other Flashcards
what is a Bartholin’s cyst?
fluid filled sac within one of Bartholin glands of the vagina
if gland becomes blocked, a cyst can develop and can become infected and lead to an abscess (E.coli, MRSA, STI)
what are Bartholin glands?
located deep to posterior aspect of labia majora and secrete mucus to lubricate
what are the risk factors for Bartholin cyst?
nulliparous at child bearing age
personal history of Bartholin cyst
sexually active
history of vulval surgery
what are the clinical features of bartholins cyst?
small ones are often asymptomatic
larger ones: vulvar pain and superficial dyspareunia
can undergo sudden rupture and relief of pain
Bartholin abscess - acute pain, difficulty passing urine, fever
on examination - unilateral labial mass, posterior aspect of labia majora
cyst is soft, fluctuant and non-tender
abscess - tense, hard and surrounding cellulitis
what investigations should be done for Bartholin cyst?
usually clinical diagnosis made
in women >40, biopsy can be considered to rule out vulval carcinoma
high vaginal swabs - rule out STI
how is a Bartholin cyst managed?
small and asymptomatic - no treatment , warm baths may help them spontaneously rupture
word catheter - incision made into cyst and catheter inserted and left for 4-6 weeks to allow a epithelised tract to form so abscess/ cyst can always drain (still risk of reoccurance, scarring, infection, dyspareunia)
marsupialisation - incision made behind hymen to allow drainage and then walls of cyst are everted and held by vaginal mucosa.
what is lichen sclerosus?
chronic inflammatory skin disease of urogenital region in women - peak incidence in prepubertal girls and post menopausal women
autoimmune component involved - genetics and other autoimmune diseases are risk factors.
what risk does lichen sclerosus carry?
has potential to progress to squamous cell carcinoma
what are the clinical features of lichen sclerosus?
white atrophic patches of skin within anogenital region - well defined
itching - may lead to erosions and pain
dyspareunia
can get adhesions e.g. clitoral hood fusion, fusion of labia minora to majora etc
what are the differentials of lichen sclerosus
candida
vertiligo
vulval cancer or VIN
how is lichen sclerosus managed?
Immunosupression - topical steroids are 1st line - slowly reduce
patients should be followed up due to SCC risk
