Vulvar Disease Flashcards
What is the Clinical appearance of Bacterial Vaginosis? Treatment?
Musty/Fishy odor Gray/White to yellow discharge pH >4.5 KOH test +Amine odor \+ whiff test Clue Cells Oral or topical metronidozol
What are the S and S of Candidiasis?
Itching
External Dysuria
Cottage Cheese
How is Candidiasis diagnosed??
Visualization of blastophores or pseudohyphae on saline or KOH
What are the Treatments of Candidiasis?
Imidazole Miconazole Clotrimazole Terconazole Fluconazole in Preggo
What are the S and S of Trichomoniasis?
Frothy discharge
Yellow-green discharge
Strawberry cervix
Edema, erethema of vulva
How is Trich Diagnosed?
Microscopic Exam
Nucleic Acid Probe test
How is Trich Treated?
Oral Metronidazole or Tinidazole
Tx partner too
What is the cause of Atrophic Vaginitis?
Dryness and Decreased Vaginal Discharge 2/2 decreased estrogen from Menopause
What is the Tx of Atrophic Vaginitis?
Moisturizing preparations
Topical or oral estrogen therapy
What are examples of Benign Vulvar disease?
Lichen Sclerosis Lichen Simplex Chronicus Lichen Planus Psoriasis Dermatitis Vulvar pain Syndrome Vulvar Lesions
What is the Presentation of Lichen Sclerosis?
Intense itching
What is the Tx of Lichen Sclerosis?
Bland emollients
Cotton underwear
No soaps on vulva
Superpotent steroid ointment 2x daily for 1 mon then 1x day
What is Lichen Simplex Chronicus?
“an itch that rashes”
2/2 an irritant dermatitis that progresses to LSC
What is the Tx of Lichen Simplex Chronicus?
Stop irritant
Antipruritic: Diphenhydramine or hydroxyzine combined with steroid cream
Antidepressant
What is Lichen Planus?
Rare inflammatory skin condition
Desquamative lesion of the vagina
Whitish lacy bands of keratosis near reddish ulcerated-like lesions
What is the Treatment of Lichen Planus?
Topical Steroid Cream
Hydrocortisone cream
More likely to recurr
What is the Tx of Vulvar Dermatitis?
Remove attending agent
Good perineal hygeine
Topical Corticosteroids
Oral antipruritics at bedtime
What are the Tx of Psoriasis?
Coal tar followed by UV light
Topical Steroids more effective
What is a Sebaceous Cyst?
Blockage of Sebaceous gland duct
Small, smooth nodular mass
Filled with cheesy sebaceous material
What is the Cyst of the canal of Nuck?
Round Ligament inserts into labia majora
Peritoneal fluid collects within
Excision may be needed
What is a Bartholin Gland Cyst?
Located at 4 and 8 on posterolateral aspect of Introitus
Mucus Secreting Gand
Cystic Dilation 2/2 obstruction of the duct
What is the Tx of Bartholin cyst?
Incision and drainage if painful
Recurrent cyst may be marsupialized
Abtx if N. Gonnorhea
Cover S. Aureus if cellulitis occurrs
What is seen in Paget’s disease of vulva?
Chronic Pruritis Velvety red lesions scar into white plaques Biopsy Wide local incision Fatal if it spreads to LN
What is Vulvar Intraepithelial Neoplasm?
50% asymptomatic
Vulvar Pruritis
Do colposcopy and biopsy
What is the Tx of VIN?
Assume it will progress to Vulvar CA
Wide local excision
Laser Excision
What is the most common type of Vulvar Cancer?
Squamous cell CA
What is the appearance of Vulvar Cancer?
Found on labia majora
-Cauliflower like mass
What are the risk factors of Vulvar Cancer?
Manopausal Status CIN, VIN, HPV Cigarette smoking Immunosupression h/o cervical CA
What is the Tx of Vulvar Cancer?
Wide local excision with inguinal LN dissection
Pelvic Rad of + mets to nodes
What is Premalignant Disease of the Vagina?
Vaginal intraepithelial Neoplasia Similar to VIN and CIN Less common Diagnosed: on PAP Colposcopy Biopsy
What is Tx and FU of VaIN?
Local Resection
Laser Ablation
5-FU
Colposcopy every 6 mon until disease free
What predisposes someone to Clear Cell Adenocarcinoma?
in utero exposure to DES
How is Vaginal Cancer Diagnosed?
Watery, blood tinged vaginal discharge Postmenopausal Bleeding Vaginal pruritis Found on PAP or Colposcopy Biopsy!
What is the Tx of Vaginal Cancer?
Stage 1, 2 surgical resection
Stage 3, 4 radiation
