Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Vulval Conditions > Flashcards

Vulval Conditions Flashcards

1
Q

What are the differentials of vulval itch?

A

Candidiasis, trichomoniasis, pubic lice, scabies, vulval intra-epithelial neoplasia, atrophic vulvovaginitis, dermatitis, psoriasis, lichen sclerosis/planus/simplex chronicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is lichen sclerosis?

A

Inflammatory scarring dermatoses of ano-genital skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who tends to suffer from lichen sclerosis?

A

6-10x more common in women

2 peaks = prepubertal girls and postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What tends to be the clinical course of lichen sclerosis?

A

Usually resolves in children but tends to be more chronic and relapsing in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the symptoms of lichen sclerosis?

A

Itch = worse at night

Pain, dyspareunia, constipation (especially children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some red flag signs for vulval cancer?

A

Persistent ulcer, lump, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some risk factors for lichen sclerosis?

A

21% linked with other autoimmune diseases (especially thyroid)
Smoking carries higher risk of developing complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Can lichen sclerosis have a psychosocial impact?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the examination signs of lichen sclerosis?

A

White papules and plaques = figure 8 pattern on vulval and perineal skin, vagina not involved
Ecchymosis, erosions, fissures, architectural change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How common is extra-genital skin involvement in lichen sclerosis?

A

Occurs in 10% of women with vulval disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the main differential of lichen sclerosis?

A

Lichen planus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some features of lichen planus?

A

Affects genital skin and mucous membranes
Usually patients aged 50-60
Associated with autoimmune disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the symptoms of lichen planus?

A

Itch, pain, dyspareunia, discharge

May be oral, nail or hair involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the other differentials of lichen sclerosis?

A

Vitiligo, mucous membrane pemphigoid, morphoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the main complication of lichen sclerosis?

A

Squamous cell carcinoma = up to 5% risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is some general skin care advice for patients with vulval itch?

A

Wash gently once daily with soap substitute and try to avoid scratching/irritants
Apply emollients to relieve dryness and itching, and to act as barrier = Epimax is first line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment of lichen sclerosis?

A

General skin care

Super potent topical steroid = clobetasol propionate 0.05% (dermovate), 1/2 fingertip amount, 12 week regime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What initial investigations are done for vulval itch?

A

High vaginal swab for infection and STI screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the symptoms of atrophic vulvovaginitis?

A

Itch, pain, mild thin white discharge, vaginal dryness, dyspareunia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the signs of the atrophic vulvovaginitis?

A

Atrophy of labia, narrowing of vaginal opening, petechial haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is atrophic vulvovaginitis associated with?

A

Low levels of oestrogen = tends to occur in postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the symptoms of the genitourinary syndrome of the menopause?

A

Narrowing of the vaginal opening, labial atrophy, decrease in vaginal length, thinning of vaginal wall, urinary symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is atrophic vulvovaginitis treated?

A

Vaginal oestrogen = can be taken with HRT

Perineal massage, lubricants, vibrator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can vaginal oestrogen be delivered?

A

Cream, oestring implant (lasts 3 months), pessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the benefits of vaginal oestrogen?

A

Doesn’t cause endometrial hyperplasia/cancer with long term use and has little systemic absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What may women with atrophic vaginitis develop?

A

Secondary vaginismus = body anticipates pain and tenses, increasing pain during sex further

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the differentials of vulval pain?

A 
Acute = herpes, aphthous ulcers, shingles, trauma, Bartholin's cyst or abscess, dermatitis
Chronic = vulvodynia, female genital mutilation, pudendal nerve dysfunction, lichen sclerosis/planus, vulval intraepithelial neoplasia
28
Q

What is vulvodynia?

A

Vulval discomfort, usually described as burning pain, occurs in absence of relevant findings or neurological disorder

29
Q

What are the classifications of vulvodynia?

A

Generalised or localised

Provoked, unprovoked or mixed

30
Q

What it usually required for vulvodynia to develop?

A

Usually requires a trigger in vulnerable individual

31
Q

What are the symptoms of vulvodynia?

A

Vulval pain during sex, burning/raw pain, feeling like there is a blockage

32
Q

What are the signs of vulvodynia?

A

High tone at introitus, tender on advancing speculum

33
Q

What are the differentials of vulvodynia?

A

Psychosexual issue, pudendal neuropathy, sacro-iliac joint problems, pelvic organ prolapse, skin conditions

34
Q

What is the management of vulvodynia?

A

Genital skin care and emollients
Localised provoked pain = lidocaine 5% ointment
Vaginal trainers and physiotherapy
Unprovoked pain = tricyclics, gabapentin/pregabalin

35
Q

What should be covered in the subjective assessment of a patient with vulvodynia by the physio?

