Vulva and vagina Flashcards
What part of the female genitalia are between the labia minora and the hymen (surrounding the vaginal & urethral opening)?
Vestibule
Describe the histological appearance of the vaginal lining:
Squamous epithelium
What is the lymphatic drainage of the vagina?
Inguinal lymph nodes (which drain into the femoral and external iliac nodes)
Give 3 causes of vulval pruritus (vulval itching):
1) Infection:
- Candidiasis (+ discharge) -> in DM, HIV
- Vulvar warts
- Pubic lice, scabies
2) Dermatological:
- Eczema, psoriasis
- Lichen simplex, lichen sclerosus
- Contact dermatitis
3) Neoplasia:
- Carcinoma
- VIN (premalignant)
(other vulval symptoms apart from pruritus include: soreness & burning, superficial dyspareunia (pain on penetration))
What causes severe pruritus of the labia major often causing inflammation and/or hypo/hyperpigmentation?
Lichen simplex
What is the treatment for lichen simplex/planus/sclerosus?
Rx = steroid cream
What is dermatological condition is common and affects all mucosal surfaces, has purplish lesions and can be erosive (=pain> pruritus)?
Lichen planus
What dermatological disorder is associated with AI conditions and causes thinning of vulvar skin?
Lichen sclerosus
List 4 common infections of the vulva:
- Herpes simplex
- Vulvar warts
- Syphilis
- Donovanosis (klebsiella granulomatis)
- Candidiasis
What is the common treatment for syphilis and donovanosis?
Antibiotics
What is the common Rx for candidiasis?
Antifungal treatment
What is a Bartholins gland cyst/abscess and how is it formed?
Gland secreating lubricating mucus behind the labia minora.
If duct blockage is present -> cyst -> infected with E coli -> abscess
What is marsupialization?
Surgical technique of cutting into an abscess and then leaving it open so that it can continue to drain/heal from the inside out.
What is the vaginal interoitus?
The opening to the vagina
What is characterised by columnar epithelium metaplasia within squamous epithelium of the vagina? When is it usually found?
Vaginal adenosis.
Usually in women whos mothers received DES (di-ethyl-stilboestrol) during pregnancy.
What is treatement/observation is performed in those with vaginal adenosis/DES exposure in utero?
Annual colposcopy screening - risk of clear cell carcinoma of the vagina
What is Vulvar Intraepithelial Neoplasia (VIN)?
Presence of atypical cells in the vulvar epithelium.
Usually multifocal:
- Warty lesions
- Hyperkeratosis
- Pigmented plaques
- erosions
- Nodules
What age bracket does usual VIN typically affect? And what is it associated with?
35-55yo.
Associations: HPV-16, CIN, smoking, immunosuppression
If one has usual type VIN, what are they at risk of?
Squamous cell carcinoma
What type of VIN is usually present in older women?
Differentiated VIN
What is differentiated VIN associated with?
Unifocal: ulcer or single plaque.
Association: lichen sclerosis
What are those with differentiated VIN more at risk of than in usual VIN?
^ risk of keratinising squamous cell carcinoma
What is the typical presentation of VIN?
Pruritus and pain
What is the Rx of VIN?
Depending on disease progression:
- Low: Emollients + topical steroids -> take biopsy
- High: Surgical excision -> biopsy: histology -> 15% women have invasive disease
What is the most common form of carcinoma of the vulva?
Squamous cell carcinoma (95%).
usually seen in post-menopausal women.
(only represents 5% of gynae cancers however)
What is vulval squamous cell carcinoma associated with ?
VIN, lichen sclerosis, immunosuppression, smoking, Paget’s disease.
Give 2 features of vulvar carcinoma:
Pruritus
Discharge/bleeding
What may you see on O/E in vulvar carcinoma?
- Ulcer or mass on the labia majora/clitoris
- ^Ingluinal LN
Describe the staging of vulvar carcinomas:
Stage 1 (50% present with this) - Confined to vulva/perineum, no LN
Stage 2 - Any size by adjacent spread (urethra, vagina, anus), no LN
Stage 3 - any size +ve LN
Stage 4 - Distal invasion (upper urethra, upper vagina, rectum, bladder, bone or distal mets)
What Ix should be performed for someone with suspected vulva carcinoma?
- Biopsy -> establish histology and staining
- Assess fitness for surgery
What is the Rx for those with vulval carcinoma?
Stage 1 - wide local excision
Other stages - wide local excision + sentinel LN biopsy (SLNB)
What is/why is sentinel lymph node biopsy performed?
Radioactive isotope + blue dye is injected into the tumour -> sentinel LN identified & biopsied for mets.
If no sentinel lymph node is found or if +ve -> complete ingunialfemoral lymphadenectomy.
A sentinel lymph node is the one to which the primary tumour first mets to.
What is the treatment of vaginal carcinoma?
Radiotherapy and radical surgery. (rare)
In utero exposure to DES (miscarriage prevention in 1950-1970) can cause why type of vaginal/vulval carcinoma?
Clear cell carcinoma.
