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Womens Health Exam 1 > Vulvovaginal disorders > Flashcards

Vulvovaginal disorders Flashcards

1
Q

The Normal Healthy Vaginal Environment is due to

A

· Symbiotic relationship of multiple aerobic, facultative anaerobic and obligate
anaerobic species

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2
Q

Vaginal Mucosa is made up of

A

stratified squamous non-keratinized epithelium
- relatively anerobic habitat

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3
Q

pH of the Normal Healthy Vaginal Environment

A

pH between 4.0 - 4.5
* Alkaline environment thanks primarily to Lactobacillus species (gram-
positive species that produces H 2O 2 , bacteriocins compounds, organic
acids including lactic and fatty acids)

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4
Q

Glycogen function in the vaginal environment

A

Glycogen present in vaginal mucosal cells – provides nutrients to the
ecosystem, metabolized to lactic acid (low in childhood and diminishes after
menopause = lower prevalence of lactobacillus species à rise in pH à altered
environment à risk of infections)

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5
Q

What things can cause vaginal dysbiosis?

A

· Hormone levels (age, pregnancy, menstrual cycle)
· Sexual activity
· Chronic stress
· Medications, soaps, detergents
· Regional disparities (local biome) & hygiene/
cultural practices
· Genetic factors such as immune system

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6
Q

What is Vulvovaginitis?

A

inflammation of the vulva and vagina

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7
Q

Vulvovaginitis etiology & risk factors

A

Etiology: pathogens (infection) or non-pathogenic sources causing
skin reaction (soaps, detergents, intercourse)
* candida albicans
* Trichomonas vaginalis
* Bacterial vaginosis
* Condylomata acuminata

Risk Factors: recent sexual activity, hormone changes, use of
contraceptives, tampons or douches

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8
Q

Vulvovaginitis presentation & eval?

A

HPI – onset, location, duration of sx,
character of sx, ?triggers (ask about risk factors), palliating and alleviating
factors, LMP date, recent medications

PE – external exam of vulva, speculum exam of vagina & cervix

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9
Q

Diagnostic evaluation of vulvovaginitis

A

Labs – obtain cultures for yeast, BV, trichomonas
UA for GC/Chlamydia
pH
Wet mount prep
+/- STI testing

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10
Q

Treatment of vulvovaginitis

A

infections (covered later), pt education of risk factors: avoid/stop offending agent, sitz bath, ?short course of topical steroids

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11
Q

What is Vulvar Dermatoses?

A

benign and neoplastic disorders of the lower vaginal tract

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12
Q

Lichen Sclerosus

A

a chronic skin condition that results in thin white patches on the skin, usually associated with vulva & perineum

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13
Q

Vulvar Dermatoses: Lichen Sclerosus etiology & risk factors

A

Etiology: unknown (Theories: Autoimmune, vitamin A deficiency, pathogen)
* Not a/w LS of pregnancy, hysterectomy or hormone replacement
Risk Factors: age; a/w a higher risk of vulvar malignancy
(squamous cell ~5%)

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14
Q

Clinical features and eval of Vulvar Dermatoses: Lichen Sclerosus

A

HPI - Pruritis, dysuria, dyspareunia, sx often
worse at night

PE – ivory-white, circumscribed atrophic patches, skin appears thin and
crinkled texture is generally pathognomonic; may involve perineum.

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15
Q

Treatment of Vulvar Dermatoses: Lichen Sclerosus

A
  • symptom control – topical corticosteroids, gentle cleansers, avoidance of harsh chemicals, abrasion like sex or panty liners;
  • Estrogen cream – used only to help with epithelial integrity
  • prevention of anatomical changes – surgeryC
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16
Q

Complications & referral considerations of vulvar Dermatoses: Lichen Sclerosus

A

Complications: skin thins over time risking infection, labia minora
regression, clitoral concealment, urethral obstruction
Referral: derm or gyn for biopsy, in long-standing cases to rule out
malignancy

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17
Q

Dermatoses: Lichen Simplex Chronicus etiology

A

vulvar skin changes resulting from chronic-
trauma from scratching/irritation; skin responds by thickening –> lichenification
* Irritation from any number of precipitating causes:
* Yeast infections, STIs, etc.
* Dermatitis (moisturizers, tight clothing, over-
washing, sweat, etc.)

