Medical Gynaecology Flashcards
First line treatment of lichen sclerosus is
typically with ultra potent topical steroids
such as clobetasol proprionate
What is Lichen sclerosus (LS) and what are it’s associations?
an inflammatory dermatosis of unknown aetiology
Associations:
Increased frequency of autoimmune disorders
Signs & Symptoms of lichen sclerosus
Pale white atrophic areas. Purpura are common Fissuring Erosions Hyperkeratosis Narrowed Introitus Pruritus Soreness/dyspareunia
Histological features of lichen sclerosus
Histological features:
Epidermal atrophy (or thinning)
Hydropic degeneration of the basal layer (sub-epidermal hyalinisation)
Dermal inflammation
Complications of lichen sclerosus
Complications of LS
Risk of developing squamous cell carcinoma (<5%)
Clitoral pseudo cyst
Sexual dysfunction
Dysaesthesia
Possible causes of PCB
Cervical polyps Ectopion Cervical cancer STIs Vaginal atrophy
Possible causes of deep desparunia
PID / STI Endometriosis Ectopic pregnancy Ovarian cyst / cancer Chronic pelvic Pain
Incidence of turners syndrome
1 in 2000 births
Causes of haemolytic anaemia
Autoimmune haemolytic anaemia
Haemolysis associated with mechanical heart valves
G6PD deficiency
Hereditary spherocytosis
Steps in managing a patient with PCB
History - sexual, contraceptive, menstrual & LMP
Speculum and Pelvic Examination
Any suspicion of cervical cancer - refer to colposcopy
Treat any local cause - cervical polyp, ectropion, cervicitis, warts
Test for STIs
Steps in managing a patient with IMB
History - sexual, contraceptive, menstrual & LMP
If suspected contraceptive problem consider modifying contraception and review in 6-8 weeks
If ongoing IMB
Speculum and Pelvic Examination
Any suspicion of cervical cancer - refer to colposcopy
Treat any local cause - cervical polyp, ectropion, cervicitis, warts
Test for STIs
what is metrorrhagia
bleeding at irregular intervals, particularly between expected menstrual periods.
what is menometrorrhagia
combination of metrorrhagia and menorrhagia.
prolonged or excessive uterine bleeding
occurs irregularly and more frequently than normal
What is polymenorrhoea
Polymenorrhea is a term used to describe a menstrual cycle that is shorter than 21 days
Symptoms of endometriosis
Cyclical pelvic pain, dysmenorrhea dyspareunia chronic pelvic pain, cyclical intestinal complaints (bloating, diarrhoea or constipation) fatigue/weariness infertility
Empirical treatment options for suspected endometriosis
Analgesia - NSAIDs
and/or hormonal treatment - COCP / desogestrel / DMPA / IUS
or oral Medroxyprogesterone / norethisterone.
support such as Endometriosis UK
treatment options for confirmed endometriosis
laparoscopic ablation or resection
+/ - Hormonal suppression
Specialist fertility referral if required
GnRH analogues- short term - or with addback HRT
Radical surgery - TAH BSO
most common cause pruritus vulvae?
Contact dermatitis
inflammatory reaction
Lichenification + hyperpigmentation when dermatitis chronic.
can be caused by:
creams (esp containing LA), Topical antibiotics,
Barrier contraception, lubricants, Perfume, soaps, bubble baths, wet wipes, Detergents, fabric conditioners, bleaches, dyes.
possible causes of pruritus vulvae?
Contact dermatitis Candida / BV / TV / HSV Pediculus pubis / Scabies (Sarcoptes scabiei) Psoriasis Lichen simplex Lichen planus Lichen sclerosus SCC / VIN / pagets Seborrhoeic dermatitis (rare)
features of vulval psoriasis
Due to the moisture and friction, the classic psoriatic lesion is replaced with a poorly demarcated, erythematous plaque
minimal scale
shiny texture
Typical psoriasis lesions occur elsewhere on the body
Genital skin affected in 29–46% of people with psoriasis.
features of vulval Lichen sclerosus
Inflammatory skin condition
often >50 yo
Any area from clitoral hood to perianal area affected - classically figure eight pattern
vagina not affected.
Lesions hypopigmented-to-white,
crinkled, fragile plaques
Bruises / blood blisters / ulcers appear after scratching / minimal friction.
Scarring + loss of vulvar architecture / resorption of labia minora, fusing in midline + burying of clitoris.
small risk SCC developing = (less than 5%).
features of vulval Lichen simplex
localized plaque - chronic eczematous inflammation
created by repeated rubbing / scratching
Can affect entire vulva /perianal area
skin leathery or lichenified or pale and wrinkled.
May be labial swelling + erythema / hair loss due to scratching
features of vulval Seborrhoeic dermatitis
ill-defined border
some scaling,
with or without involvement of other sites,
Rarely affects the vulva.
features of vulval Lichen planus
chronic inflammatory condition
affects skin / mucosal surfaces
may appear erosive, glazed or glossy erythematous plaques;
or bluish-purple, shiny, flat-topped papules + small white dots or lines (Wickham’s striae);
or uniformly white hyperkeratotic plaques.
May be loss of vulvar architecture.
small risk SCC developing of <3%
