vulvar swellings Flashcards
what are the classifications of FGM ?
type 1: partial or total removal of the clitoris and/or the prepuce
type 2: removal of the clitoris and the labia minora with or without the labia majora
type 3: tightening of the vaginal orifice by removing all parts of the external genitalia ( if=nfibulation)
what is the labia major homologous to in males ?
the scrotum
where are the round ligaments of the uterus inserted into ?
labia majora
what connects the posterior end of the labia majora ?
the posterior commissure
what connects the posterior end of the labia minora ?
posterior fourchette
what is the area inside or between the labia minora ?
the vestibule
what are the contents of the vestibule ?
the vagina
external urethral opening
2 bartholin glands
what is the vestibular bulb ?
Consists of 2 masses of erectile
tissue on each side of the vagina
what is the function of bartholin glands ?
The glands secrete thin mucus during
sexual excitement acting as a lubricant
what are bartholin glands homologous to in males ?
Cowper’s glands
what are the different shapes of the hymen ?
- Annular.
- Biperforate/Septate.
- Cribriform.
- Fringed.
- Crescentic
what is Carunculae myritiformes ?
remains of torn or lacerated hymen
what is the blood supply of the vulva ?
mainly from the pudendal artery
what is the venous drainage of the vulva ?
from plexuses
what is the lymphatic drainage of the vulva ?
superficial inguinal LN deep inguinal LN external iliac LN common iliac LN Para-aortic LN
what is the main nerve supply of the vulva ?
pudendal nerve
what are the traumatic lesions involving the vulva ?
hematoma , which may occur in labour or after vulvar surgery
what is the treatment for vulvar hematoma ?
incision and ligation of the bleeding vessels
what are the inflammatory conditions of the vulva ?
vulvitis
Bartholin’s abscess
Condylomata lata
Condyloma accuminata
what is the difference between condyloma lata and condyloma accuminata ?
lata is due to secondary syphilis
accuminata is due to HPV
what swellings can occur in the vulva due to circulatory disorders ?
varicose veins
edema
elephantiasis
what are the causes of varicose veins in the vulva and what is the management ?
usually due to pregnancy and is ligated and excised
what is the cause of elephantiasis in the vulva ?
due to chronic lymphatic obstruction
what are the different retention cysts in the vulva ?
bartholin cyst hydrocele of the canal of Nuck Endometrioma Inclusion dermoid cyst sebaceous cysts
what is the cause of bartholin cysts ?
bartholinitis
episiotomy
if the bartholin cyst were to be complicated by a secondary infection what would happen ?
formation of bartholin abscess
what is the treatment of bartholin cyst ?
excision
or
marsupialization
if it is already a bartholin abscess then incision and drainage is required
how does hydrocele of the canal of nuck happen ?
a peritoneal pouch that is accompanied by the round ligament during development remains instead of becoming obliterated , fluid accumulation occurs in this peritoneal pouch and causes hydrocele and may extend into the inguinal canal
what is the treatment of hydrocele of the canal of Nuck ?
excision of the sac and repair of inguinal hernia if there is one
what are inclusion dermoid cysts ?
small cysts containing sebaceous material due to burying of epithelium under the dermis during repair of an episiotomy
what are sebaceous cysts ?
small multiple cysts caused by retention of sebum due to occlusion of the duct
what is a hidradenoma ?
benign tumor of the sweat glands
what is a caruncle ?
adenoma of Skene’s tubules
what are skene tubules ?
glands on either side of the urethra which are homologous to the prostate in males
what is granulomatous caruncle ?
resulting from chronic urethritis
what is a nevus ?
benign cluster of melanocytes that is not a tumor but is removed because its pre-cancerous
what are the precancerous disorders of the vulva divided into ?
squamous VIN
non squamous VIN
what are the symptoms of squamous VIN ?
pruritus , cases may be asymptomatic
on examination what is observed in squamous VIN ?
multicentric , raised lesions a with a rough surface which are variable in color
white - with hyperkeratinization
red - with epithelial thinning
brown - with melanin deposition
how is a biopsy taken in squamous VIN ?
acetic acid is applied on the vulva and whatever turns white is taken for biopsy
what is the treatment for squamous VIN ?
asymptomatic : repeated biopsies
symptomatic : repeated biopsies and topical steroid creams
small lesion : excision biopsy
multifocal lesions: skinning vulvectomy
what is non-squamous VIN ?
also known as paget’s disease which is an adenocarcinoma in situ
what is the clinical picture of non-squamous VIN ?
pruritus
red crusted plaques with sharp edges
what are the associated malignancies with non-squamous VIN ?
adenocarcinoma of apocrine glands
cervical carcinoma
what is the treatment for non-squamous VIN ?
very wide local incision , almost total vulvectomy
what are the commonest secondary tumors due to retrograde flow ?
chorioamnionitis
