vulva and vagina

Question 1

list the presenting sx and examination findings of lichen simplex?

name some risk factors?

Answer 1

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

Question 2

how is lichen simplex treated?

Answer 2

Tx: emollients, moderately potent steroid

creams, avoid soap

Question 3

list the presenting sx and examination findings of lichen planus?

Answer 3

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

Question 4

how is lichen planus treated?

Answer 4

high potency steroids

Question 5

list the presenting sx and examination findings of lichen sclerosis?

Answer 5

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

Question 6

what are the complications and treatment of lichen sclerosis?

Answer 6

Vulval carcinoma in 5% cases

Tx with ultra-potent topical steroids

Question 7

list some causes of superficial dyspareunia and pain using tampons?

Answer 7

Lichen sclerosis

Vaginismus

Atrophic vaginitis

Vulvar dysaesthesia (vulvodynia) of the vestibule

Intraoital damage - excess tightening or scar tissue after repair

Question 8

list some risk factors for vulvodynia / Vulvar dysaesthesia?

Answer 8

Hx of genital tract infection
Former use of OCP
Psychosexual disorders

Question 9

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?

Answer 9

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

Question 10

what are two ways bartholins gland can present with swelling?

Answer 10

Cyst or Abscess

Blockage of duct -> cyst formation

Infection with s. aureus or e. coli -> abscess formation

Question 11

What are some side effects of receiving diethylstilbesterol DES in utero?

what monitoring must be done?

Answer 11

1. Vaginal adenosis : columnar epithelium found instead of squamous
   monitoring: yearly colposcopy if receive DES
2. Daughters of women who received this can get clear cell adenocarcinoma in their teens!

Question 12

name a premalignant disease of vulva

Answer 12

Vulval Intraepithelial Neoplasia

Question 13

what are the subtypes of VIN and how does it present?

what are the associated conditions/risk factors?

Answer 13

1. Usual Type VIN
2. Differentiated Type VIN
3. usual type:
   - most common, younger women
   - hpv 16 , smoking
   - many different appearances ; multifocal
   - pruritus and pain
4. Differentiated Type
   - older women
   - lichen sclerosis
   - ulcer, plaque ; unifocal

Question 14

which subtype of VIN has risk of progression to Keratinising squamous cell carcinoma (SCC) of the vulva

Answer 14

Differentiated Type

Question 15

which subtype of VIN is associated with warty or basaloid

squamous cell carcinoma ?

Answer 15

Usual Type VIN

Question 16

treatment for VIN?

Answer 16

Gold standard – local surgical excision

 Confirm histology and exclude invasive disease

Emollients or steroids may help

Question 17

what subtype of cancer are most vulval carcinomas?

Answer 17

squamous cell carcinoma

Question 18

what is th aetiology of vulval carcinomas?

Answer 18

Often de novo

Associated with lichen sclerosis,
immunosuppression,
smoking
Paget’s disease of the vulva

Question 19

what are th presenting sx and signs of exam of vulval caner?

Answer 19

Pruritis, bleeding or discharge, Mass

Ulcer or mass

Enlarged, immobile and hard inguinal LN

Question 20

vulvar cancer spreads via?

Answer 20

lymphatics -> inguinal LN

Question 21

how is vulvar cancere treated?

Answer 21

1a: wide local excision

Other stages:
Tumour >2cm from midline:
Triple incision radical vulvectomy

Tumour <2cm from midline:
unilateral vulvectomy

include groin lymphadenectomy

Question 22

what is a radical vulvectomy?

Answer 22

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

Question 23

names some side eeffects of vulvectomy

Answer 23

Wound breakdown
o Infection
o Leg lymphoedema
o Lymphocyst formation
o Sexual and body image problems

Question 24

how does primary vaginal carcinoma present and how is it treated?

Answer 24

presentation: similar to vulvar cancer

intravaginal radiotherapy

radical surgery, occasionally,

Question 25

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?

Answer 25

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.