vulval conditions

Question 1

lichen sclerosis

Answer 1

inflammatory, scarring dermatosis on ano-genital skin
- linked with other autoimmune - T1DM, alopecia, hypothyroid, vitiligo

any age 2 peaks -> prepubertal girls, postmenopausal women
- may resolve in kids, relapsing in adults

typical patient = 45-60y/o women with vulval itching + skin changes in vulva

Question 2

lichen sclerosis presentation

Answer 2

itch - mainly
pain + dyspareunia
constipation - esp in kids
PMH of autoimmune

white papules + plaques “porcelain white”
- vuval + perianal skin *figure of 8**

ecchymosis - ruptured blood vessels
skin tightness
architectural change - resorption of inner labia, narrowing of openings

koebner phenomenon = made worse by friction - tight underwear, urinary incontinence, scratching

Question 3

red flag in lichen sclerosis

Answer 3

persistent ulcer/lump/weight loss = SCC
- more likely in smokers
- 3.5-5% of females with genital LS

Question 4

lichen planus

Answer 4

inflammatory dermatosis that affects genital skin + mucous membranes
50-60y/o
shiny, purplish, flat topped raised area with white lines across = wickhams striae

Question 5

management of lichen sclerosis

Answer 5

potent topical steroid = clobetasol propionate 0.05% (dermovate)
- 1/2 finger tip, until 12wks then as required
- taper usage down
- used long term to control symptoms, reduce malignancy

Question 6

vulvodynia

Answer 6

vulval discomfort, described as burning pain, occurring in the absence of relevant visible finding or a specific clinically identifiable, neurological disorder
- generalised or local
- provoked / unprovoked or mixed
- usually requires trigger in a vulnerable individual

diagnosis of exclusion

Question 7

vulvodynia management

Answer 7

info, genital skin care advice + emollients
psychological interventions

localised provoked pain -> lidocaine 5%, vaginal trainers, physio

unprovoked pain ->tricyclics , gabapentin/pregabalin

Question 8

female genital mutilation

Answer 8

partial or total removal of external female genitalia or other injury for non-medical reasons
- human rights violation, child abuse
- somalia has highest rates, ethiopia, sudan, yemen

Question 9

types of female genital mutilation

Answer 9

1. partial or total removal of clitoris and/or prepuce (clitoridectomy)
2. partial or total removal of clitoris + labia minora, with or without excision of the labia majora (excision)
3. narrowing of vaginal orifice with creation of a covering seal by cutting + appositioning the labia minora and/or labia majora with or without excision of clitoris (infibulation)
4. all other harmful procedures to female genitalia for non-medical purposes

a. pricking, piercing, incising, scraping, cauterisation

Question 10

legalities of female genital mutilation

Answer 10

offence for any person to -
- perform FGM
- assist a girl to carry out FGM
- assist a non-uk person to carry out FGM outside the UK on a UK national or UK resident

7/14yrs in prision, a fine or both

Question 11

management of female genital mutilation

Answer 11

explain law
if unborn/child considered at risk then a report should be made
mandatory report all cases under 18 to police

type 3 infibulation
- de-infibulation surgical procedure
if already pregnant
- advise infibulation can lead to problems during labour or delivery
- antenatal de-infibulation perform before last 2 months of pregnancy
- if chooses csection can perform de-infibulation under spinal