Disorders of the Vulva Vagina & Cervix: Seibert Flashcards
Vulva is covered by skin that includes:
eccrine glands and hair
Dermatologic diseases seen elsewhere on skin can occur in the vulvar area such as:
psoriasis, eczema, allergic dermatitis, and variety of infectious diseases
3 Commonly seen conditions of the vulva are:
- Lichen Sclerosis
- Lichen Simplex Chronicus
- Lichen Planus
What is the MC non-neoplastic vulvur epithelial disorder?
Lichen Sclerosis
Lichen Sclerosis:
-characterized by:
intense vulvar pruritis, usually in women >60yo
Lichen Sclerosis:
-**Key characteristic vulvur skin appearance=
Vulvar skin is thin and wrinkled “cigarette paper appearance” with areas of lichenification and hyperkeratosis
Lichen Sclerosis:
-Tx?
-**stop the itch-scratch cycle, usually with antihistamine at night and high potency topical steroid
Ex. Clobetasol propionate ointment 0.05% Sig: apply to vulva bid x 2 weeks, then qd x 2 weeks, then twice weekly x 2 weeks, then prn Disp: 30 gms
Lichen Sclerosis:
-tx in extreme cases=
-Oral steroid
Lichen Sclerosis has a greater than expected risk of ______
- subsequent squamous cell carcinoma of the vulva
- Refer to OB-GYN for further eval, needs biopsy to confirm dx and R/O cancer
Lichen Simplex Chronicus= benign _______
epithelial thickening and hyperkeratosis resulting from chronic irritation
Lichen Simplex Chronicus is a non-specific reactive condition from _______
- constant irritation or rubbing
- May be from infection, chemical exposure, or allergic causes
Lichen Simplex Chronicus:
- pigmentation?
- appearance?
- Hyperpigmented or hypopigmented
- Results in thickened, leathery appearance
Lichen Simplex Chronicus:
-Pruritus? Specifically which area*
- Extreme pruritis (itch-scratch cycle)
- **Usually on labia majora
Lichen Simplex Chronicus:
- referral?
- Tx?
- to OB-GYN for further evaluation, needs biopsy to confirm diagnosis and R/O cancer
- Tx – Oral antihistamines and topical medium potency steroid like betamethasone or triamcinolone twice daily
Lichen Planus= an inflammatory _______
autoimmune disorder
Lichen Planus:
-can affect vulva and vagina, and may also have _____
-oral lesions (propensity for mucous membranes)
Lichen Planus: rarely affects _____
vulva
Lichen Planus: characterized by _______
**sharply marginated flat topped papules on skin and less sharply marginated white plaques on oral and genital mucous membranes
Lichen Planus:
-S/Sx
- itching, burning, postcoital bleeding, dyspareunia, and pain
- +/- erosions or ulcerations and more likely to involve vagina
Lichen Planus:
- referral?
- Tx?
- Refer to OB-GYN for further evaluation, needs biopsy to confirm diagnosis and R/O cancer
- Careful and frequent examination of vagina for formation of adhesions
**tx= mainly topical, starting with hydrocortisone foam for vagina (Colifoam) and more potent topical steroids may be tried externally
“planus”=think plane=flat
Behcet’s Syndrome=
Rare inflammatory disorder characterized by classic triad
Behcet’s Syndrome:
-Classic triad=
- Recurrent oral ulcers
- Recurrent genital aphthae or ulcerations (painful)
- Uveitis
Behcet’s Syndrome:
-Susceptibility associated with _____
HLA-B51 allele
Behcet’s Syndrome
- etiology ?
- Tx?
- Etiology unknown, may be autoimmune
- tx: topical and systemic corticosteroids
Pediculosis Pubis=
Crab louse(=crabs) (Phthirus pubis) transmitted through sexual contact or shared infected bedding or clothing
Pediculosis Pubis:
-describe how infection spreads (hint: eggs)
- Eggs laid at base of hair shaft
- Eggs hatch in 7-9 days
Pediculosis Pubis:
- Sx: ?
- PE finding?
- **Intense pubic and anogenital itching
- PE: Pale brown insects or ova may be seen on hair shafts
Pediculosis Pubis:
tx?
