Vulval and vaginal disorders Flashcards
How does lichen simplex present?
Severe itching, particularly at night.
Inflamed and thickened labia majora with hyper and hypo-pigmentation.
How would you treat lichen simplex?
Avoid soaps. Use emollients instead. Use topical steroids and anti-histamines.
How does lichen planus present?
Painful flat, papular, purplish lesions on mucosal surfaces.
How do you treat lichen planus?
High potency steroid creams.
How does lichen sclerosus present?
Intractable itch, discomfort, pain and dyspareunia.
O/E pink-white coalescent papules forming parchment-like skin.
How do you treat lichen sclerosus?
Potent topical steroids.
How do you treat a bartholins abscess?
Incision and drainage + marsupialisation.
What are the two types of VIN (vulval intraepithelial neoplasia)? Which is more common?
“Usual” is more common. Differentiated is less common.
What are the risk factors for “usual” VIN?
HPV 16, smoking, chronic immunosuppression.
What are the associations of differentiated VIN?
Lichen sclerosis.
How would you treat VIN?
Local surgical excision.
What is the most common vulval carcinoma? What are the others?
Squamous cell carcinomas - 95%.
Others: Melanomas, BCC, adenocarcinomas.
What are the risk factors for vulval carcinoma?
Lichen sclerosis, immunosuppression, smoking, Paget’s disease of the vulva.
How does vulval carcinoma present?
Late, typically.
Pruritis, bleeding, discharge +- mass.
O/E: ulcer / mass on labia majora or clitoris.
What investigations would you do in vulval carcinoma?
Biopsy for histology and confirmation of diagnosis.
