Vulval Conditions Flashcards
Discuss Batholin’s cyst and abscess
-Role of Batholins gland
-Pathophysiology of cyst and abscess formation
-Common infective microbes (8)
-Management (4)
- Role of Batholin’s gland
-Mucous producing to keep vulva moist
-Small amount of mucous for lubrication during intercourse 2. Pathophysiology
-Cyst forms from blockage of Batholins duct. Usually by friction caused by sexual intercourse
-Abcess forms if Cyst infected. Abcess 3 x more common than cyst - Common bacteria in Batholin’s abcess
-Neisseria gonorrhoea, Stap Aureus, Sterep Faecalis, E. Coli, Pseudomonas aeruginosa, Chlamydia trichamonas.
-Bacteroides fragilis. Clostridium perfringes - Management
- Conservative with antibiotics - not definitie management
- Word Catheter
3.I&D and Marsupialization - Excision of gland
NB: No difference in recurrence rates with Word vs Marsupilization
Discuss Benign Mullerian cysts
-Aeitology
-Sx
-Anatomical location
-Ix
-Management (2)
- Complications
- Persistance of glandular tissue
- Asx, dypareunia, vaginal discomfort
- Anywhere along the Mullerian tract.
- TVUSS or MRI
- Management
-Conservative - yearly surveillance
-Surgical excision - Complications
- malignant transformation, recurrence, infection
Discuss Gartners duct cyst
-Aeitology
-Sx
-Anatomical location
-Ix
-Management (2)
- Complications
- Persistance of mesonephric ducts
- Asx, dysparunia, vaginal discomfort
- Anterior lateral wall of upper third of vagina
- TVUSS/CT/MRI
- Management
-Yearly surveillance
-I&D or marsupilisation if large - Complications
-Infection, malignant transformation, recurrence
Discuss Skene’s gland
-Aeitology
-Sx
-Anatomical location
-Ix
-Management (2)
- Complications
- Obstruction of Skenes duct
- Urethral pain, recurrent UTI, Voiding Sx, dypareunia
- Lateral to urethral meatus
- TVUSS/MRI
- Management
-Conservative - antibiotics and analgesia
-Surgical - aspiration, marsupilisation, gland excision - Complicaiton
-Urethral diverticulum
-Recurrence
Discuss epidermal inclusion cysts
-Aeitology
-Sx
-Anatomical location
-Ix
-Management (2)
- Complications
- Entrapemnt of fragments of the epidermis
- Asx, labial discomfort
- Labia majora
- Clinical diagnosis
-non tender, mobile 5mm mass with cheese like discharge - Management
-Surveillance
-I&D - Complications
-Infection, recurrence
Discuss hidradenoma papillferum cysts
-Aeitology
-Sx
-Anatomical location
-Ix
-Management (2)
- Complications
- Blockage of sebaceous gland
- Asx, labial discomfort
- Between labia majora and minors
- Clinical dx
- Excision under LA
- Complicatins: Infection, recurrence
Discuss mucinous cysts of the labia
-Aeitology
-Sx
-Anatomical location
-Ix
-Management (2)
- Complications
- Obstruction of the vestibular glands lined by mucinous cells
- Asx, labial discomfort
- Labia minora, and vestibule. Often lateral
- Clinical dx
- Management
-Surveillance as may occasionally show squamous metaplasia
-Excision if large or expanding - Complications: Infection, recurrence
Discuss cysts of the canal of Nuck
-Aeitology
-Sx
-Anatomical location
-Ix
-Management (2)
- Complications
- Patent processus vaginalis
- Asx, discomfot
- Labia majora, mons pubis
- Clinical Dx
- Surgical resection and ligation of the neck of the processus vaginalis
- Complications: Inguinal hernia, recurrence
Discuss female genital mutilation (cutting)
-Definition
-Types (4)
-Epidemiology
- Defintion
-All procedures that involve partial or total removal of external genitalia or other injury to female genital organs for non-medical reasons - Types
Type 1 - excision of all or part of the clitorus
Type 2 - Excision of all or part of the clittorus and labia minor/majora
Type 3 - Removal of the external genitalia and narrowing of the vaginal opening (Infibulation)
Type 4 - pricking, piercing of the clitoris or labia, scraping of the vaginal tissu or introduction of substances to cause vaginal bleeding or narrowing - Epidemiology
