Vulva and Vagina (Moulton) Flashcards
Pathogenesis of clitoral agenesis?
failure of the genital tubercle to form
Cloaca
no definite separation between the vagina and bladder
with ambiguous genitalia, what gender is the infant usually assigned at birth?
female
female pseudohermaphroditism
caused by masculinization in utero of the female fetus; usually caused by endogenous hormonal milieu
male pseudohermaphroditism
results from mosaicism and varying degrees of virulization and mullerian development (ie androgen insensitivity)
Androgen insensitivity
46 XY; x linked; deficiency in androgen receptors; testes are undescended
Labial agglutination
benign neoplastic condition of the vulva; treated by estrogen cream and massage
Fox-Fordyce disease
benign neoplastic condition of the vulva severe pruritic raised yellow retention cyst in the axilla and labia major and minor, resulting from keratin-plugged inflammation aprocrine glands
Inclusion cyst
benign neoplastic condition of the vulva; located beneath the epidermis and are mobile, nontender, spherical and slow growing; no treatment required
Vulvar varicosities
benign neoplastic condition of the vulva; can enlarge during pregnancy and become very painful; have characteristic blue color
Urethral caruncles
benign neoplastic condition of the vulva; small fleshy red outgrowth at the distal edge of the urethral; caused by prolapse of the urethral epithelium
Vulvar vesitbulitis
benign neoplastic condition of the vulva; infected minor vestibular glands; presents with SEVERE over the top pain (severe introital dyspareunia)
Sebaceous cyst
benign neoplastic condition of the vulva; caused by blockage of sebaceous gland; contain cheesy sebaceous material
Fibromas of the vulva
benign neoplastic condition of the vulva; most common solid tumor of the vulva; slow growing but can become gigantic (250 lbs)
What is most common solid tumor of the vulva?
Fibroma; slow growing but can become gigantic (250 lbs)
Lipoma
slow growing tumor comprised of adipose tissue
Hidradenoma
benign neoplastic condition of the vulva arising from sweat glands
Syringoma
benign tumor of the vulva arising from an eccrine gland
Neurofibroma
benign neoplastic condition of the vulva from Von Recklinghausen’s disease
Vulvar hematoma
located collection of blood that collect following trauma; bike injuries - straddle injury, birth trauma or sexual assault
Atrophic vaginitis
dermatologic condition of the vulva; due to loss of estrogen; atrophy of external genitalia; treat with topical estrogen
Lichen Simplex Chronic
AKA Squamous cell hyperplasia; dermatologic condition of the vulva; thickening of epithelium due to prolonged itch-scratch cycle; biopsy will show **rete ridges and hyperkeratosis of keratin layer
Lichen Sclerosis
dermatologic condition of the vulva; menopausal women; 10% of untreated will develop SCC of the vulva; intense pruritus, dyspareunia and burning pain; **NO rete ridges and inflammatory cells lining the BM; “onion skin, cigarette paper, parchment like”
Characteristic finding on examination for lichen sclerosis
“onion skin, cigarette paper, parchment like” appearance; biopsy NO rete ridges and inflammatory cells lining the BM
What is the most striking feature of lichen sclerosis?
presence of a hyaline zone in the superficial dermis
Lichen Planus
dermatologic condition of the vulva; purplish, polygonal papules; tx w/ topical and systemic steroids
Two types of a vaginal septum
- transverse - upper and middle thirds of vagina; intercourse is impeded
- midline longitudinal - creates double vagina; blind vagina pouch
Vaginal agenesis
total absence of the vagina EXCEPT most distal portion derived from the urogenital sinus
Vaginal agenesis where uterus is absent but fallopian are spared
Rokintansky-Kuster-Hauser Syndrome AKA Mullein agenesis
Gartner’s Duct Cyst
remnant of the Wolffian duct; asymptomatic and require no intervention
Bartholin’s Cyst
most common vulvovaginal tumor; usually asymptomatic; NEED biopsy in women 40+ to rule out Bartholin’s carcinoma
What is the most common vulvovaginal tumor?
