Vulva and Vagina

Question 1

Causes of Pruritus Vulvae

Answer 1

Infections
Candidiasis
Vulval warts (condylomata acuminata)
Pubic lice, scabies

Dermatological disease
Eczema, Psoriasis, Lichen Sclerosus, Lichen Planus, Lichen Simplex

Neoplasia
Carcinoma
Premalignant disease: vulval intraepithelial neoplasia (VIN)

Question 2

Lichen Simplex (chronic vulval dermatitis)

Answer 2

Chronic inflammatory skin condition
Associated with eczema, dermatitis, or sensitive skin

Symptoms
Severe intractable pruritus, especially at night
Labia major is inflammed
Exacerbated by chemical irritation 
Can be linked to low iron/stress

Tx: emollients, mod potent steroids, avoid soaps

Question 3

Lichen Sclerosis

Answer 3

Autoimmune inflammatory skin condition
Results in loss of collagen in vulval epithelium

Symptoms
Pruritus worse at night
Scratching –> trauma, bleeding, worsening
Pain and dyspareunia
Pink white papules which coalesce to form parchment-like skin with fissures
Vuval carcinoma in 5% cases

Tx: ultra potent topical steroids

Question 4

Lichen Planus

Answer 4

Autoimmune
Can affect any part of the body - particularly mucosal surfaces
Flat purple papules
Can erosive and painfuk

Tx: High potent steroids - avoid surgery

Question 5

Vulvar Dysaesthesia

Answer 5

No organic vulval pathology
Provoked or spontaneous

Spontaneous = essential vulvaodynia
Burning pain more common in older patients

Vulvar dysaesthesia of the vestibule
Pian when using tampons or superficial dysparaenia
Younger women
Exclude intraoital damage

Associated with:
Pyschosexual disorders
Use of OCP
Genital tract infection

Tx: gabapentin or amitriptyline

Question 6

Bartholin’s Cyst / Abscess

Answer 6

Two glands behind labia minora
Secrete lubricating mucus for coitus
Blockage of duct –> cyst formation

Infection of cyst with staph aureus or e.coli –> Abscess

Tx: incision and drainage
Marsupialisation: incision is suture open to reduce risk of re-formation

Question 7

Intraoital Damage

Answer 7

Commonly after childbirth
over-tightening / incorrect apposition at perineal repair
Extensive scar tissue
Causes superficial dyspareunia

Tx: vaginal dilators or surgery (Fenton’s repair)

Question 8

Vaginal Adenosis

Answer 8

Columnar cells in vagina which would normally be just squamous epithelium

Occurs in women whose mother received DES (diethylstilboesterol) in pregnancy
Which is associated with genital tract abnormalities

Usually resolves spontaneously
Can become malignant (clear cell carcinoma of vagina)

DES exposure in utero –> yearly colposcopy

Can also occur secondary to trauma