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