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Yr4: Obstetrics & Gynaecology > Gynae: Cervical, Vaginal & Vulvar Disorders > Flashcards

Gynae: Cervical, Vaginal & Vulvar Disorders Flashcards

1
Q

What is the cervical transformation zone?

A

Zone between columnar epithelium of endocervix and stratified squamous epithelium of the ectocervix. Found around the opening of the cervix.

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2
Q

What is cervical ectropion?

A

Columnar epithelium of endocervix (canal of cervix) has extended out to the ectocervix (outer area of cervix)

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3
Q

State some potential causes of cervical ectropion

A

Associated with higher oestrogen levels:

  • COCP
  • Pregnancy
  • Ovulatory phase

*More common in younger women

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4
Q

Describe typical presentation of cervical ectropion

A

Many women are asymptomatic (hence found incidentally on examination) but may present with:

  • Increased vaginal discharge
  • Post-coital bleeding (columnar epithelium more fragile)
  • Vaginal bleeding
  • Dyspareunia
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5
Q

What might you find on examination of someone with cervical ectropion?

A
  • Well demarcated border between the redder, velvety columnar epithelium and the pale pink squamous epithelium
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6
Q

Discuss the management of cervical ectropion

A
  • Asymptomatic: no treatment required (typically resolves as pt gets older, stops pill, not pregnant)
  • Treatment indicated if there is problematic bleeding or other troublesome symptoms:
    • Cauterisation of ectropion using silver nitrate
    • Or cold coagulation during colposcopy
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7
Q

Is cervical ectropion associated with cervical cancer?

A

Not associated in any way

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8
Q

What are Nabothian cysts?

Do they cause harm?

A
  • Cysts (fluid filled sac) on surface of cervix. Also called nabothian follicles or mucinous retention cysts. Usually up to 1cm in size.
  • Harmless & unrelated to cervical cancer
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9
Q

Describe the pathophysiology of Nabothian cysts

A
  • Columnar epithelium of endocervix produces cervical mucus
  • When squamous epithelium of ectocervix slightly covers mucus-secreting columnar epithelium mucus can become trapped and forma cyst
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10
Q

State some potential causes/triggers for nabothian cysts

A
  • Childbirth
  • Minor trauma to cervix
  • Cervicitis
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11
Q

Describe typical presentation of Nabothian cysts

A

Often asymptomatic & found incidentally. If very large may cause feeling of fullness in pelvic area

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12
Q

Describe the appearance of Nabothian cysts

A
  • Smooth rounded bumps on cervix near to external os
  • Whiteish or yellow appearance
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13
Q

Discuss the management of Nabothian cysts

A
  • Reassurance → no harm, often resolve spontaneously → no treatment required

If unsure of diagnosis can refer for colposcopy. May be excised or biopsy if still unclear. Rarely, may be treated during colposcopy if causing symptoms.

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14
Q

What are the Bartholin glands and what is their function?

A
  • Pair of glands either side of posterior part of vaginal opening
  • Produce mucus to help with lubrication
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15
Q

What are Bartholin’s cysts? Include pathophysiology

A

Bartholin cysts form when the ducts of the Bartholin glands are blocked causing glands to become swollen and tender

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16
Q

Describe typical presentation of Bartholin’s cysts

Describe typical presentation of Bartholin’s abscess

A

Bartholin’s cyst

  • Usually unilateral
  • Swelling located at posterior of vaginal opening
  • Tender

Bartholin’s abscess

Cyst may become infected to form Bartholin’s abscess; this would present as:

  • Hot
  • Tender
  • Red
  • May drain pus
17
Q

Discuss the management of Bartholin’s cysts

A

Usually resolve with self-care measures:

  • Good hygiene
  • Analgesia
  • Warm compress

Incision is avoided if possible as high risk of cyst reoccurrence. May do biopsy if unsure of vulval malignancy.

