an _____________

A

underlying malignancy

131
Q

primary treatment for Paget’s disease

A

excision: excision with > 3 mm border from visible margin

132
Q

Paget’s disease treatment

A
  • primary treatment = excision with > 3 mm border from visible margin
  • recurrent disease may be treated with: Radiotherapy, Laser, Photodynamic therapy, 5-FU, Imiquimoid

Local recurrence rate = 31-43%

133
Q

recurrent Paget’s disease treatment

A

Radiotherapy, Laser, Photodynamic therapy, 5-FU, Imiquimoid

134
Q

brick red, scaly, velvety, eczematoid plaques with sharp borders

A

Paget’s disease

kind of looks like lichen sclerosis

135
Q

RISK FACTORS FOR VULVAR CANCER

A 
⦁	HPV infection (60%)***
⦁	smoking
⦁	lichen sclerosis
⦁	vulvar or cervical intraepithelial neoplasia
⦁	immunodeficiency syndromes
⦁	prior hx of cervical cancer
⦁	Northern european ancestry
136
Q

largest risk factor for vulvar cancer

A

HPV infection

137
Q
  • ***a second malignancy - usually _____________ = is found in up to 22% of patients with a vulvar malignancy
A

cervical cancer

138
Q

vulvar malignancy = may also have _______

A

cervical cancer

139
Q

unifocal vulvar plaque, ulcer or mass

A

vulvar cancer

lesions are multifocal in 5% of cases

140
Q

___________is a common complaint with vulvar cancer

A

Pruritus

141
Q

most common histological type for VULVAR CANCER

A

SQUAMOUS CELL

142
Q

HPV infection = largest risk factor for

A

vulvar cancer

143
Q

squamous cell

A

vulvar cancer

144
Q

modes of transmission for vulvar cancer (3)

A
  • direct extension to adjacent structures
  • lymphatic embolization to regional lymph nodes - can occur early
  • hematogenous dissemination - occurs late in the disease
145
Q

may involve genital, perianal and axillary areas

A

paget’s disease

146
Q

the reason to continue PAP smears after a hysterectomy

A

VAIN = VAGINAL INTRAEPITHELIAL NEOPLASIA

147
Q

most common cause of VAIN

A

HPV (types 6&11) - account for 80% of VAIN

148
Q

TREATMENT for VAIN

A
  • laser ablation
  • local excision
  • 5-FU
  • vaginectomy & skin graft
149
Q

what is VAIN

A

Vaginal squamous cell atypia without invasion

150
Q

scariest thing about VAIN

A

consistently associated with prior or concurrent neoplasia elsewhere in the lower genital tract
⦁ 50-90% of patients with VAIN had or currently have either intraepithelial neoplasia or carcinoma of the cervix or vulva

151
Q

consistently associated with prior or concurrent neoplasia elsewhere in the lower genital tract

A

VAIN

152
Q

HPV accounts for majority of cases of

A

VAIN

and is also a risk factor for Vulvar cancer

WOMEN'S HEALTH (13 decks)

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