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Special Pops - Women's Health > Vulval and Vaginal Diseases > Flashcards

Vulval and Vaginal Diseases Flashcards

1
Q

What is the MC benign epithelial vulvar disorder?

A

Lichen sclerosis

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2
Q

What are the white lesions of the vulva?

A

Lichen sclerosis
Lichen simplex chronicus
(benign)

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3
Q

What are the dark lesions of the vulva?

A

Melanosis/lentigo

Melanoma

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4
Q

Who is MC affected by lichen sclerosis?

A

Postmenopausal women

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5
Q

Complications of lichen sclerosis

A

5% increased risk of SCC of vulva

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6
Q

Treatment of lichen sclerosis

A
  • Control pruritus (good hygiene, avoid tight undergarments)
  • Antihistamine
  • Topical steroids
  • Topical testosterone (maybe helpful?)
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7
Q

Prognosis of lichen sclerosis

A

Chronic, recurs w/cessation of treatment

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8
Q

Describe vulvar lichen simplex chronicus

A
  • Acute condition
  • Benign epithelial thickening and hyperkeratosis
  • Secondary to chronic irritation
  • Dermal layer is spared
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9
Q

S/S of lichen simplex chronicus

A
  • Pruritus leads to thickened epithelium
  • Maceration occurs d/t humid environment
  • Raised white lesion occurs
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10
Q

Treatment of lichen simplex chronicus

A
  • Good hygiene
  • Lubricants
  • Sitz baths
  • Antihistamines, topical steroids
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11
Q

Prognosis of lichen simplex chronicus

A

About 6 weeks to heal

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12
Q

How do vulvar red lesions occur?

A
  • Thinning of epidermis reveals capillary vessels
  • Vasodilation a/w inflammation
  • Neovascularization of a neoplasia
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13
Q

Examples of vulvar red lesions

A
  • Psoriasis
  • Acute Candida infection
  • Paget’s disease
  • SLE
  • Seborrheic dermatitis
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14
Q

How do vulvar dark lesions occur?

A
  • Increased number or concentration of melanin or hemosiderin pigments
  • Trauma
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15
Q

What type of vulvar lesions require biopsy?

A

Dark lesions

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16
Q

Examples of vulvar dark lesions

A
  • Melanoma
  • Kaposi’s sarcoma
  • Dermatofibroma
  • Seborrheic keratosis
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17
Q

Describe melanosis of the vulva

A
  • Dark lesion
  • Benign
  • Pigmented flat lesion
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18
Q

Describe melanoma of the vulva

A
  • Uncommon but aggressive

- May arise from pigmented nevi

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19
Q

Examples of vulvar ulcerative lesions

A
  • Genital herpes
  • Behcet’s syndrome
  • Syphilis
  • Chancroid
  • Lymphogranuloma venereum
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20
Q

Types of herpes genitalis

A

Type 1

Type 2 MC (60%)

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21
Q

Why does having herpes genitalis increased risk of other STI?

A

The ulcerations/erosions are open and can be introduced to new diseases

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22
Q

Recurrence of herpes genitalis

A

50% pts have a recurrence w/in 6 months of primary infection

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23
Q

S/S of genital herpes primary infection

A
  • Prodrome of tingling/burning with flu-like symptoms (less common w/recurrent outbreaks)
  • 20% are asymptomatic
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24
Q

How do genital herpes present on PE?

A

Erosions/ulcerations surrounded by a red halo in a serpentine-like fashion

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25
Q

How do recurrent genital herpes ulcers present on PE?

A

Tend to be smaller, fewer and confined to one area

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26
Q

What is the gold standard diagnosis of genital herpes?

A

Viral culture from vesicle fluid or scraping

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27
Q

What is the “great imitator” of genital herpes in women?

A

Vulvovaginal candidiasis

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28
Q

Why aren’t blood cultures the gold standard diagnosis of genital herpes?

A

It takes 21-28 days to show up in the serum

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29
Q

Treatment of genital herpes

A
  • Lesions self limiting and heal spontaneously
  • Symptomatic tx
  • Antiviral (depends on initial vs. recurrence)
  • Prophylaxis if frequent outbreaks
30
Q

Describe herpes in pregnancy

A
  • Transmission to fetus is high in women who first acquire herpes near time of delivery
  • Mortality rate is HIGH (60%)
31
Q

Treatment of choice for herpes in pregnancy

A

Acyclovir and C-section

32
Q

What are condyloma acuminatum?

A

Genital warts

33
Q

What causes condyloma acuminatum?

A

HPV 6 and 11

Sexually transmitted

34
Q

S/S of condyloma acuminatum

A
  • Usually painless
  • White papillomatous growths
  • Tend to merge and grow into large cauliflower-like masses
35
Q

Where do condyloma acuminatum occur?

