vulvar swellings

Question 1

what are the classifications of FGM ?

Answer 1

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)

Question 2

what is the labia major homologous to in males ?

Answer 2

the scrotum

Question 3

where are the round ligaments of the uterus inserted into ?

Answer 3

labia majora

Question 4

what connects the posterior end of the labia majora ?

Answer 4

the posterior commissure

Question 5

what connects the posterior end of the labia minora ?

Answer 5

posterior fourchette

Question 6

what is the area inside or between the labia minora ?

Answer 6

the vestibule

Question 7

what are the contents of the vestibule ?

Answer 7

the vagina
external urethral opening
2 bartholin glands

Question 8

what is the vestibular bulb ?

Answer 8

Consists of 2 masses of erectile

tissue on each side of the vagina

Question 9

what is the function of bartholin glands ?

Answer 9

The glands secrete thin mucus during

sexual excitement acting as a lubricant

Question 10

what are bartholin glands homologous to in males ?

Answer 10

Cowper’s glands

Question 11

what are the different shapes of the hymen ?

Answer 11

• Annular.
• Biperforate/Septate.
• Cribriform.
• Fringed.
• Crescentic

Question 12

what is Carunculae myritiformes ?

Answer 12

remains of torn or lacerated hymen

Question 13

what is the blood supply of the vulva ?

Answer 13

mainly from the pudendal artery

Question 14

what is the venous drainage of the vulva ?

Answer 14

from plexuses

Question 15

what is the lymphatic drainage of the vulva ?

Answer 15

superficial inguinal LN 
deep inguinal LN 
external iliac LN 
common iliac LN 
Para-aortic LN

Question 16

what is the main nerve supply of the vulva ?

Answer 16

pudendal nerve

Question 17

what are the traumatic lesions involving the vulva ?

Answer 17

hematoma , which may occur in labour or after vulvar surgery

Question 18

what is the treatment for vulvar hematoma ?

Answer 18

incision and ligation of the bleeding vessels

Question 19

what are the inflammatory conditions of the vulva ?

Answer 19

vulvitis
Bartholin’s abscess
Condylomata lata
Condyloma accuminata

Question 20

what is the difference between condyloma lata and condyloma accuminata ?

Answer 20

lata is due to secondary syphilis

accuminata is due to HPV

Question 21

what swellings can occur in the vulva due to circulatory disorders ?

Answer 21

varicose veins
edema
elephantiasis

Question 22

what are the causes of varicose veins in the vulva and what is the management ?

Answer 22

usually due to pregnancy and is ligated and excised

Question 23

what is the cause of elephantiasis in the vulva ?

Answer 23

due to chronic lymphatic obstruction

Question 24

what are the different retention cysts in the vulva ?

Answer 24

bartholin cyst 
hydrocele of the canal of Nuck 
Endometrioma 
Inclusion dermoid cyst 
sebaceous cysts

Question 25

what is the cause of bartholin cysts ?

Answer 25

bartholinitis | episiotomy

Question 26

if the bartholin cyst were to be complicated by a secondary infection what would happen ?

Answer 26

formation of bartholin abscess

Question 27

what is the treatment of bartholin cyst ?

Answer 27

excision or marsupialization if it is already a bartholin abscess then incision and drainage is required

Question 28

how does hydrocele of the canal of nuck happen ?

Answer 28

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

Question 29

what is the treatment of hydrocele of the canal of Nuck ?

Answer 29

excision of the sac and repair of inguinal hernia if there is one

Question 30

what are inclusion dermoid cysts ?

Answer 30

small cysts containing sebaceous material due to burying of epithelium under the dermis during repair of an episiotomy

Question 31

what are sebaceous cysts ?

Answer 31

small multiple cysts caused by retention of sebum due to occlusion of the duct

Question 32

what is a hidradenoma ?

Answer 32

benign tumor of the sweat glands

Question 33

what is a caruncle ?

Answer 33

adenoma of Skene's tubules

Question 34

what are skene tubules ?

Answer 34

glands on either side of the urethra which are homologous to the prostate in males

Question 35

what is granulomatous caruncle ?

Answer 35

resulting from chronic urethritis

Question 36

what is a nevus ?

Answer 36

benign cluster of melanocytes that is not a tumor but is removed because its pre-cancerous

Question 37

what are the precancerous disorders of the vulva divided into ?

Answer 37

squamous VIN | non squamous VIN

Question 38

what are the symptoms of squamous VIN ?

Answer 38

pruritus , cases may be asymptomatic

Question 39

on examination what is observed in squamous VIN ?

Answer 39

multicentric , raised lesions a with a rough surface which are variable in color white - with hyperkeratinization red - with epithelial thinning brown - with melanin deposition

Question 40

how is a biopsy taken in squamous VIN ?

Answer 40

acetic acid is applied on the vulva and whatever turns white is taken for biopsy

Question 41

what is the treatment for squamous VIN ?

Answer 41

asymptomatic : repeated biopsies symptomatic : repeated biopsies and topical steroid creams small lesion : excision biopsy multifocal lesions: skinning vulvectomy

Question 42

what is non-squamous VIN ?

Answer 42

also known as paget's disease which is an adenocarcinoma in situ

Question 43

what is the clinical picture of non-squamous VIN ?

Answer 43

pruritus | red crusted plaques with sharp edges

Question 44

what are the associated malignancies with non-squamous VIN ?

Answer 44

adenocarcinoma of apocrine glands | cervical carcinoma

Question 45

what is the treatment for non-squamous VIN ?

Answer 45

very wide local incision , almost total vulvectomy

Question 46

what are the commonest secondary tumors due to retrograde flow ?

Answer 46

chorioamnionitis