- –Permethrin 1% cream, lindane 1% shampoo (not for pregnant or lactating women).
- *Treat all contacts and sterilize clothing/bedding
Condyloma Acuminatum= a sexually transmitted disease that has distinctly ______
verrucous lesions
Condyloma Acuminatum:
- Asymptomatic ______ growths
- Affects ____ areas
- papillary
- Affects vulva, vagina, and cervix, and in perineal, perianal, and oropharyngeal areas in both sexes
Condyloma Acuminatum:
- caused by ____
- Prevention=
- **HPV
- HPV Vaccines recommend for 11-12 yo girls and boys
- Test for other sexually transmitted diseases
Condyloma Acuminatum:
tx:
=Trichloroacetic acid, podophyllin, cryosurgery, electrosurgery, simple surgical excision, laser, **imiquimod 5% cream apply topically
-Biopsy may be needed to rule out neoplasia
Herpes Simplex Virus (HSV)=
Vesicles develop but erode rapidly resulting in ______
painful ulcer
HSV:
- each erosion is surrounded by _____
- Frequently preceded by prodrome=
- **red halo
- **prodrome=burning, itching, and flu-like symptoms
HSV-1 is usually _____, HSV-2 usually _____
**HSV-1 is usually oropharyngeal, HSV-2 usually genital mucosa (now mixed)
HSV:
lesions heal ______
spontaneously, reoccurrence common
-Main complication is HSV transmission to neonate during birth
HSV: dx?
Viral culture, PCR, Tzanck smear
HSV:
-First episode: tx?
** Acyclovir 400mg po q 8 hours x 7-10 days.
HSV: Recurrent episodes–> tx?
Acyclovir 400mg po q 8 hrs. x 5 days (treat at onset of prodromal symptoms)
HSV: prophylaxis?
Acyclovir 400mg po BID
Molluscum Contagiosum= benign, epithelial poxvirus are _____
-demographic?
- *dome shaped with a typical umbilicus
- Common in young children but in adults molluscum is usually sexually transmitted
Molluscum Contagiosum:
-affects genital, lower abd, buttocks, and _____
-dx based on characteristic _______
inner thighs
-**pearly, domed shaped papules with dimpled center, skin scraping, or biopsy to confirm – under microscope appear as numerous inclusion bodies (molluscum bodies) in cytoplasm of cell
Molluscum Contagiosum: tx?
- may resolve on its own,
- cryotherapy, curettage, and topical therapy (imiquimod)
Bartholin Duct Cyst and Abscess
=Obstruction of main duct of Bartholin gland
- -Pea sized glands at 5 and 7 o’clock
- fx of the glands are to provide moisture for the vulva
- **Duct obstruction causes cyst and abscess formation
- *Fluctuant tender mass usually palpable
Bartholin Duct Cyst and Abscess:
-acute Sx: (list)
Pain
Tenderness
Dyspareunia
Difficult walking
Bartholin Duct Cyst and Abscess: tx?
- **I&D, catheter placement, and marsupialization.
- For catheter, an elliptical incision is made along the vaginal mucosa with expression of pus
- Insert a Word catheter deep into the cavity, inflate the catheter balloon with saline
- If a Word catheter is not available, gauze can be used to pack the cavity
- Antibiotics should be administered if considerable inflammation develops
A Bartholin duct cyst in > ___yo should be biopsied to r/o bartholins gland carcinoma!!!!
40
Atrophic vaginitis= atrophy due to diminished ____
-MC in _____
estrogen levels
- **post-menopausal women
- Can be observed in prepubertal and lactating women as well due to lack of estrogen
Atrophic vaginitis:
- pH of the vagina=
- vaginal epithelium is______
- pH= abnormally high
- thinned and more susceptible to infection and trauma
Atrophic vaginitis:
Common Complaints=
Vaginal dryness Itching Burning Dyspareunia Spotting Discharge Urinary symptoms – urgency, frequency, recurrent UTI, incontinence
Atrophic vaginitis: clinical findings (4 things)
- Low estrogen
- Thin vaginal epithelium as woman ages
- **pH elevated (5-7)
- Loss of elasticity causes shortening and narrowing of the vagina
Atrophic vaginitis:
tx?
