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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
How do recurrent genital herpes ulcers present on PE?
Tend to be smaller, fewer and confined to one area
26
What is the gold standard diagnosis of genital herpes?
Viral culture from vesicle fluid or scraping
27
What is the "great imitator" of genital herpes in women?
Vulvovaginal candidiasis
28
Why aren't blood cultures the gold standard diagnosis of genital herpes?
It takes 21-28 days to show up in the serum
29
Treatment of genital herpes
- Lesions self limiting and heal spontaneously - Symptomatic tx - Antiviral (depends on initial vs. recurrence) - Prophylaxis if frequent outbreaks
30
Describe herpes in pregnancy
- Transmission to fetus is high in women who first acquire herpes near time of delivery - Mortality rate is HIGH (60%)
31
Treatment of choice for herpes in pregnancy
Acyclovir and C-section
32
What are condyloma acuminatum?
Genital warts
33
What causes condyloma acuminatum?
HPV 6 and 11 | Sexually transmitted
34
S/S of condyloma acuminatum
- Usually painless - White papillomatous growths - Tend to merge and grow into large cauliflower-like masses
35
Where do condyloma acuminatum occur?
- Vulva - Vagina - Cervix - Oropharynx - Perineum - Perianal
36
Treatment of condyloma acuminatum by health provider
- Topical trichlorocetic acid weekly - Podophyllin in tincture of benzoin - Cryosurgery, electrosurgery, laser/surgical excision
37
Treatment of condyloma acuminatum by patient
- Podofilox 0.5% solution or gel - Imiquimod 5% cream - Sinecatechins 15% ointment
38
Prognosis of condyloma acuminatum
Recurrence is frequent with all treatments
39
Describe Bartholin gland cyst/abscess
- 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
Treatment of bartholin gland cyst/abscess
- Incision and drainage - Abx if infection is present - Excision if recurrent - R/o malignancy in postmenopausal female
41
MC type of vulvar cancer
Squamous cell carcinoma (90%)
42
Describe vulvar cancer
- Uncommon - 60-70 yo peak incidence - 90% are SCC
43
What is the most important factor for prognosis of vulvar cancer?
Lymph node involvement
44
MC causes of vaginitis
- Candidiasis - Bacterial vaginosis - Trichomonas
45
Normal vaginal pH in postmenarchal and premenopausal women?
3.8 to 4.2
46
Tools to evaluate vaginitis
- Saline wet mount - KOH prep - Whiff test - Cultures
47
Describe the Whiff test
- To evaluate vaginitis - Release of fishy odor after addition of 10% KOH to discharge - Odor is d/t release of amines
48
Cultures in evaluation of vaginitis
- Little use in acute vaginitis b/c results are not immediately available - Useful for co-existing STDs
49
MC etiology of vaginal candidiasis
Candida albicans
50
Gold standard diagnosis of vaginal candidiasis
Vaginal culture
51
What is seen on wet mount with vaginal candidiasis?
- Hyphae and budding yeast forms | - Whiff test is NEGATIVE
52
Treatment of vaginal candidiasis
- Imidazole meds (creams, suppositories, oral) | - Fluconazole (PO) one time dose
53
What is considered recurrent vaginal candidiasis?
4 or more episodes in 1 year
54
Treatment of recurrent vaginal candidiasis?
- Consider underlying illness - Wear cotton underwear - Avoid clothing that traps heat and moisture - Consume yogurt w/active cultures daily - Consider treating male partner
55
MC cause of symptomatic bacterial infection in reproductive aged women?
Bacterial vaginosis
56
What is bacterial vaginosis?
Overgrowth of G. vaginalis, Mobiluncus spp, anaerobic Gram negative rods, Peptostreptococcus spp
57
S/S of bacterial vaginosis
- Fishy vaginal discharge - Pruritus - 50% are asymp
58
Diagnosis of bacterial vaginosis
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
Treatment of bacterial vaginosis
- Metronidazole | - Clindamycin
60
What are trichomonas?
- Unicellular flagellate protozoa | - Infects lower urinary tract in both females and males
61
What is the most prevalent non-viral STD in the US?
Trichomonas
62
What is a/w a "strawberry cervix"?
Trichomonas
63
Diagnosis of vaginal trichomonas
- Vaginal pH over 5.0 - Oval shaped protozoa on saline wet mount - Positive Whiff test
64
Treatment of trichomonas
- Systemic tx (metronidazole) - Treat any and all partners - Abstain from intercourse x10 days
65
Describe chemical vaginitis
- 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
Describe vaginal neoplasms
- Extremely rare - Majority are SCC - Secondary carcinoma of vagina is seen more frequently (extension of cervical cancer)
67
MC s/s of vaginal neoplasms
Postmenopausal and/or postcoital bleeding
68
Pelvic floor muscle disorders
- Cystocele - Uterine prolapse - Rectocele - Enterocele
69
Treatment of pelvic organ prolapse
- Conservative (pessary, kegels, local estrogen therapy) | - Surgery
70
What is a pessary?
- 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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