Vulvovaginal Flashcards
What tissue makes up vulvar and vaginal tissue
Squamous epithelial cells
What hormone helps thicken the vaginal mucosa
Estrogen
What produces lactic Acid and is a natural barrier
Lactobacilli
What is caused by an alteration in normal vaginal flora
Bacterial vaginosis
What bacteria causes bacterial vaginosis
Gardenerella vaginalis
What does BV do to the ph of the vagina?
Increases the PH
Name the dx.
Fishy malodorous, thin Grey white milky discharge
Bacterial vaginosis
What is needed for dx of BV
3/4 Amsels criteria
What is the 4 parts of Amsel’s criteria
Homogeneous thin Grey white discharge
+ whiff test
+ clue cells
Vaginal PH >4.5
What is added in order to determine the whiff test
Koh
Treatment for bacterial vaginosis
Metronidazole (Flagyl) 500 mg BID for 7 days
Do you need to treat sexual partners for BV
No
What bacteria causes candidiasis
Candida albicans
The following can cause what vaginal dz? Antibiotics Douching Increased estrogen levels Increased blood sugar Decreased immune system
Candidiasis
Name the dx.
Intense itching and redness near the vagina with a thick white vaginal discharge
Candidiasis
What is the gold standard to diagnosis candidiasis
Vaginal culture
What will you see on wet prep of candidiasis
Branching pseudohyphae and budding spores
What is the treatment of candidiasis
Antifungals : azoles
Topical: for vulvar sx
Systemic: Fluconazole (Diflucan) 150mg once
When is candidiasis considered recurrent
More than 4 cases a year
What is the most prevalent non-viral STI
Trichomoniasis
What bacteria causes trichomoniasis
Trichomonas vaginalis
Name the dx.
Frothy, thin yellow-green, malodorous discharge with a strawberry cervix
Trichomoniasis
What does the discharge look like in trichomoniasis
Frothy, thin yellow-green, malodorous discharge
What does the wet prep show in trichomoniasis
Motile flagellates and increased number of PMNs
Treatment of trichomoniasis
Metronidazole (Flagyl) 2g one dose
Does the partner of a pt with trichomoniasis need treated?
Yes
If you want to retest for trichomoniasis when is it suggested
3 months
What are you at risk for with trichomoniasis
Increased risk of PID and infertility
Hiv
Preterm delivery and premature rupture of membranes in pregnancy
What is due to topical irritants that causes discharge, itching, and burning
Chemical vaginitis
Treatment for chemical vaginitis
Stop the offending agent
What causes atrophic vaginitis
Decreased estrogen levels
What is the treatment of atrophic vaginitis
Vaginal moisturizers and lubricants
What is a complication of a FB in the vagina
TSS
What causes Toxic shock syndrome
Endotoxins of s. Aureus
Name the dx.
A patient comes to you with a high fever, sore throat, malaise, and a macular rash of palms and soles
Toxic shock syndrome
How do you diagnosis TSS
Positive wound or mucosal culture
What is the treatment of TSS
Empiric antibiotics
Clindamycin IV + vancomycin IV
What is the most common benign epithelial vulvar disorder
Lichen sclerosis
What are patients at risk of if they have lichen sclerosis
Squamous cell carcinoma
Name the dx.
White lesions that form plaques, intense itching, if scratched can cause telangiectasia, fissures and ulcers
Lichen sclerosis
How do you diagnosis lichen sclerosis
Biopsy
Treatment of lichen sclerosis
High potency steroid: Clobetasole 0.05%
What glands help lubricate during sexual arousal
Bartholin gland
Name the dx.
Patient comes to you with a pain near her vagina. States that she noticed a bump down there that is painful and swollen
Bartholin cyst
Treatment of bartholin cyst
Infected: I&D
Or Word catheter: leave in 4-6 weeks
Recurrent abscess: marsupialization
When can you not preform marsupialization on a bartholin cyst
When acutely infected
What 2 premalignant lesions are associated with HPV
Vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN)
What are risk factors for developing VIN and VAIN
Smoking and immunocompromised
Patients may present with vulvar itching or pain. This is often associated with candidiasis but they get no relief from treatment. Lesions may be white, brown, red, or black
Vulvar intraepithelial neoplasia
How do you diagnosis vulvar intraepithelial neoplasia
Biopsy
What is follow up for vulvar intraepithelial neoplasia
Every 6 months for 5 years after last treatment and then annually
This is often diagnosed by abnormal Pap smear, but no cervical lesions are found
Vaginal intraepithelial neoplasia
How do you diagnosis vaginal intraepithelial neoplasia
Biopsy
What is the follow-up plan for vaginal intraepithelial neoplasia
Cytology smears every 6 months for 1–2 years then annually
What is the treatment for vaginal intraepithelial neoplasia and vulvar intraepithelial neoplasia
Wide excision
Laser ablation: for multiple small lesions
For young pts can use topical Imiquimob
What decreases your risk of developing vulvar intraepithelial neoplasia or vaginal intraepithelial neoplasia
HPV vaccine
What is the most common type of vulvar cancer
Squamous cell carcinoma
What are the 2 pathways for development of vulvar cancer
- Relation to HPV infection-younger women
2. Chronic inflammation and vulvar dystrophy-older women
Name the dx.
Long history of itching with a vulvar lump/mass that is normally raised
Vulvar cancer
Where does squamous cell carcinoma in vulvar cancer normally arise
Labia
How do you treat vulvar cancer
Wide local excision with lymph node dissection
What is the most important prognostic factor when diagnosing vulvar cancer
Lymph node involvement
What cancer is vaginal cancer normally associated with
Squamous cell carcinoma
What type of cancer is most common with vaginal cancer
Squamous cell carcinoma
Name the dx.
Abnormal Pap smear. On the posterior 1/3 of vagina is a mass
Vaginal cancer
Where is the most common site for vaginal cancer
Posterior upper 1/3 of vagina
What is the treatment for vaginal cancer
Hysterectomy + vaginectomy + lymphadenectomy if stage 1
Chemo and XRT for advanced stages
What was prescribed to pregnant women to prevent miscarriage in 1938-1971
Diethylstilbestrol (DES)
What is DES linked to
Clear cell carcinoma of vagina in women