- **Supplemental estrogen therapy
- Oral/Systemic if no contraindications
- Topical (1/3 of vaginal estrogen absorbed systemically, so contraindicated in women with hx of breast or endometrial cancer):
- -Premarin vaginal cream – 0.5 grams per vagina qd x 3 weeks, off x 1 week, then repeat as needed
- -Estrace vaginal cream – 1 gram per vagina 1-3x/week , start 2-4 grams PV qd x 2 weeks, then taper dose gradually over 1-2 weeks
- -Vagifem tablets (10µg) – 1 tablet intravaginally daily x 2 weeks, then twice weekly x 3-6 months
Vulvar Malignancy:
T/F: carcinoma of the vulva is uncommon
true
-90% are squamous cell carcinoma
-More common in postmenopausal women (60-70 yo)
Vulvar Malignancy:
- hx of vulvar irritation, pruritis, ______
- **lesion?
local discomfort, and bloody discharge
-+/- ulcer or **large cauliflower lesion
Vulvar Malignancy:
- risk factors?
- dx?
- cigarette smoking, HPV, immunodeficiency, hx of cervical carcinoma, chronic vulvar irritation
- **Biopsy necessary for diagnosis
Vulvar Malignancy:
-tx
Staging and treatment are surgical
Paget Disease of the Vulva= extramammary ________
-describe
paget disease
-In situ adenocarcinoma in the epithelium of vulva and perianal regions
Paget Disease of the Vulva:
-Sx?
Itchy, red, crusted lesions usually on labia majora, may have superficial white coating **“cake icing”
Unlike mammary Paget’s disease,
20%
Paget Disease of the Vulva:
tx?
-recurrence rate?
Refer to GYN, biopsy needed
Tendency for recurrence
In the presence of ______ the vaginal epithelium thickens leading to the accumulation of glycogen in the epithelial cells
estrogen
in the vagina:
Intraepithelial glycogen metabolizes to _____ ____
lactic acid
Describe the vaginal pH
- Intraepithelial glycogen metabolizes to lactic acid
- **Results in lowering of pH to 3.5-4.0 which promotes the growth of normal vaginal flora, mainly lactobacilli and acidogenic corynebacteria
T/F: Asymptomatic Candida organisms may be present in small quantities in the vagina (normal)
true
MC reason for Pt visits to gyno?
Vulvovaginitis**
Vulvovaginitis:
- Sx?
- successful tx?
- Sx= acute or sub-acute and range in intensity from mild to severe
- Has a broad DDx
- Successful treatment depends on identification of offending organism
Vulvovaginitis:
-list MC causes
- Bacterial vaginosis
- Candidiasis
- Trichomoniasis
- Can be signs of sexually transmitted infections
-Can be associated with conditions such as:
Atrophic vaginitis
Vulvar dermatologic conditions
Vulvodynia
Vulvovaginitis:
Hx of Pt (includes)
Location of symptoms Duration Relationship to menses Response to prior treatment -Self treatment, douching, and sexual history
Vulvovaginitis:
Lab tests
- Vaginal pH (normal= 3.8-4.2)
- Amine “whiff” test
- Potassium hydroxide (KOH) microscopy
- Saline (wet prep)
-DNA of Gardnerella vaginalis, Trichomonas vaginalis
Case:
A 23 year old female patient, G0P0, comes to the office concerned about vaginal discharge
(what ?’s do you want to ask her?)
Lab: obtain vaginal sections for pH and wet prep – FIND **Clue Cells
tx?
-using pH paper: pH of vagina is 5.5,
- minimal d/c with fishy odor - PE: no erythema, or edema.
Lab: obtain vaginal sections for pH and wet prep – FIND **Clue Cells
tx= Metronidazole, Clinidamycin orally or topically
vs
–lab test you see budding hyphae= candidiasis
Tx: intervaginal treatments (syringes with antifungal tx’s)= clean, easy and simple
A 23 year old virginal woman presents to the office with a 2-day history of thick white discharge, redness of her “bottom”, and intense vaginal itching.
She had a course of oral antibiotics the prior week for sinusitis.
She denies ever having anything like this in the past.
