Disorders of vulva & vagina

Question 1

Lichen sclerosis- Eti

Answer 1

• Most common epithelial vulvar disorder
• Women > 60
• Benign, chronic inflammatory condition
• Vit A deficiency or autoimmune

Question 2

Lichen sclerosis- Sx

Answer 2

• Pruritis
• Scaring
• Erythema & edema
• White plaques
• Scratch-itch cycle
• Erosion, fissure & ulcers
• Thin, cigarette paper skin

Question 3

Lichen sclerosis- Dx

Answer 3

• Histology on biopsy:

- Thinning epithelium, lymphocytic infiltration, flattening of papillae, thin hyerperkeratotic layer

Question 4

Lichen sclerosis- Tx

Answer 4

• Avoid tight garments, keep dry
• Antihistmine
• Topical steroid- long term tx
• Immune modulators

Question 5

Lichen sclerosis- Complications

Answer 5

• High rates of squamous cell cancer

- Chronic

Question 6

Vulvar Lichen Simplex Chronicus- Eti

Answer 6

• Atopic dermatitis/ eczema, squamous cell hyperplasia of vulva
• Traumatic tissue injury
• Perpetuated by itch scratch cycle

Question 7

Vulvar Lichen Simplex Chronicus- Sx

Answer 7

• Epithelial thickening & hyperkeratosis
• Pruritis
• Raised white lesion

Question 8

Vulvar Lichen Simplex Chronicus- Dx

Answer 8

Biopsy- hyperkeratosis and acanthosis

- No dermal inflammatory infiltrate

Question 9

Vulvar Lichen Simplex Chronicus- Tx

Answer 9

• Sitz baths & lubricants
• Medium potency topical steroids
• Antihistamines

Question 10

Lichen planus- Eti

Answer 10

• Rare
• Mucocutaneous dermatosis
• Erosive
• Unknown pathogenesis

Question 11

Lichen planus- Sx

Answer 11

• Sharply marginated flat-topped papillose on skin
• Severe tissue distruction
• Scarring, urinary & sexual impairment
• Wickham striae, check mouth
• white plaques on mucous membranes

Question 12

Lichen planus- Tx

Answer 12

• Hydrocortisone foam
• Corticosteroids- potent
• Vulvar hygiene
• Cessation of scratching

Question 13

Bartholin cyst- Eti

Answer 13

• Obstruction of bartholin gland

- Infection, congenital narrowing, inspissated mucus

Question 14

Bartholin cyst- Sx

Answer 14

• Pain, tenderness, dyspareunia
• Edematous & inflamed tissues
• Fluctuant, tender mass

Question 15

Bartholin cyst- Dx

Answer 15

Inflamed gland- posterior third of labrum

Question 16

Bartholin cyst- Tx

Answer 16

• Drainage

- Abx

Question 17

Impetigo- Eti

Answer 17

• Staph aureus or strept

- More common in children

Question 18

Impetigo- Sx

Answer 18

• Thin walled bullae
• Reddened edges
• Crusted after rupture- honey colored

Question 19

Impetigo- Tx

Answer 19

• Remove crusts

- Neomycin or bacitracin

Question 20

Hidadenitis suppurativa- Eti

Answer 20

• Infection of apocrine sweat glands with staph or strept

Question 21

Hidadenitis suppurativa- Sx

Answer 21

• Pruritic subQ nodules into abscesses

- Entire skin of vulva- sinuses & scars

Question 22

Hidadenitis suppurativa- Tx

Answer 22

• Drainage

- Abx

Question 23

Vulvodynia- ETi

Answer 23

• Women 20-30- provoked
• Women 60s- unprovoked
• 16% population experiences at some time
• Localized/ provoked v. unprovoked
• hyperinnervation & neurogenic inflammation

Question 24

Vulvodynia- Sx

Answer 24

• Burning, rawness, irritation, dryness and hyperpathia
• Vestibular tenderness
• Pain on vaginal entry/ touching

Question 25

Vulvodynia- Dx

Answer 25

• Itroital pain on entry
• Lidocaine entry test
• vestibular tenderness

Question 26

Vulvodynia- Tx

Answer 26

• Pelvic floor PT
• Vulvar hygiene
• Lidocaine
• Antidepressant

Question 27

Contact dermatitis- Eti

Answer 27

• Contact with irritating or hypersensitive agent

Question 28

Contact dermatitis- Sx

Answer 28

• Inflammation of vulvar tissue

- Can be local or systemic

Question 29

Lichen planus- Dx

Answer 29

Biopsy & clinical picture

Question 30

Contact dermatitis- Tx

Answer 30

• Steroids