18
Q

Discuss the management of Bartholin’s abscess

A
  • Swab of pus/fluid for culture & abx sensitivities
  • Swab for chlamydia & gonorrhoea if risk of STI
  • Abx (start prior to sensitivities e.g. co-amoxiclav or clindamycin)
  • May require surgical interventions:
    • Word catheter: can be done in treatment room: apply local anaesthetic, make incision into abscess, drain pus, insert catheter (it is a small tube with inflatable balloon on end), inflate balloon with saline, any remaining pus can drain around catheter, tissue heals around catheter, balloon deflated and catheter removed in few weeks time once epithelisation of hole has occurred
    • Marsupialisation: requires general anaesthetic, make incision, drain abscess, suture sides of abscess open
19
Q

What is lichen sclerosus?

A

Autoimmune, chronic, inflammatory skin condition that commonly affects labia, perineum and perianal skin in women; although it can affect other areas (e.g. axilla, thighs) and men typically on foreskin & glans of penis.

20
Q

Note from Zero to Finals:

Lichen sclerosis may be confused with other conditions that include “lichen” in the name. Lichen refers to a flat eruption that spreads. It is important not to get lichen sclerosus confused with lichen simplex or lichen planus.

Lichen simplex is chronic inflammation and irritation caused by repeated scratching and rubbing of an area of skin. This presents with excoriations, plaques, scaling and thickened skin.

Lichen planus is an autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.

A
21
Q

Describe typical presentation of lichen sclerosus

A

Usually middle aged women presenting with:

  • Vulval itching
  • Skin changes affecting labia, perineal & perianal skin:
    • Porcelain white
    • Shiny
    • Slightly raised
    • Tight
    • May be papules or plaques
    • Erosions
    • Fissures
  • Koebner phenomenon
  • Skin tightness
  • Pain (worse at night)
  • Superficial dyspareunia
22
Q

Discuss the management of lichen sclerosus

A

Cannot cure hence management centred around controlling symptoms:

  • Potent topical steroids e.g. dermovate (use once day for 4/52 then taper down. Pt can increase use when flares up again)
  • Emollients
23
Q

State some potential complications of lichen sclerosus- highlight key one to remember

A
  • 5% risk of squamous cell carcinoma of vulva
  • Pain
  • Bleeding
  • Sexual dysfunction
  • Narrowing of vaginal or urethral openings
24
Q

What if FGM?

A

Female genital mutilation is surgically altering the genitalia of a female for non-medical reasons. Cultural practice that usually occurs in pre-pubertal girls. It is ILLEGAL.

**WHO “Female genital mutilation (FGM) involves the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons.”

25
Q

State and describe the 4 types of FGM

A
  • Type 1: Removal of part or all of the clitoris.
  • Type 2: Removal of part or all of the clitoris and labia minora with or without removal of labia majora
  • Type 3: Narrowing or closing the vaginal orifice (infibulation).
  • Type 4: All other unnecessary procedures to the female genitalia e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
26
Q

State some risk factors for FGM/circumstances in which you should consider FGM

A
  • Pt coming from community/area that practices FGM (Africa, Middle East & Asia)
  • Siblings or daughters of women affected by FGM
  • Extended trips with infants or children to areas where FGM is practices
  • Pregnant women with FGM with a possible female child
  • Women that decline examination or cervical screening
27
Q

State some immediate complications of FGM

A
  • Pain
  • Bleeding
  • Infection
  • Swelling
  • Urinary retention
  • Urethral damage & incontinence
28
Q

State some long term complications of FGM

A
  • Dysmenorrhoea
  • Sexual dysfunction & dyspareunia
  • Infertility
  • Increased risk of childbirth complications
  • Infections
    • Vaginal infections e.g. BV
    • Pelvic infections
    • Urinary tract infections
  • Psychological
    • Depression
    • Anxiety
    • PTSD
29
Q

Discuss the management of FGM

A
  • Education: illegal, complications
  • Report all cases of FGM in pts under 18yrs to police, social services and safeguarding, paediatrics
  • Also report all cases to:
    • Specialist gynaecology services or FGM services
    • Counselling
  • Careful consideration regarding reporting cases in over 18yrs to police or social services (use risk assessment exploring risk factors previously discussed)
  • De-infibulation for type 3 (correct narrowing or closure of vaginal orifice)

**NOTE: re-infibulation (re-closure/re-narrowing of vaginal orifice may be requested after childbirth; this is ILLEGAL)

Yr4: Obstetrics & Gynaecology (24 decks)

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