Vulval Lumps

Question 1

What are ddx of vulval lumps?

Answer 1

Varicose veins
Boils
Sebaceous cysts
Keratocanthoma
Viral warts
Condylomata lata (syphilis)
Molluscum contagiosa
Bartholin's cyst or abscess
Uterine prolapse or polyp
Inguinal hernia
Varicoecoele
Carcinoma

Question 2

What are vulval warts caused by?

Answer 2

HPV

Types 6 and 11

Question 3

What is management for vulval warts

Answer 3

Treat both partners
Exclude other genital infections
Cryoterhapy, trichloroacetic acide, excision/laser to destroy warts

Podophyllotoxin cream - use every 12h for 3 days
Only treat a few warts at once to avoid toxicity

Question 4

What is urethral carbuncle?

Answer 4

Small red swelling at the urethral orifice, caused by mental prolapse
May be tender and give dysuria
Excision or diathermy

Question 5

What is Bartholin’s cyst? How do they form?

Answer 5

Fluid filled sac within one of the Bartholin’s glands of the vagina

• Located deep to the posterior aspect of the labia major - openings located either side of vaginal orifice - secrete mucus to lubricate vagina
• Build up of mucus secretions can cause th duct o the gland to become blocked, fom which a cyst can develop
• If cyst becomes infected and untreated –> Abscess (E.coli, MRSA, STI)

Question 6

What are clinical feature of Bartholin’s cysts and abscesses?

Answer 6

Cyst
Painless
If large, vulvular pain and superficial dyspareunia
Can spontaneously rupture - sudden relief of pain
Soft, fluctuant and non-tender

Abscess
Acute onset of pain and dysuria - cannot sit down
Labial mass
Tense, hard with surrounding cellulitis

Question 7

What is management for Bartholins’ cyst/abscess?

Answer 7

Word catheter - incision made into cyst or abscess and a catheter inserted, left in place for 4-6 weeks to allow epithelialsatiion of surgically created tract

Masupialisation:
Vertical incision is made into cyst allowing for spontaneous drainage of cavity
Cyst wall is everted and approximated to the end of the vaginal mcusa by sutures
Required GA (inner cyst wall is filed back and stitched to the skin)

Question 8

What should you consider in vulval ulcers

Answer 8

Syphilis - condylomata lata
Herpes simplex
Carcinoma

Question 9

Which herpes causes genital infection

Answer 9

HSV 2

Question 10

What is treatment for HSV infection?

Answer 10

Analgesia
Sal baths
Aciclovir orally for 5d
IF >6 outbreaks/year consider suppressive aciclovir

Question 11

What are carcinoma of the vulva?

Answer 11

90% squamous cell
MElanoma
BAsal cell
Carcinoma of the BArtholin’s glands

Question 12

How does carcinoma of vulva present?

Answer 12

Lump

Indurated ulcer, which may not be noticed unless it causes pain and bleeding

Question 13

What is management for vulval carcinoma?

Answer 13

If tumour <2cm width and <1mm deep, lymph node excision is not needed
If > 1mm deep, triple incision surgery - >15mm margin local incision + ipsilateral groin node biopsy (and if affected, sample contralateral side too)

Radical vulvectomy may be needed

Radioterhapy pre-op to shrink tumours