vulval disorders Flashcards
history taking for vulval shit?
PC
- itching–> atrophic vaginitis? infection? Irritants such as soaps, detergents and barrier contraception? eczema?
- pain–> is it general pain? or dyspareunia?
- bleeding
- lump
FHx
- vulvar cancer?
PMHx
- Lichen sclerosis?
- skin conditions? eczema psoraisis
- diabetes poorly controlled?–>candida thrush
Menstrual Hx
- menopause?–>vulval carcinoma
Obstetric Hx
- are u pregnant?–> candidal thrush
Sexual Hx
- smear history?
- HPV?
- sexual partners?
Dx
- Contraceptives?
- recent broad antibiotics?–> candida
System review
- urinary symptoms?–>dysuria
- Bowel
Vulvovaginal candidiasis
Rf
S & S
Mx
RFx
- DM
- drugs: antibiotics, steroids
- pregnancy
- immunosuppression: HIV
symptoms
- itching, soreness, dysuria, discharge
signs
- ‘cottage cheese’, non-offensive discharge
- vulval erythema
Mx
Antifungal cream: CLOTRIMAZOLE pessary and cream
Atrophic Vaginitis
in menopause, E levels fall, resulting in the mucosa becoming thinner, less elastic, more dry.
this tissue more prone to inflammation
Symptoms:
- Itching
- Dryness
- Dyspareunia (discomfort or pain during sex)
- Bleeding due to localised inflammation
Management
Dryness–> Vaginal lubricants ex: Sylk, Replens & YES.
Topical E–>
Estriol cream, applied using an applicator (syringe) at bedtime
Estriol pessaries, inserted at bedtime
Estradiol tablets (Vagifem), once daily
Estradiol ring (Estring), replaced every three months
Lichen sclerosis
S & S
Dx & Mx
follow up?
an inflammatory/immune-mediated condition which usually affects the genitalia and is more common in elderly females.
Lichen sclerosus leads to atrophy + white plaques
Symptoms
- ITCHHHH
- superficial dyspareunia
Signs
- porcelain-white shiny skin.
- looks tight and may see fissures
diagnosis
clinically, but a biopsy may be performed if atypical features are present*
Management
STRONG steroids–> Dermovate! & emollients
Follow-up:
increased risk of VULVAL CANCERRR
Bartholin’s Cyst
Symptoms
Pain on sitting
Dysparinua
complication:
abccess
Imporferate hymen
