vaginal disorders Flashcards
what is Vulvovaginitis and its presentation ?
It is the inflammation of the vulva and vagina which presents as abnormal vaginal discharges, itching, burning, dysperiunia, and dysuria.
What are the non-infectious causes of vulvo-vaginitis ?
- Retained foreign bodies – e.g., tampons, condoms; tx with removal
- Atrophic vaginitis – postmenopausal females; tx with local estrogen creams.
What are the infectious causes of vulvo-vaginitis ?
- Bacterial vaginosis – imbalance in normal vaginal flora
- Candidiasis – imbalance in normal vaginal flora
- Trichomoniasis – sexually transmitted infection
What are the pathological flora seen in bacterial vaginosis ?
- Gardnerella vaginalis
- Mycoplasma homina
- Mobiluncus sp.
- Bacteriodes sp.
What is the smell and color of vaginal discharge in bacterial vaginosis ?
Homgenous greyish white color with fishy odor.
In bacterial vaginosis the PE is typically ?
Painless.
What is the Amsel criteria for bacterial vaginosis ?
Must have 3 of the following:
* White or grey vaginal discharge
* Vaginal pH > 4.5
* Clue cells
* Positive Whiff-Amine test
What is the procedure for Wiff-Amine test in BV diagnosis ?
- Obtain sample of vaginal discharge
during pelvic exam - Add several drops of 10% potassium
hydroxide (KOH) - A strong fishy odor indicates a positive
result
What is FEM exam in BV ?
It is a point of care test with high sensitivity and low specificity for BV diagnosis. It simultaneously checks enzymes and pH.
What is Afirmm VPIII nucleic acid test in BV ?
- Gardnerella vaginalis
- Candida spp.
- Trichomonas vaginalis
What is the Tx of BV?
- Metronidazole, PO for 5 to 7 days.
- Clindamycin, PO for 7 days
- Clindamycin 2% cream, PV for 7 nights.
What are the preventive measures for BV ?
- Lactic acid vaginal gels
- Eliminate/reduce vaginal douching
- Treatment of male partner NOT
necessary
What is the problem of clindamycin 2% cream ?
weaken condoms/diaphragms
What are the risk factors for vaginal candidiasis ?
- Diabetes mellitus
- Recent antibiotic use
- Immunosuppression (including chronic corticosteroid use)
- Increased oestrogen levels (OCPs, oestrogen therapy,
pregnancy)
What are the Hx findings in vaginal candidiasis ?
- Intense itching
- Vaginal discharge
- ± Vulvar burning
- ± Dyspareunia
- ± Dysuria
What is the normal vaginal pH?
3.8 to 4.2
What are the vaginal pH in BV vs candidia Vs trichomoniasis ?
Candidiasis < 4.5
Trichomoniasis and BV > 4.5
What is the KOH wiff test findings in BV, Trico and candidiasis ?
BV= always positive , T= sometimes positive, candidiasis = always negative.
What are the saline Wet mount findings in various conditions ?
*Normal = Epithelial cells,
lactobacilli
*BV = Clue cells
*Trico= Motile
trichomonads
* candidiasis = Normal ± WBCs
Maybe hyphae
What is the only condition in which KOH wet mount is used ?
Candidiasis in which it will show Hyphae, mycelium, and
spores.
What is cystocele ?
Anterior vaginal wall prolapse involving the urinary bladder
What is Rectocele?
Posterior vaginal wall prolapse involving the rectum
What is Uterine prolapse
descent of the uterus into and through the vaginal canal
What is the presentation of cystourethrocele?
Usually cystocele and rectocele often occurs together. When cyctocele is accompanied by uretherocele it is called cystourethrocele.
What are the components of the Pelvic Organ Prolapse Quantification System ?
Stage 0: No prolapse
Stage I: Most distal prolapse is more than 1 cm above the hymen
Stage II: Most distal prolapse is between 1 cm above and 1 cm below the hymen
Stage III: Most distal prolapse is more than 1 cm below hymen but 2 cm shorter than total vaginal length
Stage IV: Complete eversion
What is the presentation of cycstocele and rectocele ?
- Pelvic or vaginal “fullness”
- Pelvic pressure
- Feels like something is “falling out”
- Dyspareunia
- Stress incontinence
- Prolapse
- Bulging through introitus, esp with straining or coughing
- If small, can be confused for mass or cyst
- Diagnosis is usually made clinically
What is the Tx of small unobstructive prolapse ?
- Observation
- Pessary
- PT and pelvic floor exercises
What is the management of obstructive prolapse?
- surgical Anterior or posterior colporhaphy
- Vaginal vault suspension
What is the cause of utrine prolapse ?
Weakened muscles and ligaments that surround and support the
uterus results in descent of the uterus through the vagina,
protruding through introitus. It is seen in aged, post meonpausal woman with Hx of one or more vaginal deliveries.
What is the Hx in uterine prolapse ?
- Sensation of pelvic fullness or
heaviness - Occasional “tissue” protruding through vagina
- Something is “falling out”
- Sensation of “sitting on a ball”
- Incontinence
- Constipation
What is the Tx of low grade uterine protrusion?
- Pessaries
- Elective surgery for those who do not want pessary
What is the Tx of high grade protrusion ?
- Hysterectomy
- Vaginal vault suspension
- +/- Colporrhaphy