Her symptoms are confirmed on physical exam.
dx=
Vulvovaginal candidiasis
Vulvovaginal Candidiasis:
- 90% caused by _____
- remaining 10%=
candida albicans
-Remaining 10%: Candida glabrata, Candida tropicalis,or Torulopsis glabrata
-Generally don’t co-exist with other infections – not an STI
Vulvovaginal Candidiasis:
-more likely to occur in women who are:
pregnant, diabetic, obese, immunosuppressed, on medications such as: corticosteroids, OCPs, or antibiotics
- Increased in those who wear tight clothing, habitual use of panty liners
- *Must keep vulva and vaginal area dry
Vulvovaginal Candidiasis:
-common complaints=
Itching (may be intense) -**White vaginal discharge (thick, curd like) Vulvar erythema Asymptomatic Burning following urination
Vulvovaginal candidiasis:
-clinical findings
- Vulva and vaginal tissue bright red
- Excoriated external vaginal tissue possible
- **Thick, adherent “cottage cheese” discharge
- **pH of 4.5 or greater
- Odorless
Vulvovaginal candidiasis:
-gold standard for dx=
**Vaginal culture
Candidiasis (cells show?)
- Branching pseudohyphae and spores
* *“spaghetti and meatballs”
Vulvovaginal candidiasis:
-treatments:
- available as topical creams, vaginal suppositories, and oral agents
- -Fluconazole 150mg oral 1 tablet po x 1 single dose
- -Clotrimazole 1% cream 5 g intravaginally x 7 -14 days
- -Miconazole 2 % cream 5 g intravaginally x 7 days
- -Nystatin 100,000 unit vaginal tablet, 1 tablet x 14 days
-Keep area clean and dry!
- May also use boric acid
- Prolonged treatment may be necessary in complicated cases
- **Recurrent disease common
Note: dont memorize tx’s JUST KNOW azoles**
The patient’s presentation strongly suggests candida vulvovaginitis
- -The course of broad-spectrum antibiotics is a likely predisposing factor.
- -The KOH prep confirms the dx, and the normal saline prep is negative for bacterial vaginosis and trichomoniasis
- -A culture is not necessary in relatively straightforward cases, as this one appears to be, and surveillance for STDs is not needed because she denies sexual activity.
- **A single dose of _____
**oral Diflucan successfully treats this patient’s Sx
Bacterial Vaginosis (BV):
-organism
-Discharge?
-
- Gardnerella vaginitis
- **Thin gray-white to yellow discharge
- Discharge mildly adherent to vaginal wall
Bacterial Vaginosis (BV):
- Mild vulvar irritation in ___% of cases
- pH=
25%
->4.5
Bacterial Vaginosis (BV): -Wet prep shows:
**shows WBC, clumps of bacteria, loss of normal lactobacilli and characteristic “clue cells” (more than 20% of epithelial cells)
Bacterial Vaginosis (BV): dx defined by **amsel criteria--any 3 of the following 4 criteria:
1) Abnormal gray discharge
2) pH > 4.5
3) + whiff test
4) presence of clue cells
Treatment of BV:
(**metronidazole or clindamycin )
Metronidazole oral- 500mg orally twice daily x 7 days or
Metronidazole gel - 0.75% 1 full applicator (5g) intravaginally, once a day x 5 days
Clindamycin cream – 2%, 1 full applicator (5g) intravaginally at bedtime x 7 days
Clindamycin oral – 300mg orally twice a day x 7 days
**Treatment in Pregnant patients – Metronidazole 250mg orally 3x daily x 7 days (may increase risk of preterm delivery)
Trichomonas Vaginitis:
- organism?
- Flagellate protozoan lives in vagina, skene ducts and ____
- Trichmonas vaginalis
- male or female urethra
Trichomonas Vaginitis:
- how common?
- Associated with:
- **MC non-viral sexually transmitted disease in US
- perinatal complications including preterm birth and increased incidence in transmission of HIV
Trichomonas Vaginitis:
-often coexists with _____
other STDs, so offer testing to Pts
Trichomonas Vaginitis:
-common complaints?
Vulvar itching, burning, copious discharge with odor, dysuria, and dyspareunia
-May be asymptomatic
Trichomonas Vaginitis:
-Clinical Findings:
discharge?
pH?
