Vulval Vagina Flashcards
Vulvodynia definition + SX
chronic pain lasting >3mo that presents with burning of the vulva
SX
○ Localized, provoked: vulval vestibule
○ Generalized, unprovoked: entire vulva
○ Primary: pain has always been there
○ Secondary: pain has come on after sensitising genital condition (candidiasis)
chronic vulval burning
can be provoked by tampons, sex, tight clothes
afterburn: pain continues for hours to days after, an include dysuria (often misdiagnosed as a UTI)
Vulvodynia IX and MX
no specific test
look for candidiasis as a trigger
avoid speculum exams -> pain
educate
reassure that it is a common condition
genital skin care: clean outside, dry, lubricants for sex
pelvic floor physio
Needing medical MX: topical lignocaine, Tricyclic antidepressants (for neuropathic pain mx)
Vaginismus
Painful spasmodic condition of the vagina in response to physical contact or pressure especially during sex
- Cycle: dyspareunia → fear of pain w intercourse → anxiety → vaginismus - Primary: always been present - Secondary: following a trigger - Situational: only certain situations - Global: all penetration is painful
SX
- Tightening of vaginal muscle -> inability to penetrate
- Tension, pain, burning on penetration
- Decreased libido, avoiding sex
- Phobia, fear of pain
MX
- 1st line: pelvic floor physio (combination of manual techniques, dilation, pt education & desensitisation) - Anxiolytic medications - Local Botox injections to pelvic floor muscles
Vulval carcinoma SX
new vulval lump is vulva CA until proven otherwise in older patients
presents: lump/growth on vulva, itchiness/burning sensation, AUB (IMB, PCB, PMB), D/C
Vulval carcinoma SX
new vulval lump is vulva CA until proven otherwise in older women >40
presents: lump/growth on vulva, itchiness/burning sensation, AUB (IMB, PCB, PMB), D/C
Vulval intraepithelial neoplasia
associted with HPV 16/18
younger patients
warty structure on vagina
usually resolves spontaneously, can progress to malignant SCC
SX
raised, defined lesions
warty, multiple
itchy, sore, catches on undies
often self resolves
Vulval carcinoma
arises mainly from HPV mediated VIN that progresses (squamous cell dysplasia)
older patients
DX with BX
raised ulcer/lump, non healing itchy, painless
IX
- vulvoscopy with acetic acid -> white lesion w BX of labia (iodine can be used to better visualise)
- HPV PCR
- Imaging for staging
MX
- wide local excision +/- LN
- skinning vulvectomy
- hemi-vulvectomy
Vulval carcinoma
arises mainly from HPV mediated VIN that progresses (squamous cell dysplasia)
older patients
DX with BX
raised ulcer/lump, non healing itchy, painless
IX
- vulvoscopy with acetic acid -> white lesion w BX of labia (iodine can be used to better visualise)
- HPV PCR
- Imaging for staging
MX
- wide local excision +/- LN
- skinning vulvectomy
- hemi-vulvectomy
Vaginal carcinoma
more likely to arise as a result of mets from ovarian CA (rather than primary)
SX
- PCB, PMB, IMB
- watery vaginal D/C
- dysparenunia
- fistula in advanced CA
HPV rx
EX: Immobilised, erythematous mass on posterior wall
IX with punch BX and staging
MX
- hysterectomy, vaginectomy, radiation
Bartholin’s cyst and abscess
- In puberty, Bartholin’s glands secrete lubricant
- Obstruction of the gland -> retention of secretions -> cyst
- Cyst may then become infected (polymicrobial) -> abscess (e. Coli, Neisseria, chlamydia)
Vulval/vaginal cysts SX
occurs in usually in women of reproductive age
cyst signs
- small -> asymptomatic
- larger -> dysparaunia, local irritation
Abscess
- painful, erythema, fever, D/C, swelling
Vulval vaginal cysts IX
Clinical usually
in women >40 -> unlikely presentation -> BX to R/O vulval CA
Vulval/vaginal Cysts MX
Asymptomatic -> conservative, SITZ bath
symptomatic -> marsupialization
Vulval/vaginal Cysts MX
Asymptomatic -> conservative, SITZ bath
symptomatic -> marsupialization
SKENE’S DUCT ABSCESS
- The skene’s ducts provide lubrication to the urethral meatus, located close to 12 o-clock
- Often aSx, may cause urinary obstruction, incomplete emptying, dysuria when they are larger
