Pelvic Pain/ Vaginal Pain/ Dyspareunia/ vulvar disorders

Question 1

What are the commonest causes of primary dysmenorrhea?

Answer 1

Ruptured Graafian follicle (mittelschmerz)
Endometriosis
Adhesions

Question 2

What are features of a patient with a ruptured ovarian cyst?

Answer 2

Usually 15-25
Sudden onset pain in iliac fossa
May be nausea and vomiting
No systemic signs
Pain usually settles within a few hours

Question 3

What are clinical features of a patient with acute torsion of an ovarian cyst?

Answer 3

Severe cramping lower abdominal pain
Diffuse pain. May radiate to flank, back or thigh
Repeated vomiting
Exquisite pelvic tenderness
Patient looks ill
Smooth, round, mobile mass palpable in abdomen
May be tenderness and guarding over the mass, especially if leakage

Question 4

What are risk factors for an ectopic pregnancy?

Answer 4

Previous ectopic pregnancy
Previous PID
Previous abdominal or pelvic surgery especial sterilisation reversal
IUD
IVF

Question 5

What is the presentation of genital lichen planus?

Answer 5

Pruritis, vaginal discharge, dyspareunia if erosions and post coital bleeding
Vulvar lesions appear as whitish reticulated papules and plaques. A delicate white lacy pattern at the periphery of the lesion is a distinctive feature

Question 6

What is the presentation of lichen sclerosus?

Answer 6

Well defined white, finely wrinkled plaques that almost exclusively affect the anogenital skin
Pruritis is the main symptom
Management based on weaning corticosteroid use (down to 1% daily for long term) + 6 monthly checks for development of SCC (approx 4% lifetime risk)