A
  • Vulva
  • Vagina
  • Cervix
  • Oropharynx
  • Perineum
  • Perianal
36
Q

Treatment of condyloma acuminatum by health provider

A
  • Topical trichlorocetic acid weekly
  • Podophyllin in tincture of benzoin
  • Cryosurgery, electrosurgery, laser/surgical excision
37
Q

Treatment of condyloma acuminatum by patient

A
  • Podofilox 0.5% solution or gel
  • Imiquimod 5% cream
  • Sinecatechins 15% ointment
38
Q

Prognosis of condyloma acuminatum

A

Recurrence is frequent with all treatments

39
Q

Describe Bartholin gland cyst/abscess

A
  • Gland is located deep in posterior third of each labia majora w/duct opening into vestibule at 4 and 8 o’clock position
  • Obstruction of duct can lead to cyst/abscess
40
Q

Treatment of bartholin gland cyst/abscess

A
  • Incision and drainage
  • Abx if infection is present
  • Excision if recurrent
  • R/o malignancy in postmenopausal female
41
Q

MC type of vulvar cancer

A

Squamous cell carcinoma (90%)

42
Q

Describe vulvar cancer

A
  • Uncommon
  • 60-70 yo peak incidence
  • 90% are SCC
43
Q

What is the most important factor for prognosis of vulvar cancer?

A

Lymph node involvement

44
Q

MC causes of vaginitis

A
  • Candidiasis
  • Bacterial vaginosis
  • Trichomonas
45
Q

Normal vaginal pH in postmenarchal and premenopausal women?

A

3.8 to 4.2

46
Q

Tools to evaluate vaginitis

A
  • Saline wet mount
  • KOH prep
  • Whiff test
  • Cultures
47
Q

Describe the Whiff test

A
  • To evaluate vaginitis
  • Release of fishy odor after addition of 10% KOH to discharge
  • Odor is d/t release of amines
48
Q

Cultures in evaluation of vaginitis

A
  • Little use in acute vaginitis b/c results are not immediately available
  • Useful for co-existing STDs
49
Q

MC etiology of vaginal candidiasis

A

Candida albicans

50
Q

Gold standard diagnosis of vaginal candidiasis

A

Vaginal culture

51
Q

What is seen on wet mount with vaginal candidiasis?

A
  • Hyphae and budding yeast forms

- Whiff test is NEGATIVE

52
Q

Treatment of vaginal candidiasis

A
  • Imidazole meds (creams, suppositories, oral)

- Fluconazole (PO) one time dose

53
Q

What is considered recurrent vaginal candidiasis?

A

4 or more episodes in 1 year

54
Q

Treatment of recurrent vaginal candidiasis?

A
  • Consider underlying illness
  • Wear cotton underwear
  • Avoid clothing that traps heat and moisture
  • Consume yogurt w/active cultures daily
  • Consider treating male partner
55
Q

MC cause of symptomatic bacterial infection in reproductive aged women?

A

Bacterial vaginosis

56
Q

What is bacterial vaginosis?

A

Overgrowth of G. vaginalis, Mobiluncus spp, anaerobic Gram negative rods, Peptostreptococcus spp

57
Q

S/S of bacterial vaginosis

A
  • Fishy vaginal discharge
  • Pruritus
  • 50% are asymp
58
Q

Diagnosis of bacterial vaginosis

A

3 out of 4 need to be met:

  • Homogenous white/gray adherent discharge
  • Vaginal pH over 4.5
  • Positive Whiff test
  • Clue cells on wet mount
59
Q

Treatment of bacterial vaginosis

A
  • Metronidazole

- Clindamycin

60
Q

What are trichomonas?

A
  • Unicellular flagellate protozoa

- Infects lower urinary tract in both females and males

61
Q

What is the most prevalent non-viral STD in the US?

A

Trichomonas

62
Q

What is a/w a “strawberry cervix”?

A

Trichomonas

63
Q

Diagnosis of vaginal trichomonas

A
  • Vaginal pH over 5.0
  • Oval shaped protozoa on saline wet mount
  • Positive Whiff test
64
Q

Treatment of trichomonas

A
  • Systemic tx (metronidazole)
  • Treat any and all partners
  • Abstain from intercourse x10 days
65
Q

Describe chemical vaginitis

A
  • Irritated vulva w/excoriations
  • All lab tests negative
  • Reaction to agents used in soaps, bubble bath, TP, etc.
  • Discontinue product and use hydrocortisone cream for sx
66
Q

Describe vaginal neoplasms

A
  • Extremely rare
  • Majority are SCC
  • Secondary carcinoma of vagina is seen more frequently (extension of cervical cancer)
67
Q

MC s/s of vaginal neoplasms

A

Postmenopausal and/or postcoital bleeding

68
Q

Pelvic floor muscle disorders

A
  • Cystocele
  • Uterine prolapse
  • Rectocele
  • Enterocele
69
Q

Treatment of pelvic organ prolapse

A
  • Conservative (pessary, kegels, local estrogen therapy)

- Surgery

70
Q

What is a pessary?

A
  • Used to tx pelvic organ prolapse
  • Support uterus and vaginal walls
  • Changed every 2-3 months

Special Pops - Women's Health (11 decks)

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