Women's Health- Vulval disorders

Question 1

anatomy of the vagina and vulva

Answer 1

**

Question 2

how does a bartholins gland cyst develop

Answer 2

swelling of the labia majora

tender

can develop to an abcess

Question 3

treatment of sebaceous cysts, boils and carbuncles

Answer 3

incision and drainage

tend to recur

Question 4

describe cysts of the canal of Nuck

Answer 4

embryological remnants

type of benign neoplasm

also described as a female hydrocele

treated surgically

Question 5

where is lymphogranuloma venereum commonly seen

Answer 5

in the tropics

L1-L3 of chlamydia trachomatis

benign infective cause of swelling of the inguinal nodes

Question 6

what is the gold standard for diagnosis of HSV

Answer 6

viral culture from the vesicles

Question 7

what are maternal risks of genital herpes in pregnancy (RARE)

Answer 7

meningitis

sacral radiculopathy

dysuria/ urinary retention

transverse myelitis

disseminated infection

Question 8

what are fetal risks of genital herpes in pregnancy

Answer 8

transmission rate from vaginal delivery during primary infection may be as high as 50%- eyes/mouth/ disseminated/ delayed milestones

Question 9

what is the management for genital herpes in pregnancy

Answer 9

treatment with aciclovir to reduce risk of recurrent outbreak

Question 10

can crohns disease affect the vuval?

Answer 10

yes- rare phenomenom

cutaneous manifestation of IBD

granulomatous genital inflammation/ulcers/ erythema/ draining fistula

Question 11

if Crohn’s vulval complications are not treated what can happen?

Question 12

what are rare causes of ulceration

Question 13

what are vulval dermatoses

Answer 13

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)

Question 14

describe lichen sclerosus

Answer 14

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

Question 15

describe lichen planus

Answer 15

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

Question 16

describe lichen simplex chronicus

Answer 16

thickening of the skin due to scratching

Question 17

describe vulvodynia/vestibulodynia

Answer 17

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

Question 18

describe vulval intraepithelial neoplasia

Answer 18

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

Question 19

how does vulval intraepithelial neiplasia present

Answer 19

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

Question 20

describe pagets disease

Answer 20

intraepithelial abnormal glandular cells

pre invasive lesion for adenocarcinoma of the vulva

4-8% are associated with primary adenocarcinoma

Question 21

describe vulval cancer

Answer 21

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

Question 22

what is the management for vulval cancer?

Answer 22

FIGO staging

1a- wide local excision
1b- IV a Radical vulvectomy and bilateral groin node dissection

chemo + radio treatment if nodes involved