Vaginal and Vulval Disorders Flashcards
What is a Bartholin’s cyst?
Fluid-filled sac within one of the Bartholin’s glands
Where are the Bartholin’s glands located?
Deep to the posterior aspect of the labia majora
Where are the openings of the Bartholin’s cysts?
Either side of the vaginal orifice at 4 and 8 o’clock
What is the role of the Bartholin’s glands?
Secrete mucus to lubricate the vagina
What are the Bartholin’s glands also known as?
Greater vestibular glands
What pathogens commonly cause abscesses to form in Bartholin’s glands?
E. coli
MRSA
STI
What are the risk factors for Bartholin’s cyst?
Prev event
Sexually active
History of vulval surgery
Nulliparous
How do Bartholin’s cysts present?
Small - asymptomatic
Large - vulvar pain
Rupture - acute onset pain
How does a Bartholin’s abscess present?
Acute onset pain
Difficulty passing urine
How does a Bartholin’s cyst feel on examination?
Soft, fluctuant, non-tender
How does a Bartholin’s abscess feel on examination?
Tense, hard lump
Surrounding cellulitis
Which diagnosis should be excluded in investigation of a Bartholin’s cyst in >40s?
Vulval carcinoma
How is a small Bartholin’s cyst managed?
None if asymptomatic
Recommend warm baths
How is a large Bartholin’s cyst managed?
Drainage by either
Word Catheter
Masupialisation
In which scenario would excision of a Bartholin’s cyst be performed?
High suspicion of malignancy
What is lichen sclerosus?
Chronic inflammatory skin disease of anogenital skin
What are the two peaks in age of presentation of lichen sclerosus?
Prepubescent girls
Post-menopausal women
What are the antibodies against in lichen sclerosus?
ECM protein 1
What are the clinical features of lichen sclerosus?
White atrophic patches on skin
Itching
Dyspareunia
What features may be seen on examination of lichen sclerosus?
Clitoral hood fusion
Fusion of labia
Loss of vaginal opening
How is lichen sclerosus managed?
Immunosuppression with topical steroids
