Women's Health- Vulval disorders Flashcards
anatomy of the vagina and vulva
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how does a bartholins gland cyst develop
swelling of the labia majora
tender
can develop to an abcess
treatment of sebaceous cysts, boils and carbuncles
incision and drainage
tend to recur
describe cysts of the canal of Nuck
embryological remnants
type of benign neoplasm
also described as a female hydrocele
treated surgically
where is lymphogranuloma venereum commonly seen
in the tropics
L1-L3 of chlamydia trachomatis
benign infective cause of swelling of the inguinal nodes
what is the gold standard for diagnosis of HSV
viral culture from the vesicles
what are maternal risks of genital herpes in pregnancy (RARE)
meningitis
sacral radiculopathy
dysuria/ urinary retention
transverse myelitis
disseminated infection
what are fetal risks of genital herpes in pregnancy
transmission rate from vaginal delivery during primary infection may be as high as 50%- eyes/mouth/ disseminated/ delayed milestones
what is the management for genital herpes in pregnancy
treatment with aciclovir to reduce risk of recurrent outbreak
can crohns disease affect the vuval?
yes- rare phenomenom
cutaneous manifestation of IBD
granulomatous genital inflammation/ulcers/ erythema/ draining fistula
if Crohn’s vulval complications are not treated what can happen?
what are rare causes of ulceration
what are vulval dermatoses
range of benign skin conditions
causes white patches or fissures
-lichen Sclerosus
-Lichen planus
-vulval dermatitis
-lichen simplex chronicus
-vuval psoriasis
-eczema (atopy)
-contact dermatitis (allergens)
describe lichen sclerosus
chronic, AI
1:300- 1:1000
burning pain, itch
white, shiny, wrinkly
figure of 8
causes loss of architecture with labial fusion
needs a biopsy
treated with potent steroid ointment
if neglected can cause vulval squamous cell cancer
describe lichen planus
rare
purplish papules/plaques
white streaks on them
wickhams striae/ mouth and vulva
painful red ulcerative area atound interoitus
itch, pain, PCB, discharge
Mx same as lichen sclerosis- potent steroid
describe lichen simplex chronicus
thickening of the skin due to scratching
describe vulvodynia/vestibulodynia
dysaesthesia- poorly localised constant vulval pain or around the introitus
burning/stinging/raw discomfort/neuropathic pain
worse when sitting down
can be sequele of LS
examination- notmal/painful with Qtip
describe vulval intraepithelial neoplasia
pre invasive condition
dysplastic lesion of squamous epithelium
HPV 16 is oncogenic
smoking/immunosuppression
VIN 1 &2 causes loss of differentiation in the lower third and two thirds of the epidermis respectively
VIN 3 LOD od entire epidermis with intact BM
how does vulval intraepithelial neiplasia present
itchy, warty, flat, erythematous
it is biopsied
medical treatment is imiquimod cream- 15-20% recurrence
surgical is not recommended as there is high risk of recurrence but options are Wide local excision
describe pagets disease
intraepithelial abnormal glandular cells
pre invasive lesion for adenocarcinoma of the vulva
4-8% are associated with primary adenocarcinoma
describe vulval cancer
80% of cases are >65 years old
aetiology: LS/VIN/ Pagets? LP
85% SCC 5% malignant melanoma, 10% adenocarcinoma
affects vagina, urethra, clitoris and rectum
spread is to ingiuno femoral nodes
itch, ulcer, mass, bleeding
MRI
what is the management for vulval cancer?
FIGO staging
1a- wide local excision
1b- IV a Radical vulvectomy and bilateral groin node dissection
chemo + radio treatment if nodes involved
