Gynaecology Flashcards
1
Q
Cervical Cancer Screening in Australia
A
- 5 yearly cervical screening
- primary HPV test with partial HPV genotyping and reflex liquid-based cytology triage
- 25 to 69yo with exit testing up to 74yo
- self-collection of a HPV sample for under-screened and never-screened women
- these changes are estimated to result in a further 30% reduction in the incidence of cervical cancer over time
2
Q
HPV Vacccination
A
- persistent infection with oncogenic HPV is associated with the development of cervical cancer
- also implicated in the development of other cancers including neoplasms of the vulva, vagina, anus, penis and some head and neck cancers
- types 16 and 18 account for 70% of cervical cancers
- types 6 and 11 account for 90% of genital warts
- routine school-based vaccination of girls and boys in the first year of high school (12-13yo)
- 3 IM doses at 0, 2 and 6 months for long-lasting immunity
- vaccines are made from virus-like proteins
- 4v HPV vaccine Gardasil - 16, 18, 6 and 11
3
Q
Cytological Follow-up After Hysterectomy
A
- undergone hysterectomy for benign disease, Hx of normal Pap smears, and histopath of cervix shows no neoplastic or premalignant change: no further Pap smear screening
- if Pap smear Hx and/or histo not available: take baseline vault smear and if normal, nil further screening
- subtotal hysterectomy: continue routine cervical screening
- high grade lesion (CIN 2-3/ACIS) completely excised at hysterectomy: vault smears annually for 5 years, then resume routine screening (increased risk of VAIN or invasive cancer)
- previous LSIL however resumed normal screening prior to hysterectomy: nil routine screening
- previous VAIN: cytology every 1-2 years
- symptomatic women always need further assessment
4
Q
FGM
Classification
A
- all procedures involving partial or total removal of the external genitalia or other injury to the female genital organs whether for cultural or non-therapeutic reasons
- Type 1: partial or total removal of the clitoris and/or the prepuce (clitoridectomy)
- Type 2: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision)
- Type 3: narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)
- Type 4: all other harmful procedures to the female genitalia for non-medical purposes (eg pricking, piercing, incising, scraping and cauterising
5
Q
FGM
Countries Commonly Performed
A
- Somalia
- Sudan
- Ethiopia
- Egypt
- (north-east Africa)
- a few populations in the middle-east and Asia
6
Q
FGM
Long Term Health Consequences
A
- impaired sexual function: apareunia, dyspareunia, anorgasmia, reduced sexual pleasure
- urinary tract: recurrent UTI, prolonged voiding time, difficulty obtaining a MSU sample
- recurrent vaginal infections
- menstrual problems: haematocolpos, retained menstrual clots
- local scar complications: keloid, dermal cysts
- local pain: chronic neuropathic pain
- difficulty with minor gynaecological procedures eg Pap smear
- psychological: PTSD, anxiety, depression
7
Q
FGM
Pregnancy Consequences
A
- difficulty with VEs in pregnancy and labour
- difficulty with intrapartum procedures eg amniotomy, FSE
- difficulty with IDC if required
- increased likelihood of severe perineal trauma and vaginal laceration
- increased likelihood of episiotomy
- increased risk of Caesarean section
- fear of childbirth
- increased risk of perinatal death (in developing countries)
8
Q
FGM
Management
A
- prevention through community education, information, and support
- the legal status of FGM in Aus and NZ should be explained to women and their families
- if a clinician has concern about FGM occurring or has occurred, legal requirements for reporting and referral
- offer antenatal deinfibulation
- anterior episiotomy may be required during delivery
- mediolateral episiotomy will often be required due to increased scarring and loss of skin elasticity at the vaginal introitus
