Benign genital tract disorders Flashcards
(59 cards)
Diagnosis of benign epithelial disorders of vulva/vagina?
CLINICALLY.
Lichen sclerosis
Thinning of the vulvar skin. Sx: asymptomatic or can have pruritis/dyspareunia
An inflammatory dermatosis
Postmenopauseal women
3-4% inc risk of vulvar skin cancer
Lichen planus
Papular or erosive lesions of the vulva that may also involve vagina. Pruritis–>severe erosions.
Purple papules with white striae on vulva
Complication of vaginal adhesions with erosive vaginitis
50s or 60s
3-4% inc risk of vulvar skin cancer
Lichen simplex chronicus
“itch that rashes”; chronic pruritis
THICKENED skin because of the scratching
When should you biopsy the lesion?
If there is ulceration, unifocal lesion, uncertain suspicion of lichen sclerosis, unidentifiable lesions, unresponsive to treatment.
Treatment?
Hygeine, loose clothes, unscented soaps.
Topical steroid like clobetasol for LS, LP, or SEVERE LSC
MC tumor found on the vulva?
Epidermal inclusion cysts. Formed by occlusion of hair follicle.
Sebaceous cyst
When duct of sebaceous gland is blocked. Often multiple and asymptomatic
Hiradenitis suppurativa
Skin disease that affects the apocrine sweat glands
Where is skene’s gland?
Next to the urethral meatus
Where are Bartholin’s glands?
4 and 8 o’clock
How do you treat a Bartholin’s gland cyst? Recurrent ones?
What should you do in one that appears in a woman over 40?
Word catheter placement (balloon left in place for 4-6 wks then serially reduced in size while the cyst/tract re-epithelialize)
Marsupialization- incision, removal, cyst wall sutured to vaginal mucosa to prevent reformation.
Over 40- biopsy it to r/o rare possibility of Bartholin’s gland carcinoma.
What is a Gartner duct cyst? Usually found where?
Presenting sx?
Rx?
Remnant of the mesonephric ducts of the Wolffian system.
Anterolateral vagina.
Usually ASYMPTOMATIC but could have dyspareunia or difficulty inserting a tampon
Excision (use vasopressin bc they tend to bleed a lot)
Rx of urethral caruncles or urethral prolapse? Who?
None req.
Postmenopauseal women due to vulvovaginal atrophy.
DES exposure #1 risk?
Cervical insufficiency in pregnancy.
Clear cell adenocarcinoma of cervix and vagina in only 0.1% of exposed!!!!! Women under 20
What is a nabothian cyst?
Dilated retention cyst of the cervix. Caused by intermittent blockage of an endocervical gland.
Usually asymptomatic.
Look like dots on cervix.
Rx of cervical polyp that is asymptomatic?
Remove it anyway bc it could mask something BAD, like cancer, fibroids, adenomyosis, etc.
Symptoms of cervical polyp
Intermenstrual or postcoital spotting
Can cervix have fibroids?
Yes, either arising from it OR prolapsing into it from the endometrial cavity
What complications can a cervical fibroid have in pregnancy?
Poor dilation, malpresentation, obstruction of the birth canal, hemorrhage (think stretching out during dilation and bam.)
What can lead to cervical stenosis?
Infection, atrophy, scarring, idiopathic
Neoplasm, polyp, fibroid.
Sx of cervical stenosis?
ASYMPTOMATIC and doesn’t affect menstruation or fertility
Rx of cervical stenosis?
IF there are sx, gently dilate cervix. Can leave a catheter in for a few days.
How does labial fusion come about?
Excess androgen exposure or enzymatic deficiency. MC from CAH 21-a-hydroxylase deficiency.
