Benign Conditions of the Vulva/Vagina, Psychosexual Disorders and FGM

Question 1

Lichen planus

Answer 1

Recurrent inflammatory disorder of skin and mucous membranes

Question 2

Lichen planus Rx

Answer 2

1st line; High dose topical steroids (clobetasol)

2nd line: Topical calcineurin inhibtor (tacrolimus)

Question 3

Lichen sclerosus

Answer 3

itchy white patches ?immune related

Question 4

Lichen sclerosus Mx

Answer 4

Good skin care
1st line: strong steroid ointment (clobetasol)
2: calcineurin inhibitor (tacrolimus)

Question 5

Pruritis Vulvae

Answer 5

Possible causes: infection eczema, contact dermatitis
Remove soap/cause
Mild steroid -> stronger if severe

Question 6

Bartholin cyst/abcess Mx

Answer 6

C: if cyst discharging and patient well Rx: fluclox.
S: incision and drainage (+/- Word catheter to retain patency)

Question 7

Marsupialisation of a cyst?

Answer 7

Suture internal aspect to outside preventing reformation

GA/Spinal anaesthesia

Question 8

PACES counselling of a Bartholin cyst

Answer 8

RF: nulliparous, child bearing age, Hx
Dx: infected blockage of duct
Mx: observation and ABx, I+D +/- Word catheter, marsupialisation
Recommend STI screen

Question 9

Vaginismus

Answer 9

pelvic floor spasm preventing sex, examination, tampon insertion

Question 10

Vaginismus Mx

Answer 10

Say I’m using a “small” speculum
Encourage self exploration
Discuss is surgery and option

Question 11

FGM - Your requirements?

Answer 11

Any case reported in notes
Any case in <18y report to police
Check if there are girls at risk

Question 12

FGM Mx

Answer 12

De-infibulation:

• ideally pre-conceptually
• under adequate sedation
• incision made on vulval scar
• prior UTI screen
• Access to support