vaginal and vulval disorders Flashcards
what is pagets disease of the vulva
intraepithelial adenocarcinoma
who does pagets disease of the vulva affect
postmenopausal women
60-80 most commonly
what is the most common presentation for pagets disease of the vulva
chronic pruritus
what can pagets disease of the vulva look like
red/pink scaly plaque on the vulva, commonly on the labia majora
what is needed for a diagnosis of pagets disease of the vulva
biopsy
surgical management of pagets disease of the vulva
wide local excision and mohs micrographic surgery
name some non-surgical options for treatment of pagets disease of the vulva
imiquimod, 5-fluorouracil, radiotherapy
name some risk factors for vulval carcinoma
increasing age, lichen sclerosus, HPV infection, pagets disease of the vulva
what is the most common type of vulval cancer
squamous cell carcinoma
what is vulval intraepithelial neoplasia
precursor to HPV-driven squamous cell carcinoma
management of vulval intraepithelial neoplasia
biopsy and resection
where is vulval cancer usually found
on the labia
how can vulval carcinoma present
lump (+/- lymphadenopathy)
itching
non-healing ulcer
pain
skin changes
bleeding or discharge unrelated to the menstrual cycle
investigation of vulval carcinoma
examination + biopsy
management of vulval carcinoma
wide local incision
+/- adjuvant chemoradiotherapy
what is a complication of a bartholins gland becoming blocked
cyst becomes an infected abscess
who usually presents with a bartholins cyst
20-30
how does the presentation of a bartholins cyst differ to an abscess
both present with a palpable swelling
abscess: pain, lymphadenopathy, erythema
conservative management of a bartholins cyst
warm salt water baths
management of a bartholins abscess
word catheter - allows fluid to drain continuously
what is bacterial vaginosis
overgrowth of anaerobic bacteria in the vagina
is BV an STI
no but can be precipitated by sex
what is the most commonly associated bacteria with BV
gardnerella vaginalis
name some risk factors for BV
multiple sexual partners
excessive vaginal cleaning
recent antibiotics
smoking
copper coil
classic presentation of BV
fishy smelling watery grey/white discharge
investigations for BV and positive result
pH above 4.5
charcoal vaginal swab - clue cells on microscopy
clue cells on microscopy
BV !!
what criteria can be used to diagnose BV
amsel criteria
management of BV
metronidazole
what is the common name for vaginal candidiasis
thrush
what is the most common organism associated with vaginal candidiasis and describe it
candida albicans - gram positive fungi
name some risk factors for vaginal candidiasis
increased oestrogen
poorly controlled diabetes
immunusoppression
clinical presentation of vaginal candidiasis
thick white discharge - no smell
vulval and vaginal itching
management of vaginal candidiasis
clotrimazole
what should we consider testing for in patients with recurrent vaginal candidiasis
HIV
what are the 2 main causes of stress incontinence
urethral hypermobility - impaired pelvic floor
intrinsic sphincter deficiency
what is the most common causative factor for stress incontinence
childbirth
what might stress incontinence be associated with
prolapse
what causes urge incontinence
overactivity of the detrusor muscle
what is overactive bladder syndrome
chronic condition that results from hyperactivity of the detrusor muscle
name some risk factors for overactive bladder syndrome
increasing age, female, pregnancy + childbirth, DM
classic presentation of overactive bladder syndrome
frequency and nocturia
what investigation can be done to evaluate bladder muscle functoin
urodynamics
conservative management of overactive bladder syndrome
reduce oral intake, avoid caffeine and alcohol, bladder retraining
medical management of overactive bladder syndrome
solifenacin
surgical management of overactive bladder syndrome
botox, percutaneous tibial nerve stimulation
conservative management of stress incontinence
weight management, pelvic floor training, incontinence ring
medical management (or help to manage) stress incontinence
vaginal oestrogen
surgical management of stress incontinence
bulking agents, fascial slings, colposuspension
name some risk factors for prolapse
female, increasing age, obesity, smoking (chronic cough), prior pelvic surgery, constipation, heavy lifting
what is urethrocele
prolapse of the urethra into the vagina
what is cystocele
prolapse of the bladder into the vagina
what is cystourethrocele
prolapse of both urethra and bladder into the vagina
what is uterine prolapse
descent of the uterus into the vagina
what is vaginal vault prolapse and who can get them
post-hysterectomy
descent of the vaginal vault
what is rectocele
prolapse of the rectum into the vagina
what is a 1st degree prolapse
descent but still in the upper half of the vagina
2nd degree prolapse
descended to the introitus
3rd degree prolapse
protrudes out of the vagina
procidentia
prolapse entirely outside of the vagina
symptoms of a uterine prolapse
sensation of heaviness or pulling in the pelvis
urinary problems - incontinence or retention
how do symptoms of prolapse differ throughout the day
worsen as the day goes on
what can be use to stage prolapse
POP-Q - measures the site of prolapse in relation to the hymenal ring
conservative management of prolapse
avoid heavy lifting, lose wright, stop smoking, reduce constipation
pelvic floor for minimum of 3 months
what can be given to patients for management of prolapse when surgery is contraindicated
vaginal pessary
what is lichen sclerosus
chronic inflammatory skin disease of the anogenital region
how does lichen sclerosus present
white patches on skin, may progress to scarring
itchiness and pain - exacerbated by urination or sex
management of lichen sclerosus
topical steroid e.g. dermovate
what does having lichen sclerosus give you an increased risk of
squamous cell carcinoma
what should be recommended during childbirth for a women who has had FGM
anterior episiotomy
