Vulva and Vagina Disorders Flashcards
Normal vaginal pH
4.0-4.5
What would you suspect if you saw erythema, lesions or fissures on the vulva?
dermatitis
pH range for trichomoniasis vaginal infection
5.0-6.0
pH range for candidial infection
4.0-4.5
Not helpful in evaluation of vaginosis
bacterial cultures
Most common cause of discharge of women of childbearing age
bacterial vaginosis
Pathophysiology of bacterial vaginosis
Decrease in hydrogen-peroxidase lactobacilli. Increase in primarily gram negative rods
Exam findings may include: fishy odor, clue cells, and thin, white/gray discharge
bacterial vaginosis
Preferred treatment for bacterial vaginosis
Metronidazole: Oral 500mg BID for 7 days
How does bacterial vaginosis affect pregnancy?
associated with preterm birth
Primary etiologic agent for vulvovaginal candidiasis
Candida albicans
On speculum exam: Thick, white, sometimes “cottage cheese”, discharge. In severe cases a gray membrane
Vulvovaginal Candidiasis
Prescription treatment vulvovaginal candidiasis
Fluconazole (Diflucan)
Most common STI WORLD wide. Flagellated protozoan
Trichomonas vaginalis
On speculum exam may seen green, malodorous, frothy discharge
trichomonas vaginitis
Characteristic look of cervix with a trichomonas infection due to irritation of protozoan
“strawberry” cervix
Treatment for trichomonas for both partners in addition to abstaining from sex until tx is completed
Tinadazole (Tindamax) or metronidazole (Flagyl)
1 time dose of 2 grams
Presenting symptoms include painful genital ulcers, itching, dysuria, tender inguinal lymphadenopathy
genital herpes
What would you expect to see on physical exam with a patient who has genital herpes?
multiple vesicles on erythematous base
How do you confirm diagnosis of genital herpes?
viral cell culture or PCR
What is the treatment for primary infection of genital herpes?
acyclovir (Zovirax), famcyclovir (Famvir), or valocyclovir (Valtrex) for 7-10 days
Length of duration for recurrent genital herpes treatment
1-3 days
MOST common viral sexually transmitted disease in the U.S. Etiologic agent is often HPV serotypes
Codylomata acuminata (anogenital warts)
Clinical manifestations include pruritis, burning, pain that can interfere with defecation and coitus
Codylomata acuminata (anogenital warts)
Chemical treatment of Codylomata acuminata (anogenital warts) for pregnant women
Trichloroacetic acid
Multiple, 1-2 mm raised, painless lesions. Dome-shaped with central dimple. Contain cheesy-white material
Mulloscum Contagiosum
Can occur in women of any age who experience a decrease in estrogenic stimulation of urogenital tissue
Atrophic Vaginitis
Clinical presentation includes: 2 yrs since natural menopause, loss of labial/vulvar fullness, pallor of urethral/vaginal epithelium, narrow introitus, minimal vaginal moisture
atrophic vagnitis
Most effective therapy for Atrophic Vaginitis
vaginal estrogen therapy
Caused by intense inflammatory reaction. Diagnosed by biopsy.
lichen sclerosis
Symptom that is a hallmark for lichen sclerosis
vulvar pruritis that is so intense it interferes with sleep
PE findings include well-demarcated white, finely wrinkled, atrophic patches
lichen sclerosis
Treatment for lichen sclerosis
clobetasol propionate 0.05% cream for 6-12 weeks (topical steroids)
Most common large cyst of the vulva—average 1-3 cm size. Tx not necessary in asymptomatic women < 40 yrs
Bartholin Duct Cyst
Clinical manifestations include exquisite pain, erythematous, warm, tenderness of swollen Bartholin gland
Bartholin Duct Abscess
Intraepithelial adenocarcinoma. Lesions are brick red, scaly, velvety eczematoid plaque with sharp border
Paget’s Disease
Treatment for Paget’s disease of genitalia
excision with > 3 mm border from visible margin
Risk factors include HPV infection, cigarette smoking, lichen sclerosis, northern european ancestory
vulvar cancer
What are the clinical manifestations of vulvar cancer?
Unifocal vulvar plaque, ulcer or mass
Most common histological cell type of vulvar cancer
squamous cell
Why should we continue pap smears after hysterectomy?
risk of vaginal Intraepithelial Neoplasia
