Vagina Flashcards
Lichen Sclerosis- pathophysiology
Most common non-neoplastic
Lichen Sclerosis- epidemiology
> 60
Lichen Sclerosis- S/S & PE
Intense vulvar pruritis
Vulvar skin - thin/wrinkled ““cigarette paper appearance””
- lichenification, hyperkeratosis, erosions, fissures, subepithelial hemorrhages, ulcerations
Lichen Sclerosis- treatment
Stop Itch Cycle!!
Antihistamine @ night + high dose topical steroid
- Clobetasol propionate ointment
PO steroids - severe
Refer to OB -> BIOPSY
Lichen Sclerosis- prognosis
RISK - squamous cell carcinoma of vulva
Lichen Simplex Chronicus- pathophysiology
Benign epithelial thickening and hyperkeratosis
non-specific reactive condition from constant irritation or rubbing
Lichen Simplex Chronicus- cause
Chronic irritation
Chemical, infection, allergic
Lichen Simplex Chronicus- S/S & PE
Hyper or hypopigmented
Thickened, leathery appearance
Extreme prurutis - labia majora
Lichen Simplex Chronicus- treatment
Refer to OB -> BIOPSY
PO antihistamines + topical med steroid
- betamethasone or tiamcinolone
Lichen Simplex Chronicus- prognosis
Not associated w/ cancer risk
Lichen Planus- pathophysiology
Inflammatory autoimmune disorder
Lichen Planus- S/S & PE
Flat topped papules - white plaques
- on vulva, vagina, oral
Ulceration or erosions - usually on vagina
Itching, burning, postcoital bleeding, dyspareunia, pain
Lichen Planus- treatment
Refer to OB -> BIOPSY
Frequent exam for formation of adhesions
Topical hydrocortisone foam
- Colifoam
High dose topical can be tried externally
Lichen Planus- prognosis
Very Rare
Behcet’s Syndrome- pathophysiology
Rare inflammatory disorder
Behcet’s Syndrome- cause
HLA-B51
Behcet’s Syndrome- S/S & PE
Triad - oral ulcers, genial apthae/ulcerations, uveitis
Behcet’s Syndrome- treatment
Topical and Systemic corticosteroids
Refer to OB -> Biopsy
Bartholin Duct Cyst/abscess- pathophysiology
Obstruction of main duct of Bartholin gland
Barholin gland - 5 and 7 o’clock
- provide moisture
Obstruction -> cycsts or abscess
Bartholin Duct Cyst/abscess- S/S & PE
Fluctuant tender mass - palpable
Pain, tenderness, dyspareunia, difficult walking
Bartholin Duct Cyst/abscess- treatment
I&D Catheter placement - elliptical incision along vaginal mucosa w/ expression of pus - insert word cath deep in cavity - can use gauze to pack cavity Marsupialization
abx - if inflammation
Atrophic vaginitis- pathophysiology
atrophy
Atrophic vaginitis- cause
Dec Estrogen levels
Atrophic vaginitis- epidemiology
Postmenopausal
Prepubertal
Lactating women
Atrophic vaginitis- S/S & PE
pH of vag high 5-7
Epithelium thinned
- more susceptible to infection/trauma
Los of elasticity - shortening/narrowing of vag
Vaginal dryness, itching, burning, dyspareunia, spotting, discharge, urinary symptoms - urgency, frequency, UTI, incontinence
Low estrogen
Atrophic vaginitis- treatment
Estrogen Therapy - PO or systemic - contra - topical - 1/3 will be absorbed systemic - don't give to hx or breast or endometrial cancer Premarin vaginal cream Estrace vaginal cream Vagifem tablets