The vagina and vulva Flashcards
What epithelium lines the vagina?
Squamos
What is found posterior to the vagina?
upper 1/3 is the pouch of douglas and lower 2/3s is the rectum
What is the lymph drainage from the vagina?
inguinal lymph nodes - femoral - external iliac- mets spread
What symptoms are linked to the vulva?
Pruritis, soreness, burning, superficical dyspareunia
Which infections can occur at the vulva?
Candidiasis +/- vaginal discharge, diabetes, systemic disease. Vulval warts- condylomata acuminate. pubic lice, scabies, HSV, syphillis, donovanosis
What is donovanosis?
Bacterial infection with klebsiella granulomatis causing ulcerative genital lesions.
Which derm diseases are seen at the vulva?
Eczema and psoriasis
Which condition is thickening of the skin of the vulva with scaling that arises secondary to repetitive scratching or rubbing seen?
Lichen simplex
What treatment can be given to relieve lichen simplex?
Emollients, steroid creams, antihistamines and pt advised to avoid soap contact.
In which condition is erythematous, inflammed, scaly, well-demarcated, lichenified, firm, rough plaques, exaggerated skin lines with hyperpigmentation and maybe a cutaneous horn seen?
Lichen simplex
In which condition is white thickening of the skin of the vulva seen?
Lichen sclerosis
Which condition presents with thin vulval epithelium (due to loss of collagen) with lesions that appear small, flat and of a white/ivory colour?
Lichen sclerosis
In which condition is the affected vulva skin unbearably itchy (pruritis vulvae) and/ or vulvodynia (sore) sometimes with bruises, blood blisters and ulcers appear after scratching or on their own?
Lichen sclerosis
Which conditions are associated with lichen sclerosis?
Autoimmune disease, thyroid disease and vitiligo
Which vulval disease is associated with a lack of collagen?
Lichen sclerosis
What percent of patients are at risk of developing vulvar carcinoma which presents with a slowly-growing lump or sore that doesn’t heal?
5%
Which rash of the vulva is chronically recurrent and is due to inflammation?
Lichen planus
Which disease of the vulva is characterised by small, flat- topped, many sided (polygonal) bumps/papules- purplish in colour that can grow together into rough scaly plaques on the skin.
Lichen planus
Which condition of the vulva has flat topped lilac or violet spots a few millimeters in diameter on the skin?
Lichen planus
Apart from the vulva, what else can lichen planus affect?
Hair, nails, mucous membranes
Where is donovanosis commonly found?
It is an STI commonly found in tropical, and subtropical areas such as Southeast India, Guyana and New Guinea
How is candidiasis commonly seen in?
Patients with diabetes, pregnant women, women using antibiotics and those with compromised immunity.
What are bartholins glands and what is their function?
2 glands behind the labia minora which secrete lubricating mucus for coitus.
What infection is commonly seen when the ducts of bartholins glands become blocked and form cysts/abscesses?
Staph a and e.coli
How are bartholins cysts treated?
Incision, drainage and marsupialization
What is marsupialization?
Surgical technique of cutting into a cyst and suturing the edges of the slit to form a continuour surface from the exterior to the interior of the cyst, the cyst remains open and can drain freely. This is used to treat a cyst that a single draining would not be effective for and complete removal of the surrounding structure would be undesirable.
What is the name of the surgery which can treat an introital tear?
Fentons procedure
What causes introital damage?
Over tightening due to incorrect perineal repair or extensive scar tissue. Commonly follows childbirth
What are the symptoms of VIN?
Puritis, pain and change in appearance of the skin- popular, white areas
What type of VIN is most usually seen?
HPV 16-18.
What type of lesion is seen in VIN, hpv 16-18?
A warty, basaloid lesion
The other type of VIN- the differentiated type, commonly develops more often in women with what condition?
Lichen sclerosis. It is also keratinizing.
Which type of VIN is the major cause of vulval cancer in women over 45?
Differentiated type
How do you treat VIN?
Alleviate the pain and itching and with high grade VIN: local incision, laser therapy, topical immunomodulators such as imiquimod (also used to treat genital warts and acitinic keratinosis)
What is the pathology of 95% of vulval carcinomas?
squamous cell carcinomas
What is the pathology of 5% of vulval carcinomas?
Melanomas, BCC, adenocarcinomas, sarcomas
What are the causes of vulval carcinoma?
VIN, de novo, lichen sclerosis, immunosuppression, smoking and pagets
What are the clinical features of vulva cancer?
Pruritis, bleeding, discharge and a mass
On examination of a vulval carcinoma, what is likely found?
Ulcer/mass/hard enlarged immobile inguinal nodes
How does vulval cancer spread via lymph?
superficial inguinal nodes to deep inguinal nodes to femoral- externam iliac
How is stage 1 vulval cancer described?
Its a tumour less than 2cm with no nodal involvement
1a- stromal invasion -<1mm
1b- stromal invasion >1mm
How is stage 2 vulval cancer described?
Tumour more then 2cm with no nodes
How is stage 3 vulval cancer described?
Spread beyond vulva, periuneum to urethra, vagina, anus. Nodes only affected unilaterally
How is stage 4 vulval cancer described?
Tumour is in rectum, bladder, bone or distant mets. Nodes are affected bilaterally
What is the treatment for vulval cancer?
Stage 1a- wide local excision, no lymphadenectomy
Other stages- wide local excision and groin lymphadenectomy
Radiotherapy is used on large tumours to shrink down
Which carcinoma of the vagina is commonly seen is late teenage years and is related to children of women who were given DES during pregnancy in the 1950s?
Clear cell adenocarcinoma
What are the symptoms of primary vaginal carcinoma and who is it seen in?
Older women and its squamous with bleeding, discharge, a mass and maybe an ulcer common symptoms.
What is the treatment for primary vaginal carcinoma?
Vaginal radiotherapy. radical surgery.
Where does secondary vaginal cancer usually originate?
Cervix, endometrium and vulva
What type of discharge is commonly associated with TV?
Offensive, yellow/green, frothy discharge
Vulvovaginitis
Strawberry cervix
What type of discharge is associated with BV?
Offensive, thin, white/grey, ‘fishy’ discharge
Next question
What type of discharge is associated with candida?
‘Cottage cheese’ discharge
Vulvitis
Itch
In which two conditions is cervical excitation found?
Ectopic and PID
