vulva and vagina Flashcards
list the presenting sx and examination findings of lichen simplex?
name some risk factors?
Severe intractrable pruritis, especially at
night
Labia major is inflamed and thickened
Shows hyper- and hypopigmentation
Sx exacerbated by chemical or contact
dermatitis
Can be linked to stress or low iron stores
associations; eczema, dermatitis
how is lichen simplex treated?
Tx: emollients, moderately potent steroid
creams, avoid soap
list the presenting sx and examination findings of lichen planus?
affect any part of body, but particularly mucosal surfaces e.g. mouth and genitals
Flat purple papules
white patches on your gums, tongue or the insides of your cheeks
Can be erosive and associated with pain
burning and stinging in your mouth, especially when you eat or drink
bald patches appearing on your scalp
sore red patches on your vulva
Itching
how is lichen planus treated?
high potency steroids
list the presenting sx and examination findings of lichen sclerosis?
Severe pruritis, worse at night
Scratching -> trauma and bleeding, skin
splitting and sx of discomfort, pain and
dyspareunia
Pink white papules which coalesce to form
parchment-like skin with fissures
Inflammatory adhesions -> fusion of labia
and narrowing of intraoitus
what are the complications and treatment of lichen sclerosis?
Vulval carcinoma in 5% cases
Tx with ultra-potent topical steroids
list some causes of superficial dyspareunia and pain using tampons?
Lichen sclerosis
Vaginismus
Atrophic vaginitis
Vulvar dysaesthesia (vulvodynia) of the vestibule
Intraoital damage - excess tightening or scar tissue after repair
list some risk factors for vulvodynia / Vulvar dysaesthesia?
Hx of genital tract infection
Former use of OCP
Psychosexual disorders
a 35 year old woman presents with an acutely painful and large, tender, red swelling in the vulva region.
what is the ddx and treatment?
Bartholin glands cyst
tx:
1. If the abscess is discharging and the patient is well, treat with oral antibiotics (usually flucloxacillin)
2. incision + drainage
3. Marsupialisation : suture incision open to reduce re-
formation
what are two ways bartholins gland can present with swelling?
Cyst or Abscess
Blockage of duct -> cyst formation
Infection with s. aureus or e. coli -> abscess formation
What are some side effects of receiving diethylstilbesterol DES in utero?
what monitoring must be done?
- Vaginal adenosis : columnar epithelium found instead of squamous
monitoring: yearly colposcopy if receive DES - Daughters of women who received this can get clear cell adenocarcinoma in their teens!
name a premalignant disease of vulva
Vulval Intraepithelial Neoplasia
what are the subtypes of VIN and how does it present?
what are the associated conditions/risk factors?
- Usual Type VIN
- Differentiated Type VIN
- usual type:
- most common, younger women
- hpv 16 , smoking
- many different appearances ; multifocal
- pruritus and pain - Differentiated Type
- older women
- lichen sclerosis
- ulcer, plaque ; unifocal
which subtype of VIN has risk of progression to Keratinising squamous cell carcinoma (SCC) of the vulva
Differentiated Type
which subtype of VIN is associated with warty or basaloid
squamous cell carcinoma ?
Usual Type VIN
treatment for VIN?
Gold standard – local surgical excision
Confirm histology and exclude invasive disease
Emollients or steroids may help
what subtype of cancer are most vulval carcinomas?
squamous cell carcinoma
what is th aetiology of vulval carcinomas?
Often de novo
Associated with lichen sclerosis,
immunosuppression,
smoking
Paget’s disease of the vulva
what are th presenting sx and signs of exam of vulval caner?
Pruritis, bleeding or discharge, Mass
Ulcer or mass
Enlarged, immobile and hard inguinal LN
vulvar cancer spreads via?
lymphatics -> inguinal LN
how is vulvar cancere treated?
1a: wide local excision
Other stages:
Tumour >2cm from midline:
Triple incision radical vulvectomy
Tumour <2cm from midline:
unilateral vulvectomy
include groin lymphadenectomy
what is a radical vulvectomy?
Surgery to remove the entire vulva (the external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina) and nearby lymph nodes
names some side eeffects of vulvectomy
Wound breakdown o Infection o Leg lymphoedema o Lymphocyst formation o Sexual and body image problems
how does primary vaginal carcinoma present and how is it treated?
presentation: similar to vulvar cancer
intravaginal radiotherapy
radical surgery, occasionally,
A 50 year old woman presents with Mild to severe vulval itching and One or more slightly raised, well-defined skin lesions that may be pink, red, brown, or white. Diagnosis and prognosis?
If left untreated, VIN may resolve spontaneously or it may develop into an invasive cancer.
On average, it takes well over 10 years for VIN to progress to cancer.
2 types:
High grade squamous intraepithelial lesion (usual-type) — risk factors include smoking and immunosuppression.
Intraepithelial neoplasia (differentiated-type) — associated with lichen sclerosus.