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18
Q

Risk factors of Dermatoses: Lichen Simplex Chronicus

A

poor adherence to treatments for
precipitating causes; worse with stress

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19
Q

Clinical features of Dermatoses: Lichen Simplex Chronicus

A

thickened vulvar skin with increased
skin markings, no loss of anatomical structure

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20
Q

Diagnosis of Dermatoses: Lichen Simplex Chronicus

A

Evaluation: Rule out candidiasis/other possible precipitating causes
Biopsy to rule out psoriasis which can contribute to malignancies

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21
Q

Treatment & Management of Dermatoses: Lichen Simplex Chronicus

A

STOP THE SCRATCH CYCLE!
* oral antihistamines, topical steroids, treatment of underlying condition

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22
Q

Dermatoses: Contact Dermatitis

A

inflammatory response to a primary irritant or allergen

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23
Q

Etiology & Risk Factors of Contact Dermatitis

A

based on allergy profile; about 54% of
unexplained cases of vulvar puritus and inflammation

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24
Q

Clinical Presentation of Contact Dermatitis

A

immediate itching/burning
sensation (irritant); delayed onset of itching, localized erythema, edema, and possibly vesicle/bullae formation if due to allergen

Evaluation: consider patch testing, look for associated conditions: candidiasis, psoriasis, SCC

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25
Q

Dermatoses: Contact Dermatitis diagnosis

A

primarily based on H&P and evaluation for other conditions

26
Q

Treatment of Dermatoses: Contact Dermatitis

A
  • remove offending agent,
  • restore skin barrier function (sitz bath plain water, plain petrolatum),
  • treat any underlying infection,
  • Consider topical steroids
  • Cool packs (NOT COLD)
  • Antihistamine (hydroxyzine)
27
Q

Bartholin’s Gland Abscess etiology

A

Bartholin gland is obstructed
secondary to either trauma or
inflammation

28
Q

Clinical Presentation of Bartholin’s Gland Abscess

A

pain, swelling, erythema, dyspareunia, difficulty
walking

29
Q

Management &Treatment of a Bartholin’s Gland Abscess

A

depends on size and if it is self-draining
* Small: sitz baths, warm compresses
* Moderate-Large: I&D, culture, Word catheter placement, +/- antibiotic if systemic sx

30
Q

Complications of a Bartholin’s Gland Abscess

A

large abscesses or cyst formations may require marsupialization vs. complete excision

31
Q

Cystocele

A

weak vaginal wall à protrusion of bladder into vaginal vault

32
Q

Risk Factors for a cystocele

A

multiparous, age, hysterectomy, obesity/increased abdominal pressure,
genetics

33
Q

Clinical Presentation of Cystocele

A

dyspareunia, incomplete bladder emptying à recurrent UTIs and/or incontinence, discomfort with coughing/lifting/standing

34
Q

Evaluation & Diagnosis of a cystocele

A

PE – clinical, bladder studies

35
Q

Treatment & Management of a cystocele

A

Mild – pelvic floor PT/kegels, vaginal estrogen
Mod/Severe – pessary, surgery (refer to urology, GYN)

36
Q

Rectocele etiology & risk factors

A

Etiology: Increased pelvic floor pressure
Risk Factors: multiparous, age, repeated heavy
lifting, chronic constipation, straining, cough

37
Q

Clinical presentation & evaluation of a rectocele

A

Clinical Presentation: sensation of hernia,
constipation or fecal incontinence, dyspareunia
Evaluation & Diagnosis: PE (clinical)

38
Q

Management & Treatment of a rectocele

A

Expectant: pelvic floor
training, avoidance of risk factors
Referral: for pessary or surgery if severe, worsening

39
Q

Vaginal/Uterine Prolapse etiology and risk factors

A

Etiology: Stretched/weakened pelvic floor muscles and ligaments
Risk Factors: Multiparous, age, genetics, obesity

40
Q

Clinical Presentation & evaluation of Vaginal/Uterine Prolapse

A

dyspareunia, incomplete bladder emptying à recurrent UTIs
and/or incontinence, discomfort with coughing/lifting/standing
Evaluation & Diagnosis: PE – clinical, bladder studies

41
Q

Treatment & Management of Vaginal/Uterine Prolapse

A

Mild – pelvic floor PT/kegels, vaginal estrogen
Mod/Severe – pessary, surgery (refer to urology, GYN

42
Q

Supportive measures for Pelvic Organ Prolapse

A
  • High-fiber diet and laxatives to improve constipation
  • Weight reduction in persons with obesity
  • Limitation of straining and lifting are helpful
43
Q