-200 million women affected
-3 million girls at risk every year
-80% are type 1 and 2
-15% are type 3
Discuss FGM in NZ in terms of the law (4)
- No evidence that it is practiced in NZ
- Ilegal to perform under 1996 Crimes Act
- Ilegal to arrange/encourage/assist/convince another person to have FGM overseas
- Imprisonment up to 7yrs
- Mandatory reporting for children at risk
Discuss the complications of FGM
-Short term (8)
-Long term (8)
- Short term complications
-Haemorrage - most common complication (clittoral artery)
-Infection - sepsis, HIV
-Pain
-Shock - septic, haemorragic, neurological
-Chronic infection from poor healing
-Urinary retention
-Injury to proximal organs, bladder, urethra, bowel
-Injury to girl while imobilising - soft tissue, fracture - Longterm complications
-Urinary issues: UTI, obstruction, incontinence, hydronephrosis, fistulation
-Menstural issues: amenorrhoea, dysmenorrhoea, haematocolpos, endometriosis, retrograde menstruation
-Infection - abcesses, HIV, PID
-Dermatological - neurinoma, keloid scarring, ulcers
-Mental health: PTSD, depression, anxiety
-Sexual issues: Dysparenunia, reduced sexual pleasure, vaginismis
-Infertility - PID or inability to have intercourse
-Childbirth issues: Retained fetus in miscarriage, difficult D&C, Difficult to manage labour: VE, IDC, Intrapartum procedures, Prolonged / obstructed labour, PPH, perineal tears, fistula formation, HIE, Increased CS
Discuss management in pregnancy for women with FGM
-Antenatal (4)
-Intrapartum (5)
-Postpartum (1)
- Antenatal care
-Identify and counsel
-Assess type and ability to VE
-Ref for deinfibulation - second trimester if required
-Cousel on increased risks and management of FGM in labour
-Offer defibulation in second trimester if required - Intrapartum care
-FGM not a reason for CS
-Deinfibulation in first or second stage if required
-Low threshold for epis given scar tissue
-Suture skin edges together
-Reinfibulation - illegal - Post partum
-Deinfibulation cares
Discuss defibulation
1. Prepocedure counselling (4)
2. Procedure (7)
3. Post porocedure (7)
- Pre-procedure cares
-Counselling re what to expect post procedure
-Change to urination flow and menstural flow
-Avoid intercourse til healed
-Will not cause prolapse
-Reinfibulation is illegal - Procedure
-Anaesthetic LA or GA
-Infiltrate midline with LA
-Elevate anterior skin away from underlying structures
-Incise scar tissue posterior to anterior
-Extend excision until external urethral meatus is visible
-Avoid involvement of clitoral stump (pain and bleeding)
-Over sew skin edges with fine dissolvable subcut suture - Post procedure care
-Analgesia
-Offer smear
-Counsel hygiene cares, suture cares, infection risk
-Avoid sexual intercourse until healed
-Discuss legal status of FGM in NZ
-Refer for social support if required
-FU 6 weeks
How should you respond to a parent who wants to take their daugther back to home country for FGM (6)
- Explain illegal to perform on person in NZ or to take a child overseas for that purpose
- FGM is considered violation of human rights
- In new country FGM doesn’t have same positive value and may cause prejudice or disadvantage marriage
- Resaerch shoes countries where FGM is prevalent many communities want it to end
- Research shows that where FGM is prevalent men prefer to marry uncut women
- Explain health implications for women
Discuss VAIN
-Defintion
-Classification
-Risk factors
-Incidence
- Vaginal intra-epithelial lesion. Doesn’t involve tne basement membrane. Premalignant condition
- Classification
LSIL - Previously VAIN I
HSIL - Previously VAIN 2 & 3. 2-12% chance of invasive cancer - Risk factors
-Persistent infection with oncogenic HPV
-Often seen in conjunction with CIN
-Immunosupression and smoking - Rare