A

Presenting complaint, location and characteristic of pain, co-morbidities, psychogenic factors, surgery

36
Q

What should be covered in the objective assessment of a patient with vulvodynia by the physio?

A

Examination of joints and vagina, muscle testing, vaginismus, posture, body language and behaviour

37
Q

What treatments can the physio offer for vulvodynia?

A

Lumbar spine and/or pelvic girdle mobilisation techniques, posture, movement strategies, core stability exercises, manual handling and stretching, biofeedback, acupuncture

38
Q

What is female genital mutilation?

A

All procedures involving partial or total removal of external female genitalia or other injury to female genital organs for non-medical reasons

39
Q

Why is female genital mutilation practiced?

A

Insurance of virginity and chastity, cultural identity, religious beliefs (not supported by any doctrine)

40
Q

What is type 1 female genital mutilation?

A

Clitoridectomy = partial or total removal of clitoris and/or prepuce

41
Q

What is type 2 female genital mutilation?

A

Excision = partial or total removal of clitoris and labia minora, with or without excision of labia majora

42
Q

What is type 3 female genital mutilation?

A

Infibulation = narrowing of vaginal orifice with creation of covering seal by cutting and appositioning labia minora and/or labia majora, with or without excision of clitoris

43
Q

What is type 4 female genital mutilation?

A

All other harmful procedures to female genitalia for non-medical purposes

44
Q

What is the legal stance on female genital mutilation?

A

Illegal in UK to perform FGM, assist any girl to carry out FGM or assist a non-UK person to carry out FGM outside UK on UK resident

45
Q

What are the short term complications of female genital mutilation?

A

Haemorrhage, urinary retention, genital swelling, infection, sepsis

46
Q

What are the long term complications of female genital mutilation?

A

UTI (types 2 and 3), urinary stricture or fistula, dyspareunia or apareunia, PTSD, haematocolpos, HIV, hep B

47
Q

What are the obstetric complications of female genital mutilation?

A

Obstructed labour, postpartum haemorrhage, perineal trauma and sphincter injury, C-section, stillbirth

48
Q

What should be included in the examination of a patient with female genital mutilation?

A

Inspection of the vulva = needed to determine type of FGM

49
Q

How is type 3 female genital mutilation treated?

A

De-infibulation = ideally offer before first intercourse and pregnancy

50
Q

When should antenatal de-infibulation be offered?

A

Before last 2 months of pregnancy = can give under spinal if mother chooses to have C-section

51
Q

What should be done if female genital mutilation is identified?

A

Must explain UK law on FGM
Report to social work if unborn child at risk
Individual risk assessment done by midwife/obstetrician using FGM safeguarding risk assessment tool

52
Q

Do you have to report all pregnant women identified as having suffered female genital mutilation?

A

No = not mandatory to report all women but have duty to protect any children recognised to be at risk

53
Q

What are the acute differentials of painful genital lesions?

A

Ulceration = herpes, shingles, aphthous ulcers
Lumps = Bartholin’s abscess, abscess, furuncle/caruncle, hydradenitis supparative
Trauma

54
Q

What are the chronic differentials of painful genital lesions?

A

Lichen sclerosis, lichen planus, vulval intraepithelial neoplasia, vulval cancer

55
Q

How can vulval cancer present?

A

May present with burning sensation in vulva associated with itching

56
Q

What may be seen on examination of vulval cancer?

A

Raised vulval ulcer = may have keratinisation in middle and indurated edges
May have satellite lesions

57
Q

What investigations can be done for vulval cancer?

A

Lesion biopsy
USS of groin if lymph node involvement
MRI of perineum if lesion close to anus

58
Q

What area should be included in a biopsy for vulval cancer?

A

Area of epithelium where there is transition of normal to malignant tissue in biopsy

59
Q

Is vulval cancer common?

A

No = most common type is squamous cell carcinoma

60
Q

Where do vulval adenocarcinomas tend to occur?

A

In Bartholin’s glands

61
Q

What are the precursors of vulval cancer?

A

HPV in young women

Lichen sclerosis in older women

62
Q

How is vulval cancer treated?

A

Mainstay is surgery = chemoradiotherapy can be used as adjuvant, may need reconstruction by plastic surgeons

63
Q

How long do you follow vulval cancer up for?

A

5 years post-treatment

64
Q

What vulval cancer lesions are suitable for wide local excision without groin node dissection?

A

Lesions confined to vulva/perineum with stromal invasion <=1mm

65
Q

What vulval cancer lesions are suitable for wide local excision and groin node dissection?

A

Lesion confined to pelvis, but >1mm depth of invasion

66
Q

How are vulval cancer lesions with obvious groin node involvement treated?

A

Chemoradiotherapy

Reproduction (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions