Gynaecology: Vulval Disease

Question 1

What is the vulva?

Answer 1

Collective term for the external female genitalia.

Importantly it is SKIN, and it’s pathology is mostly dermatological.

Question 2

What are the main vulval symptoms/ presentations?

Answer 2

• Itching (eczema, psoriasis)
• Pain
• Bleeding
• Lumps

Question 3

How does vulvovaginal candidiasis/thrush present?

Answer 3

• Itchy, sore
• Discharge (thick, white, no discharge)
• Pain on urination
• Possibly previous AB use

Question 4

How do you manage VV Candidiasis?

Answer 4

Antifungals: Clotrimazole pessary and cream

Question 5

Describe the signs and symptoms of Lichen Sclerosis

Answer 5

Symptoms:

• Pain on sex or urination
• Difficulty passing urine or opening bowls
• Itchiness

Symptoms:

• Midline fusion
• Fragile atrophy
• White/glazed appearance
• Fragile tissue bleeding
• Figure of 8 distribution
• Loss of normal architecture

Question 6

What is Lichen Sclerosis?

Answer 6

Auto-immune, inflammatory condition that causes chronic inflammation and scar tissue formation, labia fusion.

Mostly affects women 50+. Can cause secondary infection or urinary retention.

RF for VIN and vulval cancer.

Question 7

How is LS managed?

Answer 7

Ultra-potent topical steroids: DERMOVATE.

Question 8

What are the Bartholin glands?

Answer 8

Small non-palpable glands which secrete lubricant during sex through a duct.

Obstruction leads to cyst and potentially abscess.

Question 9

How do Bartholin’s cysts present?

Answer 9

• Small, tender painful lump

- Generally not that erythematous

Question 10

How would a Bartholin’s Abscess present?

Answer 10

• Tender, large lump
• Significant pain
• Significant erythema
• Systemically unwell e.g. fever

Question 11

How are Bartholin’s cysts managed?

Answer 11

Conservative:

• Painkillers
• Baths help drain

Sx Management:

• Drainage and Placement of a Word catheter
• Marsupialisation; opening up the cyst and leaving it open to drain
• (both these options are more permanent fixes because B cysts tend to reccur)

Question 12

How does vulval cancer present?

Answer 12

Ulcerative lesion on the vulva (SCC)

Question 13

What are the RFs for vulval cancer?

Answer 13

• HPV
• Lichen sclerosis
• Increasing age

Question 14

How do you investigate vulval cancer?

Answer 14

• Biopsy
• Staging CT + FIGO staging
• Lymph node involvement suggests poor prognosis

Question 15

How is vulval cancer managed?

Answer 15

Largely surgical excision w or w/o radiotherapy

Question 16

What are the complications of LS?

Answer 16

• Secondary infection
• Fissures
• UR
• Cancer
• VIN
• Constipation