VAGINA/EXTERNAL GENITALIA

Question 1

If there is a painless mass or lump located on the side of the vaginal opening -dx? Tx?

Answer 1

Bartholin cyst

- Sitz baths, surgical drainage, abx – depends on size and sxs

Question 2

If a pt has dysuria and increased vaginal discharge, on exam you note a fishy smell, with thin white/grey discharge – dx? Tx?

Answer 2

Bacterial vaginosis (gardenella vaginalis)
              Tx – metronidazole or clinda

Question 3

How do you confirm diagnosis of bacterial vaginosis?

Answer 3

pH over 4.5

- KOH - Wet mount shows CLUE CELLS (“whiff test”)

Question 4

A pt presents with pruritis and dysuria with thick white cottage cheese like discharge – dx? Tx?

Answer 4

Candida (candida albicans)

Tx – any of the azoles, fluconazole or nystatin

Question 5

How do you confirm diagnosis of candida vaginitis?

Answer 5

wet mount will show budding yeast and hyphae

Question 6

Pt presents with dysuria, on vaginal exam you note a green frothy discharge and strawberry cervix -dx? Tx?

Answer 6

Trichomonas

Tx – Metronidazole

Question 7

What is vestibulitis or vulvodynia?

Answer 7

Extreme pain during attempted vaginal entry (intercourse or tampons)

Question 8

How do you treat vestibulitis or vulvodynia?

Answer 8

pelvic floor PT/biofeedback
Lidocaine cream
Dilators
SSRI’s

Question 9

If a pt has dryness and dyspareunia and they are post menopausal -dx? Tx?

Answer 9

atrophic vaginitis

Tx – intravaginal estrogen (cream and ring)

Question 10

A pt presents with intense pruritis of the perineum, on exam you note erythema and white plaques in the non-hair bearing areas of the vulva, perineum, and perianal, almost in an hourglass pattern. Dx?

Answer 10

Lichen sclerosis

Question 11

What is the MC vulvar dermatologic disorder?

Answer 11

Lichen sclerosis

Question 12

How do you treat lichen sclerosis? What can it progress to without treatment?

Answer 12

Tx – stop the scratch/itch cycle – steroids (topical) tapered strong to maintenance
- Can progress to loss of genital landmarks and increased risk for SCC

Question 13

Pt presents with intense itching of the pubic region, especially at night. On exam you sores from itching and small gray-white nits on hair. – Dx? Tx?

Answer 13

Pubic lice
Tx – permethrin, wash all clothes & bedding in hot water (can also seal things that can’t be washed in a bag with medicated spray x 10-14 days)
- Educate on spread from sexual partners!

Question 14

A pt presents with erythematous papules or pustules in the bikini area that appear similar to razor bumps – what is it? Tx?

Answer 14

Folliculitis

Tx – gentle cleansing, mild compresses. Topical clinda or erythro can help

Question 15

What would cause hot tub folliculitis vs regular folliculitis?

Answer 15

Hot tub – pseudomonal

Regular – S. aureus