Vagina Flashcards by Ismerai Reyes

Lichen Sclerosis- pathophysiology

Most common non-neoplastic

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Lichen Sclerosis- epidemiology

> 60

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Lichen Sclerosis- S/S & PE

Intense vulvar pruritis
Vulvar skin - thin/wrinkled ““cigarette paper appearance””
- lichenification, hyperkeratosis, erosions, fissures, subepithelial hemorrhages, ulcerations

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Lichen Sclerosis- treatment

Stop Itch Cycle!!
Antihistamine @ night + high dose topical steroid
- Clobetasol propionate ointment
PO steroids - severe

Refer to OB -> BIOPSY

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Lichen Sclerosis- prognosis

RISK - squamous cell carcinoma of vulva

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Lichen Simplex Chronicus- pathophysiology

Benign epithelial thickening and hyperkeratosis

non-specific reactive condition from constant irritation or rubbing

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Lichen Simplex Chronicus- cause

Chronic irritation

Chemical, infection, allergic

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Lichen Simplex Chronicus- S/S & PE

Hyper or hypopigmented
Thickened, leathery appearance
Extreme prurutis - labia majora

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Lichen Simplex Chronicus- treatment

Refer to OB -> BIOPSY

PO antihistamines + topical med steroid
- betamethasone or tiamcinolone

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Lichen Simplex Chronicus- prognosis

Not associated w/ cancer risk

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Lichen Planus- pathophysiology

Inflammatory autoimmune disorder

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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

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Lichen Planus- treatment

Refer to OB -> BIOPSY
Frequent exam for formation of adhesions

Topical hydrocortisone foam
- Colifoam
High dose topical can be tried externally

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Lichen Planus- prognosis

Very Rare

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Behcet’s Syndrome- pathophysiology

Rare inflammatory disorder

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Behcet’s Syndrome- cause

HLA-B51

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Behcet’s Syndrome- S/S & PE

Triad - oral ulcers, genial apthae/ulcerations, uveitis

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Behcet’s Syndrome- treatment

Topical and Systemic corticosteroids

Refer to OB -> Biopsy

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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

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Bartholin Duct Cyst/abscess- S/S & PE

Fluctuant tender mass - palpable

Pain, tenderness, dyspareunia, difficult walking

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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

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Atrophic vaginitis- pathophysiology

atrophy

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Atrophic vaginitis- cause

Dec Estrogen levels

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Atrophic vaginitis- epidemiology

Postmenopausal
Prepubertal
Lactating women

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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 ```

Vulvar Malignancy- pathophysiology

Carcinoma of Vulva | - v rare

Vulvar Malignancy- epidemiology

``` Postmenopausal Smoking HPV Immunodeficiency hx cervical carcinoma Chronic vulvar irritation ```

Vulvar Malignancy- S/S & PE

Hx - vulvar irritation, pruritis, discomfort, bloody discharge Ulcer or large cauliflower lesion

Vulvar Malignancy- treatment

Surgery - stage/treat

Paget Disease- pathophysiology

Extramammary Paget dis In situ adenocarcinoma in epithelium of vulva and perianal regions

Paget Disease- S/S & PE

Itchy, red, crusted lesion - labia major | White coating - caking icing

Paget Disease- treatment

Refer to OB -> biopsy

Paget Disease- prognosis

Recur

Foreign bodies- cause

``` Paper Cotton Retained tampon Contraceptive Pessary ```

Foreign bodies- S/S & PE

Malodorous vaginal discharge Intramenstrual spotting 2nd to - vaginal epithelium drying and microculcerations Ulcerative lesions - vaginal fornices - rolled, irregular edges w/ red granulation tissue base

Foreign bodies- treatment

Remove foreign object Abx - not usually needed - yes if - cellulitis, systemic symptoms

Toxic Shock Syndrome- pathophysiology

Tampon usage

Toxic Shock Syndrome- cause

Staph exotoxins

Toxic Shock Syndrome- S/S & PE

``` High fever Severe HA Sore throat Myalgia V/diarrhea Skin rash - gone after 24/48hrs Desquamation of palms and soles - 2-3w post Hypotension -> shock - w/in 48 Multiorgan failure ```

Toxic Shock Syndrome- treatment

``` Remove tampon Vaginal cultures Copious irrigation of saline Penicillin or Vanco DON’T USE TAMPONS AGAIN ```

Malignant Disease of Vagina- pathophysiology

Rare - primary | Met or vaginal involvement via directly from cervix - more common

Malignant Disease of Vagina- cause

Clear cell adenocarcinoma | -> mom was treated w/ DES during pregnancy

Malignant Disease of Vagina- S/S & PE

Asymptomatic Early - painless bleeding, ulcerated tumor Late - bleeding, pain, weight loss, swelling

Malignant Disease of Vagina- labs & imaging

Biopsy

Malignant Disease of Vagina- treatment

Surgery Radiology Chemo

Pelvic Organ Prolapse- S/S & PE

``` Cystocele - bladder prolapse - anterior front vaginal wall - falls towards vagains -> bulge - difficulty getting urine started or completely out Cystourethrocele - bladder and urethra Rectocele - rectum or large bowel - posterior back vaginal wall - diff to pass stool, more mechanical ```

Ectropion- pathophysiology

Eversion of columnar epithelium into ectocervix Ectocervix - vagina - squamous epithelium Endocervix - uterus - columnar epithelium

Ectropion- epidemiology

Pregnancy | Puberty

Ectropion- S/S & PE

Cervix - red, granular, inflamed Benign - biopsy to r/o cancer

Nabothian Cysts- pathophysiology

Very common

Nabothian Cysts- cause

Squamous epithelium of ectocervix grows over simple columna of endocervix

Nabothian Cysts- S/S & PE

asymptomatic | Translucent - yellow mucous filled cysts on surface of cervix

Cervical stenosis- pathophysiology

Internal OS

Cervical stenosis- cause

Cone biopsy LEEP Ablative techniques

Cervical stenosis- S/S & PE

Amenorrhea Pelvic pain Infertility

Cervical stenosis- diagnosis

Can't pass sound or dilator through Os

Cervical stenosis- treatment

Dilators

Cervical Polyp- pathophysiology

Common External Os

Cervical Polyp- cause

Focal hyperplasia of endocervix

Cervical Polyp- S/S & PE

Soft, red, pedunculated protrusion from cervical canal 1mm- 2-3cm intermenstrual or postcoital bleeding

Cervical Polyp- labs & imaging

Biopsy Imaging - hysterosalpingogram, saline infusion sonohysterography

Cervical Polyp- treatment

Polypectomy

Incompetent Cervix- pathophysiology

Weak cervical tissue -> premature birth or loss of prego

Incompetent Cervix- treatment

Cervical cerclage bed rest Progesterone