6 - Gynae - Disorders of the Vulva and Vagina - Miscellaneous Benign Disorders

Question 1

name the 9 benign disorders of the vulva

Answer 1

lichen simplex, planus and sclerosus
vulvar dysaesthesia (vulvodynia)/vulval pain syndromes
infection of vulva and vestibule
bartholins gland cyst/abscess
introital damage
vaginal cysts
vaginal adenosis

Question 2

Vaginal adenosis - when ?? found in normally ? epithelium of vagina. Common in women whos mum had ? in preg (ass w ? abnormalities)
Usually what happens? v occasionally turns ? (? cell ?)
Women w ? exposure in utero are screened ? with ?. May also occur 2’ to ?

Answer 2

columnar epithelium - squamous
DES - tract abnormalities
spont resolution
malignant - clear cell ca
DES annually with colposcopy
trauma

Question 3

Vaginal cysts - ? cysts commonly arise in vagina. ? ? appearance. can be as large as ? ball. Often mistaken for ?
Seldom cause Sx but excise if ? .

Answer 3

congenital - smooth white - golf - prolapse - dyspareunia

Question 4

Introital damage - commonly after ?. what three things commonly presx with sf dyspareunia?
Sx resolve with ?
If introitus too ? - vaginal ? or surgery (? repair) used.

Answer 4

childbirth
overtightening, extensive scar tissue, incorrect apposition
time
tight - dilators - fentons repair

Question 5

Bartholins gland cyst/abscess-
2 glands behind ?? secr ? ? for coitus. ?of ducts -> ?
if ? occurs, commonly with ? or ?, an ? forms
Presents as acutely ?, ? tender red ?.
Trt with ? and ?, and ? where incision stitched open to prevent ?

Answer 5

labia minora secr lubricating mucus for coitus
blockage > cysts
infection, s aureus/e coli, abscess
painful, large, tender red swelling
incision and drainage and marsupialisation - reformation

Question 6

infections of the vulva and vestibule -
4 infections affecting vulva?
? may affect vulva if prolonged ? ? - more common in ?, ?, ? use or ? - presx with ? and ? of vulva and anus, rather than ? - a prolonged ? or oral ? may be needed.

Answer 6

HSV, vulval warts, syphilis, donovnanosis
candidiasis - moisture exposure - DMs, preg, ABx use or imm comp - present with irritation and soreness - rather than discharge
topical antifungal

Question 7

Vulvar dysaesthesia (vulvodynia)/Vulval pain syndromes-
diagnosis of ?, w no ? of ? vulval disease.
it can be provoked or ? and is subdivided by ? - Local (vestibular) or ?.
-ass w many RFs including Hx of ? tract infections, former use of ? ? and ? disorders.

Answer 7

exclusion, evidence, organic
spont, site, generalised
genital, oral contraceptive, psychosexual

Question 8

Vulvar dysaesthesia (vulvodynia)/Vulval pain syndromes-

• spontaneous generalised vulvar dysaesthesia = ? pain, more common in ? pts. Vulvar dysaesthesia -> ? dyspareunia/ pain using ?, more in ? women, exclude ? ? .
• ? agents seldom useful, ?/? sometimes used.

Answer 8

burning, older
sf, tampons, younger, introital damage
topical, gabapentin/amitriptyline

Question 9

Lichen Simplex (chronic vulval dermatitis)
-women w ? skin, ? or ? can presx w ? Sx -> lichen simplex - a ? inflam skin condition.
Presentx - severe ? ?, esp at night. Usually labia ?, inflamed and ? with hyper and hypo ?

Answer 9

sensitive, eczema, dermatitis
vulval, chronic
intractable pruritis
majora - thickened - pigmentation

Question 10

Lichen Simplex (chronic vulval dermatitis) - Sx exacerbated by ? or ? dermatitis, sometimes linked to ? or low body ? . vulval ? if diagnosis in doubt. irritants eg ? should be avoided, ? , ?potent ? creams and ? used to break ?? cycle

Answer 10

chemical - contact - stress - iron - biopsy - soap - emollients - mod - steroid - antihistamines - itch-scratch

Question 11

Lichen planus - common disease, affecting ? on body, esp ? surfaces eg mouth and ?
Presx w ?, papular, ? lesions. In mouth and genitals it can be ?, more commonly gives ? rather than ?. aetiology may be ? . all ?, not linked to ? status. Trt with ? potency steroid creams and avoid ?

Answer 11

anywhere - mucosal - genitals - flat - purplish - erosive - pain - pruritis - autoimmune - ages - hormonal - high - surgery

Question 12

Lichen Sclerosus - vulval ? is ?, loss of ?
may have ? basis, ? disease and ? may coexist.
around ?% have or go on to develop another ? condition.
typically ?, occasionally much ?.
causes severe ?, which may worsen at ?

Answer 12

epithelium - thin - collagen

autoimmune - thyroid - vitiligo - 40 - autoimmune - postmenopausal - younger - pruritis - night

Question 13

Lichen Sclerosus - uncontrollable ? may lead to trauma w ? and ? splitting giving Sx of discomfort, pain and ?
appearance: pink-white ?, that coalesce to give ? like skin with fissures.
inflam ? can form > ? of labia and narrowing of ?
vulval carcinoma candev in ?%
? important to exclude ? and confirm diagnosis. Trt w ultra-potent ? ?

Answer 13

itching - bleeding - skin - dyspareunia - papules - parchment - adhesions - fusion - introitus - 5 - biopsy - carcinoma - topical steroids