The only cure for symptomatic cystocele, rectocele, or enterocele is _____

A

corrective surgery

44
Q

Vaginal Candidiasis etiology

A

C. albicans normal resident of the human body
* imbalance between this yeast and its host à candidiasis.
* Other species: C tropicalis and C glabrata,
* Sexual transmission is uncommon, and treatment of sexual partners is
unnecessary

45
Q

Risk factors for Vaginal Candidiasis

A

mmunosuppression, diabetes mellitus (some meds), pregnancy, and recent broad-spectrum antibiotic use

46
Q

Clinical presentation & eval of Vaginal Candidiasis

A

Clinical Presentation: vulvar pruritus, burning, erythema, and edema,
Evaluation & Diagnosis: On PE you may see excoriations (common),
* Ivory-white vaginal discharge “cottage cheese–like”
* Microscopic examination with saline and 10% KOH prep –> yeast

47
Q

Treatment & Management of Vaginal Candidiasis

A

Consider probiotic products (lactobacillus)

Uncomplicated = sporadic, immunocompetent pts, and likely C albicans
* Azoles very effective
* Fluconazole 150 mg PO x 1

Complicated = frequent recurrence, severe symptoms, immunosuppressed pts and/or non-albicans species
* Fluconazole 100-mg, 150mg or 200 mg PO q72h (once every 3 days) x 3 doses
* Consider suppression therapy with fluconazole

48
Q

MOST COMMON CAUSE of vaginal discharge among reproductive age women

A

Bacterial Vaginosis

49
Q

Bacterial Vaginosis etiology

A

overgrowth of anaerobic species, usually Gardnerella, but also
Prevotella, Mobiluncus, and Bacteroides species; Atopobium vaginae.
There is also a significant reduction in Lactobacillus.

50
Q

Risk Factors for Bacterial Vaginosis

A

not considered an STI
* multiple or new sexual partners, female partners, oral sex, douching, Black race,
smoking, and intrauterine device (IUD) use
* condom use lowers the risk

51
Q

Clinical presentation of Bacterial Vaginosis

A
  • nonirritating, malodorous vaginal discharge but not always present.
  • examination reveals no abnormalities: vagina is not erythematous, cervix is
    normal in appearance
52
Q

Evaluation & Diagnosis of Bacterial Vaginosis

A

PE
Wet Prep: swab-collected sample of
discharge mixed with drops of saline on a
microscope slide

53
Q

_____ are the most reliable
indicators of BV

A

Clue cells

54
Q

Bacterial Vaginosis complications

A

observed in women with BV include:
* vaginitis, endometritis, post-abortal endometritis,
* pelvic inflammatory disease (PID) unassociated with Neisseria gonorrhoeae or Chlamydia trachomatis,
* susceptibility to human immunodeficiency virus (HIV) acquisition, and
* acute pelvic infections following pelvic surgery, especially hysterectomy

55
Q

Vaginal Chlamydia etiology & risk factors

A

Etiology: sexually transmitted C trachomatis infection
Risk factors: unprotected sex (of any kind), multiple partners

56
Q

Vaginal Chlamydia clinical features and eval

A

Clinical Features: pelvic pain, vaginal discharge (white),
dysuria
Evaluation & Diagnosis: Nucleic Acid Amplification Test
(NAAT) of urine sample, vaginal or cervical swab, reportable
disease

57
Q

Complications of vaginal chlamydia

A

Pelvic Inflammatory Disease
abstinence until woman/partners treated and asymptomatic

58
Q

Vaginal Gonorrhea etiology & risk factors

A

Etiology: sexually transmitted N. gonorrheae infection
Risk Factors: unprotected sex (all kinds), multiple sexual partners and MSM

59
Q

Most frequently reported ID in the US

A

Vaginal Chlamydia

60
Q

Women are often asymptomatic who have _____

A

Vaginal Gonorrhea

61
Q

Clinical Presentation & eval of Vaginal Gonorrhea

A

Clinical Presentation: often asymptomatic, yellowish discharge, pelvic pain, dysuria
Evaluation & Diagnosis: NAAT endocervical swab

62
Q

Complications of vaginal gonorrhea

A

Pelvic Inflammatory Disease
abstinence until woman/partners treated and asymptomatic

Womens Health Exam 1 (7 decks)

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