Conditions Of The Vulva And Vagina

Question 1

What are examples of traumatic lesions of the vulva?

Answer 1

Vulvar hematomas, female genital circumcision and obstetric related trauma

Question 2

What is a vulvar hematoma?

Answer 2

Loculated collections of blood that collect following trauma (i.e. bike injuries [straddle injury*], birth trauma or sexual assault); close observation and occasional surgical exploration may be warranted

Question 3

What is obstetric related trauma?

Answer 3

Usually from lacerations or episiotomies can result in scarring

Question 4

What changes occur with lichen sclerosis?

Answer 4

Loss of labia minora, shrinking or loss of the labia majora, severe constriction of the introitus, clitoris can become inverted and trapped

Question 5

What are the features seen upon biopsy of lichen simplex chronicus?

Answer 5

Marked hyperkeratosis and parakeratosis with a prominent granular layer; Acanthodii’s with elongation of rete ridges; dense infiltrate of chronic inflammatory cells, mainly lymphocytes in the superficial dermis

Question 6

What are the features seen upon biopsy of lichen sclerosis?

Answer 6

Hyperkeratosis but the epidermis is thinner than normal; most striking feature is the presence of a hyaline zone in the superficial dermis (result of edema and degeneration of the collagen and elastic fibers of the dermis)

Question 7

Most vulvar neoplasms are what?

Answer 7

Squamous cell carcinoma

Question 8

What are the demographics of vulvar SCC?

Answer 8

Occur mainly in postmenopausal women; mean age = 65 yo

Question 9

What is the most frequently reported sx of vulvar cancer?

Answer 9

Long Hx of chronic vulvar pruritus

Question 10

What type of epithelium lines the vagina?

Answer 10

Nonkeratinized stratified squamous epithelium

Question 11

What keeps the vagina at a pH of 3.8-4.2?

Answer 11

Lactic acid and hydrogen peroxide producing lactobacilli; they also provide some protection against STI

Question 12

What are the factors that can alter the protective microflora in the vagina?

Answer 12

Abx (suppress growth of normal organisms which can lead to pathologic stains predominating (e.g. yeasts)); douching; intercourse (semen can raise pH to 7.2 for 6-8 hrs); foreign body (retained from tampon in adults or foreign object in children which can disrupt normal flora and make secondary infections more likely)

Question 13

What are the parts of an investigation of vaginal discharge?

Answer 13

Obtain Hx (discharge color, amount, texture and odor); nitrazine paper to determine vaginal pH; microscope (sample discharge from posterior fornix and place on slide)