Gynecology - Disorders + congenital disorders of vagina

Question 1

What is the most common benign cystic lesion of the vagina?

Answer 1

Gartner’s Duct cyst/Vaginal inclusion cyst - is usually asymptomatic and discovered incidently on sono.

Question 2

Where is the Gartner’s duct cyst located?

Answer 2

On the anterolateral wall of the proximal vagina.

Question 3

Location of the different cysts in the female genital tract:
(Bartholin’s gland cyst, Vaginal inclusion cyst/Gartner’s duct cyst, Skene’s duct (paraurethral) cyst, Nabothian cyst)

Answer 3

Bartholin’s gland cyst: Asx or pelvic pressure, visualized at 4 or 8 o’clock position

Vaginal inclusion cyst/Gartner’s duct cyst: May occur anywhere in vagina, usually after some kind of trauma

Skene’s duct cyst: Usually asx, rarely urinary outflow obstr.

Nabothian cyst: Usually asx and picked up on cervical exam

=> Resection only indicated in presence of complications.

Question 4

What is atrophic vaginitis/vaginal atrophy?

Answer 4

Thinning of the vaginal epithelium due to decreased estrogen levels. Very common in postmenopausal years

Question 5

Sx of vaginal atrophy and what does it look like?

Answer 5

Pruritus, dyspareunia, dryness, burning, discharge. Looks pale, smooth, shiny vaginal epithelium. May be minor lacerations from intercourse or itching.

Question 6

How do you treat atrophic vaginitis?

Answer 6

Elective estrogen replacement. Contraindications to HRT include estrogen-sensitive tumors (breast, endometrial, ovarian), end stage liver feilure, PMHX of estrogen-related thromboembolism.
- Secondary Mx include moisturizers and lubricants.

Question 7

What type of vaginal septums are there?

Answer 7

1. Transverse vaginal septum

2. Longitudinal vaginal septum

Question 8

Sx of transverse vaginal seputm?

Answer 8

• Primary amenorrhea/”Cryptomenorrhea”

- Incomplete septa may have normal menstruation but can cause dyspareunia or labor issues

Question 9

Sx of longitudinal vaginal septum?

Answer 9

• Often asymptomatic

- May be assoc. w/ uterine septum or uterine didelphys which can lead to OB complication.

Question 10

What is Labial fusion, and what is the most common cause of it?

Answer 10

Fusion of the labiae majorae or minorae.
Most common due to excess exposure to androgens (either in the womb or after birth) or reduced exposure to estrogens.
! 21-hydroxylase deficiency is a very common cause of labial fusion, and this can be one of the early symptoms of CAH!

Question 11

Management of labial fusion?

Answer 11

Focused on determining and treating the underlying cause. In many cases, the labiae will spontaneously separate. For idiopathic, symptomatic cases, estrogen cream may be applied.

Question 12

What is imperforate Hymen?

Answer 12

Failure of the embryologic hymen to cannalize, resulting in a transverse barrier of tissue at the introitus.

Question 13

Most common symptoms of an imperforate hymen?

Answer 13

Cryptomenorrhea. Primary amenorrhea, cyclical pelvic pain, central pelvic mass (hematometria, hematocolpos)

Question 14

Differential diagnosis of imperforate hymen, and how to differentiate?

Answer 14

Vaginal agenesis, vaginal atresia, transverse vaginal septum.
Sonography or MRI can be useful to differentiate.

Question 15

How do you treat imperforate hymen?

Answer 15

Surgical correction (hymenectomy)

Question 16

What is vaginal atresia?

Answer 16

Developmental failure of the lower 2/3 of the vagina. The upper 1/3 of the vagina and the upper reproductive tract are all normal. The lower 2/3 of the vagina is replaced with fibrous tissue, which may appear distinct frm the tissue seen in an imperforate hymen. Only a vaginal “dimple” may be present. Treat with surgical correction.

Question 17

What is Vaginal Agenesis also known as?

Answer 17

Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.

Question 18

What is Vaginal Agenesis?

Answer 18

Failure of the Mullerian ducts to develop, resulting in absence of fallopian tubes, uterus, cervix and upper 1/3 of vagina. However, ovaries are present, hence the pt is hormonally normal.

Question 19

Symptoms of Vaginal Agenesis?

Answer 19

Primary amenorrhea. In this case, there is no uterus, so there is no menstruation or cryptomenorrhea. Thelarche and adrenarche are obtained, but not menarche.

Question 20

Differential diagnosis of Vaginal Agenesis include:

Answer 20

Androgen insensitivity syndrome. (Also lack upper vagina and upper GT organs, but they also lack ovaries and will fail to attain adrenarche).

Question 21

Treatment of Vaginal Agenesis?

Answer 21

Serial vaginal dilators, surgery may be undertaken to create a neovagina (McIndoe procedure commonly used). SE TABELL PÅ FILMEN cong.disorders of lower reproductive tract.