genitourinary - vaginal and vulval conditions

Question 1

topical oestrogen (pessaries, vaginal rings, cream gel) is used to treat …

Answer 1

symptoms of vaginal atrophy related to oestrogen deficiency in postmenopausal women

Question 2

true or false - topical oestrogens e.g. estradiol pessaries & vaginal rings/estriol pessaries, cream and gel are used to treat symptoms of vaginal atrophy related to oestrogen deficiency in perimenopausal or menopausal women

Answer 2

FALSE
in POSTmenopausal women

Question 3

how long can topical oestrogen therapy for vaginal atrophy in postmenopausal women be continued for? and how long for reviews?

Answer 3

continue for as long as needed to relieve symptoms
review initially at 3 months, then at least annually

Question 4

true or false - vaginal oestrogens can be considered in women with pelvic organ prolapse who have signs of vaginal atrophy

Answer 4

true

Question 5

what is vaginal atrophy and when does it occur

Answer 5

Vaginal atrophy is thinning, drying and inflammation of the vaginal walls that may occur when your body has less oestrogen. Often occurs after menopause

Question 6

What are some non-hormonal preparation options for vaginal atrophy and when can they be used

Answer 6

E.g. vaginal moisturisers

Menopausal women with vaginal dryness can use vaginal moisturisers and lubricants alone or in addition to vaginal oestrogen

Question 7

What is vulvovaginal candidiasis

Answer 7

genital thrush
symptomatic inflammation of vagina and/or vulva caused by superficial fungal infection

Question 8

vulvovaginal candidiasis is most often caused by

Answer 8

candida albicans

Question 9

acute vulvovaginal candidiasis treatment

Answer 9

• either azole drug e.g. fluconazole, itraconazole
• or intravaginal imidazole pessary or cream e.g. clotrimazole, ecoconazole inserted high into vagina

Question 10

how long are intravaginal imidazoles effect against candida for vulvovaginal candidiasis effective for?

Answer 10

effective in short courses of 1-14 days according to prep used
treatment can be repeated if initial course fails to control symptoms or if symptoms recur after 7 dats

Question 11

VULVOVAGINAL CANDIDIASIS IN PREGNANCY - how to treat

Answer 11

• common during pregnancy
• treat with intravaginal application of imidazole e.g. clotrimazole
• longer duration of treatment needed - usually ~7 days
• limited systemic absorption of imidazoles from vagina

Question 12

True or false - you can treat vulvovaginal candidiasis in pregnancy with an azole oral drug

Answer 12

false. avoid in pregnancy

Question 13

Recurrent vulvovaginal candidiasis is likely if predisposing factors e.g.

Answer 13

• recent (up to 3 months before) abx treatment
• poorly controlled DM
• pregnancy
• immunosuppressed
• HRT use
• possible oral contraceptive use

Question 14

true or false - HRT use can cause thrush

Answer 14

true

Question 15

Treatment of recurrent vaginal thrush

Answer 15

• initial treatment with oral fluconazole (induction regimen) to ensure clinical remission
• followed immediately by a maintenance regimen for 6 moths
• when oral fluconazole treatment is unsuitable, an intravaginal imidazole can be given