Bartholin’s Cyst; usually asymptomatic; NEED biopsy in women 40+ to rule out Bartholin’s carcinoma
Why is a biopsy required in women 40+ who have an asymptomatic Bartholin’s cyst?
to rule out Bartholin’s carcinoma
Treatment of a bartholin’s gland abscess?
Marsupialization; created new ductal opening by evening the cyst wall onto the epithelial surface where it sutured with interrupted absorbable sutures
Cystocele
anterior vaginal prolapse
Rectocele
posterior vaginal prolapse
Most common vulvar neoplasm?
Squamous cell carcinoma (90%); frequently reported with long history of chronic vulvar pruritus; requires a biopsy
VIN Usual type
vulvar intraepithelial neoplasia IVIN) III - squamous cell carcinoma in situ; associated with HPV (type 16) and smoking; younger pts; associated with hx of STDs and condyloma
VIN Differentiated type
vulvar intraepithelial neoplasia IVIN) III - squamous cell carcinoma in situ; NOT associated with HPV (type 16) and smoking; associated with lichen sclerosis; older patients
Radiation is contraindicated in which vulvar carcinoma?
Verrucous carcinoma b/c may induce anapestic transformation; variant of SCC; lesions are caulk-flower like
Verrucous carcinoma
a variant of SCC of the vulva; lesions are caulk-flower like; radiation is contraindicated b/c may induce anapestic transformation
Bartholins gland carcinoma
painless vulvar mass can arise from a bartholin cyst; reoccurrence is common; 5 yr survival rate 85%
VAIN
Vaginal intraepithelial neoplasia (VAIN); HPV related; asymptomatic; abnormal Pap test; usually pt is post hysterectomy; diagnosis with colposcopes directed vaginal biopsy
What is required to diagnosis carcinoma of the vagina?
a punch biopsy; usually SCC (85%)
Sarcoma botryoides
pediatric vaginal cancer (2-3 yrs); present with grape-like polyps protruding from the Introits; embryonal rhabdomyosarcoma
Normal physiology of the vagina
lined by nonkeratinized stratified squamous epithelium; contains lactic acid and hydrogen peroxide producing lactobacilli; pH 3.8-4.2 (acidic); semen rises pH (pH 7.2 for 6-8 hrs)
What is the normal pH of the vagina?
pH 3.8-4.2 (acidic)
Bacterial Vaginosis (BV)
most common vaginitis; most common organism is Gardnerella vaginalis; risk factors are multiple sex partners; saline mount “clue cells”, “fishy” odor; KOH positive whiff test; vaginal pH >4.5; NOT a sexually transmitted infection
Is Bacterial Vaginosis (BV) a sexually transmitted infection?
NO. so do no have to treat sexual partners
Most common organism of Bacterial Vaginosis?
Gardnerella vaginalis
Diagnosis of bacterial vaginosis?
saline mount “clue cells”, “fishy” odor; KOH positive whiff test; vaginal pH >4.5
Vulvovaginal candidiasis (VVC)
yeast infection; second most common vaginitis; caused by Candida albicans (90%); risk factors high estrogen levels; discharge is white adherent and clumpy “cottage cheese”; KOH positive for budding yeast; vaginal pH <4.5
Diagnosis of Vulvovaginal candidiasis (VVC)
discharge is white adherent and clumpy “cottage cheese”; KOH positive for budding yeast; vaginal pH <4.5
Trichomoniasis
STI - evaluate and treat all partners; caused by flagellated protozoan T. vaginalis; unprotected sexual encounters; “frothy” vaginal discharge; saline mount reveals motile trichomonads, pH > 4.5 and strawberry cervix
Diagnosis of Trichomoniasis
“frothy” vaginal discharge; saline mount reveals motile trichomonads, pH > 4.5 and strawberry cervix
