Conditions of the Vulva and Vagina

Question 1

Examples of ambiguous genitalia presentations

Answer 1

Bifed Clitoris
Clitoromegaly
Cloaca
Labiascrotal fold fusion

Question 2

In Female Pseudohermaphroditism, what are the most obvious presentations?

Answer 2

Masculinization of a female fetus presenting with clitoromegaly, hypospadiac urethra, malposititioned vagina.
Internal organs normal

Question 3

What is the most common cause of male pseudohermaphroditism?

Answer 3

Genetic Mosaicism- Can result in AIS

Question 4

Androgen Insensitivity Syndrome

Answer 4

Results from deficiency/inactivity of androgen receptors.
46XY genetic male, phenotypic female
X-linked recessive
Testes are undescended and need to be removed due to risk of malignancy

Question 5

In True hermaphroditism, what genitalia are present?

Answer 5

Both male and female internal/external

Question 6

List the congenital anomalies of the vulva

Answer 6

Pseudohermaphroditism
Androgen Insensitivity Syndrome
Hermaphroditism

Question 7

List the Benign conditions of the Vulva

Answer 7

Labial Agglutination
Fox-Fordyce Disease
Inclusion Cysts 
Vulvar Varicosities 
Lentigo and Nevi 
Urethral Caruncles
Vulvar Vestibulitis 
Sebacious Cysts
Fibromas/Lipomas
Hidradenoma
Syringoma 
Neurofibroma
Angioma

Question 8

What is the treatment for Labial Agglutination?

Answer 8

Estrogen Cream and massage to separate the majora

Question 9

What disease results from keratin-plugged inflammation of apocrine glands in the axilla, major and minora that results in a yellow raised cyst?

Answer 9

Fox-Fordyce Disease

Question 10

How would you describe an inclusion cyst?

Answer 10

sub epidermal, mobile, nontender, spherical cyst that typically doesn’t require treatment
MOST COMMON genital cyst

Question 11

What are vulvar varicosities

Answer 11

Enlarged, distended veins that can become painful around the vulva

Question 12

Urethral Caruncles develop from damage to what?

Answer 12

Urethral Epithelium.
Appears as a small fleshy red outgrowth at the distal edge of the urethra due to either prolapse of epithelium (children) or eversion of epithelium (post-menopausal females)

Question 13

A woman suffering from severe dyspareunia with 1-4mm erythematous dots that are extremely tender is due to which glands becoming infected?

Answer 13

Minor Vestibular Glands (Vulvar Vestibulitis)

Question 14

Where do sebaceous cysts usually present?

Answer 14

inner surface of labia minora/majora

Pussy Pimple

Question 15

What is the most common benign solid tumor of the vulva?

Answer 15

Fibromas

Question 16

What benign pathology arises from a lesion in the sweat gland of the vulva?

Answer 16

Hidradenoma

“Sweating needs hydration”

Question 17

Syringoma

Answer 17

Eccrine gland tumor

Question 18

How do angiomas present?

Answer 18

2-3 mm red lesions in 40’s and 50’s

Question 19

Traumatic Lesions of the Vulva

Answer 19

Hematomas
Circumcision
Obstetric trauma

Question 20

Atrophic Vaginitis results in what presentation?

Answer 20

Labial regression
Loss of Rugae
Vaginal orifice constriction

Question 21

Lichen Simplex Chronicus results in thickening/thinning of epithelium?

Answer 21

thickening due to itch/scratch cycle

Ddx: Psoriasis

Question 22

A menopausal woman complains of pruritus, pain with sex, and burning. Exam reveals vulvar thinning with a parchment like appearance. What is the diagnosis?

Answer 22

Lichen Sclerosis

Question 23

Lichen Planus

Answer 23

6 P’s: Purple, Pruiritic, Polygonal, Papules, Planar, Plaques

Question 24

In psoriasis of the vulva, are the characteristic silver scales always present?

Answer 24

Not always, so may just appear erythematous

Question 25

Triad of symptoms in Bechet’s Disease

Answer 25

Genital and Oral ulcers with uveitis

Question 26

What is a common cause of decubitus ulcers of the vulva?

Answer 26

Incontinence

Question 27

Allison sits naked on a couch covered with cat hair that she is allergic to. What is she at risk for developing?

Answer 27

Contact Dermatitis

Question 28

Vaginal Introitus anomalies

Answer 28

Imperforate Hymen

Vaginal Septa

Question 29

Gartner’s Duct cysts arise from remnants of what?

Answer 29

Wolfiann Ducts

Question 30

What is Adenosis?

Answer 30

Islands of glandular tissue in the normal vaginal epithelium.
Caused by DES exposure or malignancy

Question 31

Urtheral Diverticula can cause recurrent what?

Answer 31

UTI’s
Dysuria
Urethral dilation

Question 32

Define Endometriosis

Answer 32

Uterine tissue growth outside of the Uterus

Question 33

What is the most common vulvovaginal tumor?

Answer 33

Bartholin Cyst

Question 34

A 42 y/o woman presents with a swelling lateral to her vulva that is painless and nonerythematous. After ruling out hernia, it is diagnosed as the most common vulvovaginal tumor. What should you do next?

Answer 34

Biopsy to rule out carcinoma. It’s a Bartholin Cyst and she’s over 40

Question 35

Describe a Cystocele vs. a Rectocele

Answer 35

Cystocele is caused by the bladder impinging on the anterior vagina
Rectocele is caused by the rectum impinging on the posterior vagina

Question 36

Describe the 3 types of Fistulas

Answer 36

Rectovaginal
Uretherovaginal
Viscovaginal

Question 37

Which VIN-III is associated with HPV?

Answer 37

VIN usual-type

differentiated is associated with dermatologic conditions

Question 38

Paget’s Disease of the Vulva

Answer 38

demarcated eczematous appearance with fiery red background

Question 39

How does Vulvar SCC present?

Answer 39

Pruritic, raised ulcerated lesion that is pigmented or warty

Question 40

Which type of Malignancy of the vulva is radiation contraindicated?

Answer 40

Verrucous Carcinoma

Question 41

What is Vaginal Intraepithelial Neoplasia (VEIN)?

Answer 41

HPV related neoplasia treated with 5-FU

Question 42

What neoplasia presents as a grape-like cluster protruding from the vagina?

Answer 42

Sarcoma Botryoides aka Rhabdomyosarcoma

Question 43

A strawberry cervix is associated with what type of infection?

Answer 43

Trichomoniasis