Vulval Disease

Question 1

What is lichen sclerosis?

Answer 1

autoimmune condition - elastic tissue turns to collagen

Question 2

How does lichen sclerosis present?

Answer 2

usually after middle age
intensely itchy vulva
‘bruised’ red purpuric signs
bullae, erosions and ulcerations

Question 3

What eventually happens to the vulva in lichen sclerosis?

Answer 3

becomes white, flat, shiny

Question 4

In lichen sclerosis, why is there long term surveillance if its unresponsive to treatment?

Answer 4

can be premalignant

Question 5

What is the treatment of lichen sclerosis?

Answer 5

topical steroid - clobetasol proporionate

vulval ablation - to relieve itch

Question 6

What is leukoplakia?

Answer 6

white vulval patches due to skin thickening and hypertrophy

Question 7

How does leukoplakia present?

Answer 7

itch

white patches

Question 8

How is leukoplakia diagnosed?

Answer 8

biopsy - as may be premalignant

clinical

Question 9

How is leukoplakia diagnosed?

Answer 9

topical corticosteroid
PUVA
methotrexate, ciclosporin

Question 10

How does lichen planus present?

Answer 10

pain
itch - less likely than pain
in mouth and genital areas
can be erosive - well demarcated glazed appearance around introitus

Question 11

How is lichen planus treated?

Answer 11

vulval care

Question 12

What is lichen simplex?

Answer 12

non specific inflammation of the vulva

Question 13

What can exacerbate lichen simplex?

Answer 13

stress
sensitising chemicals
low iron

Question 14

How does lichen simplex present?

Answer 14

chronic itching
worse at night
history of sensitive skin or eczema

Question 15

What is the treatment of lichen simplex?

Answer 15

vulval care
steroids to break itch/scratch cycle
antihistamines can help

Question 16

What is vulval care?

Answer 16

soap substitute for washing 
clean vulva once daily with hand 
loose fitting cotton underwear 
sleep without pants 
avoid soaps, bubble bath, shower gels 
regular emollient use

Question 17

What is vulval intraepithelial neoplasia? (VIN)

Answer 17

pre invasive phase of vulval malignant

Question 18

What drives VIN?

Answer 18

usually HPV (esp type 16)

Question 19

What is VIN like in younger people?

Answer 19

often multifocal, recurrent and persistent causing treatment problems

Question 20

What is VIN like in older people?

Answer 20

greater risk of progression to invasive squamous carcinoma

Question 21

How is VIN diagnosed?

Answer 21

biopsy

5% acetic acid stains affected areas

Question 22

How is VIN treated?

Answer 22

wide local excision

with access to reconstructive surgery afterwards

Question 23

What are 90% of vulval carcinomas?

Answer 23

vulvar invasive squamous carcinoma

Question 24

Who usually gets vulvar invasive squamous carcinoma?

Answer 24

elderly women

Question 25

How does vulvar invasive squamous carcinoma present?

Answer 25

vulval lump

indurated ulcer - bleeding, pain

Question 26

How is vulvar invasive squamous carcinoma treated?

Answer 26

wide local excision and ipsilateral groin node biopsy

more advanced disease: radical vulvectomy, inguinal lymphadenectomy

Question 27

What causes vulval/genital warts?

Answer 27

HPV
types 6 and 11
usually spread by sexual contact

Question 28

How are genital warts treated?

Answer 28

diathermy, cryocautery, laser

self application of podophyllotoxin cream

Question 29

What is a bartholins cyst?

Answer 29

Bartholin’s glands lie under labia minora - secrete thin mucus
duct blocks - painless cyst

Question 30

What is a Bartholin’s abscess?

Answer 30

if Bartholin’s cyst becomes infected

Question 31

How does a Bartholin’s abscess present?

Answer 31

hugely painful - can’t sit down (Maddie)
hugely swollen, hot, red labia
big swelling

Question 32

How is a Bartholin’s abscess treated?

Answer 32

incision and drainage