- **Thin, “frothy” discharge, foul smelling
- Yellow-green
- pH > 5
- Vaginal erythema
- **Multiple petechiae (strawberry spots) in vagina or cervix
- Many are asymptomatic
Trichomonas Vaginitis:
-wet mount findings=
**increased number of polymorpho-nuclear cells and motile flagellates
strawberry spots=
**trich
Trichomonas Vaginitis:
-Dx?
- Confirmed by microscopic examination of vaginal secretions in wet-mount prep (sensitivity 60-70%)
- Other tests include culture, immunochromatographic capillary flow dipstick technology and nucleic acid test (NAAT)
- Test for other STD’s if patient has Trichomonas
Trichomonas Vaginitis Treatment
- **Systemic tx with metronidazole=1st line
- -Metronidazole oral – 2 grams orally given in a single dose
- -Tinidazole oral – 2 grams orally given in a single dose
- Treat sexual partners
- Avoid unprotected intercourse during treatment
-**Pregnancy concerns:
Associated with preterm delivery and increased incidence of HIV
Thin, frothy, foul flagellates=
**trichomonas
Grey, pH, whiff, clue cells=
**BV
Itchy, white, adherent, no odor=
**Candidiasis/Yeast
Foreign bodies (list MC ex’s)
Paper Cotton Other material Retained tampon Contraceptive device Pessary
Foreign bodies:
- common complains
- sx usually 2/2:
- Abnormal malodorous vaginal discharge
- Intramenstrual spotting
-2/2: drying of the vaginal epithelium and micro-ulcerations
Foreign Bodies:
clinical findings of retained tampon
- *Ulcerative lesions typical of retained tampon
- Typically located in the vaginal fornices and have rolled, irregular edges with a red granulation tissue base
Foreign Bodies:
-how quickly do lesions heal once tampon is discontinued?
lesions heal spontaneously!
–If retained for a long period of time, may erode into bladder or colon.
Foreign Bodies: tx?
-Removal foreign object
- Antibiotics not usually needed
- -Do treat with antibiotics if: cellulitis or systemic symptoms like fever
_______ is the most serious complication associated with tampon use
–Linked to ____ vaginal infection in healthy women
- *Toxic shock
- staphylococcal
Toxic Shock syndrome: Sx are 2/2 release of _____
**staph exotoxins
Toxic Shock syndrome:
-Sx:
High fever (> 38.9oC, 102o F) Severe headache Sore throat Myalgia Vomiting Diarrhea
- Skin rash – disappears after 24-48 hours
- Desquamation of palms and soles follows in 2-3 weeks
- Hypotension leading to shock levels within 48 hours
- **Multi-organ system failure may occur
Any menstruating women presenting with sudden onset of febrile illness should be evaluated and treated for _____
*toxic shock
Toxic shock syndrome:
-tx?
- Remove tampon
- Vaginal cultures taken
- Copious irrigation of saline to decrease organism inoculation
- B-lactamase-resistant penicillin or Vancomycin
T/F: a Pt with toxic shock should NEVER use a tampon again
true!!
PID (Pelvic Inflammatory Disease)= an inflammatory disorder of the ______
-often caused by:
- upper genital tract
- ** N. gonorrhoeae +/- C. trachomatis
- Also caused by anaerobes, other microbes of GU tract
PID (Pelvic Inflammatory Disease):
-morbidity?
-
- *Serious cause of morbility, mortality, and infertility
- Often undiagnosed
- Subtle S/Sx
- Can be confused with other disorders such as toxic shock syndrome, acute appendicitis, etc.
PID continued: Risk Factors
-**Younger than 25 Previous PID Untreated STI Multiple sexual partners -Uses douche -IUD (slight increased risk in first 3 weeks after implantation)
PID continued: Sx?
Abdominal pain Fever Vaginal/cervical discharge Pain or bleeding with intercourse Dysuria Irregular vaginal bleeding Sexually active
PID continued: Dx
-Minimum criteria=
Minimum criteria: Cervical motion tenderness OR Uterine motion tenderness OR Adnexal tenderness
PLUS:
Fever, cervical discharge, elevated ESR, elevated CRP, documented cervical infection
**must do pelvic exam to assess for Cervical motion tenderness
PID Tx:
1 in ___ women will have infertility issues; increased risk of ectopic pregnancy
-Test ALL patients for HIV, Gonorrhea, & ______
-ALL tx protocols must treat:
- 1 in 8
- Chlamydia
- **Gonorrhea and Chlamydia
- Avoid intercourse for entire treatment course
- Treat all recent sexual partners (within 60 days)
- *Common tx: Ceftriaxone IM plus Doxycycline +/- Metronidazole
Malignant Disease of the Vagina:
- how common?
- Metastatic or vaginal involvement via ______
- Rare, primary carcinoma of vagina (0.3%) of all gyn. cancers
- direct extension from cervix is much more common
Malignant Disease of the Vagina:
- ___% are squamous cell cancers
- Sx?
- 85%
- May be asymptomatic, early disease may have painless bleeding from ulcerated tumor, late disease with bleeding, pain, weight loss, and swelling
Malignant Disease of the Vagina:
-association b/w **clear cell adenocarcinoma of vagina in young women whose mothers were treated with ____
**DES during pregnancy
Malignant Disease of the Vagina:
- dx?
- tx
- Biopsy
- tx= may be surgical, radiotherapy, and in some cases chemotherapy
DES=
-DES daughters at increased risk of ______
=Diethylstilbestrol (DES), a synthetic nonsteroidal estrogen was used between 1940-1971 in US to prevent premature birth, miscarriages, and other OB complications
- DES crosses the placenta and affects reproductive cell tract differentiation
- ***DES daughters – increased risk vaginal clear cell carcinoma and other GU tract abnormalities, possible increase risk of breast cancer
Vaginal Prolapse:
Cystocele=
bladder prolapse
Vaginal prolapse:
-describe. the anterior vaginal wall
-Cystourethrocele=
-Prolapse of the anterior (front) vaginal wall
-Falls towards the vagina and creates bulge
-**Common for bladder and urethra to prolapse together,
=Called *cystourethrocele
Rectocele=
prolapse of rectum or large bowel
The cervix is the lower portion of the uterus and is divided into:
endocervix=
&
Ectocervix=
Endocervix= Portion of cervix extending into the uterus, opens through internal os, columnar epithelium
Ectocervix= Portion of cervix extending into the vagina, opens through external os, squamous epithelium
SCJ – Squamous columnar junction
Ectropion= eversion of ____
columnar epithelium onto ectocervix
Ectropion:
- cervix appears _____
- malignant or benign?
- associated with:
- red, granular, and inflammed
- Benign but must do further testing to R/O cervical cancer
- hormone changes – pregnancy and puberty
Cystic abnormalities of cervix:
Nabothian Cysts=
-cause?
- **Very common, typically asymptomatic, is a translucent-yellow mucous-filled cyst on the surface of the cervix, vary in size
- They are most often caused when stratified squamous epithelium of the ectocervix grows over the simple columnar epithelium of the endocervix trapping cervical mucous inside the crypts
Cervicitis=
Cervix in direct contact with vagina and therefore exposed to viral, bacterial, fungal, and parasitic agents
-Annually 3 million women diagnosed with cervicitis
Cervicitis:
-List ex’s of viral, bacterial, fungal, and parasitic agents
Chlamydia and Gonorrhea Herpes HPV Trichomoniasis Bacterial vaginosis Mycoplasma
- If left untreated can lead to higher risk for infertility, ectopic pregnancy, and chronic pelvic pain
- Cervicitis often asymptomatic, or sx similar to vaginitis
Acute cervicitis:
______ vaginal discharge is primary sign of acute cervicitis
**purulent
Acute Cervicitis:
Thick creamy purulent discharge in ______ infection
Thick creamy purulent discharge in GC
Acute Cervicitis:
Greenish-white and foamy in ________ infection
trich
**In Trichomonas, cervix may look like a strawberry
Acute Cervicitis:
-Discharge is Thin and gray in _______ infection
bacterial vaginosis
Acute Cervicitis:
Other Sx
-Cervix inflamed, edematous
-Vulvar burning and itching
Urethritis, dysuria, and urgency
-Cervical friability
-Postcoital bleeding or intermenstrual spotting
Chronic Cervicitis:
_______ is chief Sx
**Leukorrhea (not usually as profuse as acute cervicitis)
Chronic Cervicitis:
other sx
May cause vulvar irritation Thick or mucous like discharge Patchy erythema Lower abdominal pain Lumbosacral backaches Dysmenorrhea Dyspareunia Urinary urgency, frequency, or dysuria Postcoital bleeding
Cervicitis: lab findings
-Wet Prep –
Presence of flagellated organism=
Trichomonas
Cervicitis: lab findings
-Wet Prep –
Presence of speckled periphery to the epithelial cell (clue cell) hallmark of _______
**bacterial vaginosis
Cervicitis: lab findings
-KOH Prep – presence of distinctive hyphae seen with:
Candidia
Cervicitis:
-when should you get vaginal cultures?
Culture – G/C, HSV
Cervicitis:
-CBC shows ______
White count may be normal or leukocyte slightly elevated – not typically part of lab order for cervicitis
Cervical infections:
-complications?
Salpingitis/PID
Infertility
Ectopic pregnancy
Chronic pelvic pain
Cervical infections:
- prevention?
- tx?
- No unprotected sexual contact
- Avoid infected partners
- Barrier method contraception
tx:
Depends on patient - desire for maintaining fertility, pregnant, or breastfeeding, severity of cervical infection, and presence or absence of complicating factors
Cervical Injury:
-lacerations=
- Common complication of vaginal delivery, most common site lateral aspect
- Very common with operative deliveries (forceps or vacuum)
- Occurs with some Gyn surgical procedures or instruments
Cervical Injury:
-perforations=
- Seen with self induced abortion using a sharp object
- Inadvertently during uterine sounding, cervical dilation, or cervical cone
Cervical Injury:
-ulcerations=
Pressure necrosis due to vaginal pessary or when uterine prolapse protrudes through the vaginal introitus
Cervical Stenosis:
-occurs at the level of the ______
**internal cervical OS
Cervical stenosis:
- may lead to ____
- Caused by:
- May lead to amenorrhea and pelvic pain
- May contribute to infertility
-Caused by Cone biopsy, LEEP, ablative techniques for treatment of dysplasia
Cervical Stenosis:
- dx?
- tx?
- dx made when you are unable to pass a sound or dilator through the cervical opening
- tx=dilators CAREFULLY
Cervical Polyp=
-describe
-size=
how common?
=A soft, red, pedunculated protrusion from the cervical canal at external os
- Size: few mm to 2-3 cm
- Common
Cervical Polyp:
-arise as a result of _____
focal hyperplasia of endocervix
Cervical Polyp:
- attached to ____
- dx?
endocervical mucosa near the external os
-**Biopsy!
Microscopic examination confirms the diagnosis
Cervical Polyp . Clinical Findings: -S/Sx= -Imaging= -Labs=
- S/sx: intermenstrual or postcoital bleeding
- Imaging: Hysterosalpingogram or saline infusion sonohysterography
Labs: Biopsy!
Cervical Polyp:
-DDx=
- Adenocarcinoma
- Endometrial sarcoma
- Submucosal pedunculated myoma or endometrial polyp
Cervical polyp:
tx?
Polypectomy may be done in office (grasp pedicle close to base with polyp forcep, twisting it until the growth is avulsed.
–If large, may require removal under anesthesia – send specimen to pathology
Incompetent Cervix= condition that occurs when ______
weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy
Incompetent cervix:
-risk factors?
Congenital
Cervical trauma
D&C
History of pre-term delivery
Incompetent cervix:
-tx?
Cervical Cerclage
Bed Rest
Frequent Ultrasounds
-Progesterone - progesterone keeps a woman’s cervix long and closed, and her uterine muscles from contracting. A drop in progesterone shortens and opens the cervix and causes the uterine muscles to contract
Cervical Summary
THINK infection, TREAT infection, SAVE fertility
For all of the previous content: when in doubt, refer!!
PID is more systemic inflammatory Sx vs cervicitis can be isolated to just the cervix
