Disorders of vulva and vagina.

Question 1

What is lichen planus? (2)

Answer 1

Can affect skin anywhere but particularly mucosal surfaces such as mouth and genitals.
They are flat, papular, purple lesions and can be painful or pruritic.

Question 2

What is lichen sclerosis? (2)

What are the symptoms? (2)

Answer 2

Vulval epithelium is thin and has loss of collagen.
There may be an autoimmune basis and thyroid and vitiligo may co-exist.

Intense itching, particularly at night. Scratching can cause bleeding, discomfort and dyspareunia.

Question 3

What is a Bartholin’s gland cyst/abscess? (2)

Answer 3

The two glands behind the labia minor produced lubricating mucus for coitus. Blockage of this duct cause cyst formation, which can then become infected to form an abscess.

Question 4

What is the most common cancer of the vulva? (1)

Answer 4

Squamous cell carcinoma. (95%)

Question 5

Name 2 risk factors for vulval cancer. (2)

Answer 5

Presence of VIN, smoking, lichen sclerosis, immunosuppression, Paget’s disease of the vulva.

Question 6

What is the management of vulval carcinoma? (2)

Answer 6

Biopsy
Wide local excision
Groin node dissection
Radiotherapy if LN involved.

Question 7

Define a prolapse. (1)

Answer 7

Descent of the uterus and/or vaginal walls beyond normal anatomical confines as a rest of weakness in the supporting structures.

Question 8

What are the four main types of prolapse. (4)

Answer 8

Urethrocoele: prolapse of the lower anterior vaginal wall
Cystocoele: prolapse of upper anterior vaginal wall
Rectocoele: prolapse of lower posterior vaginal wall
Enterocoele: prolapse of the upper posterior vaginal wall

Question 9

What is a vault or apical prolapse? (1)

Answer 9

Apical: where uterus, cervix and top of vagina prolapse
Vault: after hysterectomy, top of vagina prolapses

Question 10

Name 3 factors that predispose to a prolapse. (3)

Answer 10

• Vaginal delivery: esp large foetus, prolonged second stage, instrumental delivery
• Congenital factors: Ehlers-Danlos
• Menopause
• Chronic factors: chronic increase in intra-abdominal pressure eg obesity, constipation, chronic cough
• Iatrogenic: Pelvic surgery

Question 11

What symptoms are associated with a uterovaginal prolapse? (2)

Answer 11

Often asymptomatic.
Dragging sensation or lump coming down.
Bulge of vaginal wall visible from outside or using Sims’ speculum.

Question 12

How can a prolapse be prevented? (2)

Answer 12

• Improved management of labour: early recognition of obstructed labour, avoidance of prolonged second stage.
• Pelvic floor exercises after birth.

Question 13

Name 3 treatments for the management of prolapse. (3)

Answer 13

Conservative: stop smoking, lose weight
Pessaries: ring or shelf- change 6-9 monthly.
Surgical repair: anterior/posteriod repair as necessary; Hysteropexy or vaginal hysterectomy for uterine.

Question 14

Why are pre-pubertal girls and post-enopausal women at higher risk of vaginal infections? (1)

Answer 14

lack of oestrogen causes thin atrophic epithelium with a higher pH and increased susceptibility for infection.

Question 15

What is endometritis? (1)

Answer 15

Infection of the endometrium. Usually ascending infection from the lower genital tract or secondary to instrumentation of the uterus

Question 16

What is the most common cause of PID? (2)

Answer 16

Chlamydia and gonorrhoea.

Question 17

name 2 risk factors for developing PID. (2)

Answer 17

Previous STI, within 20 days of IUD/IUS insertion, multiple sexual partners, lack of barrier contraception, age<25.

Question 18

How is PID treated? (2)

Answer 18

Analgesia, antibiotics.
Surgery if abscess.
Consider contact tracing.

Question 19

Name 2 complications of PID. (2)

Answer 19

Pelvic abscess, chronic PID, chronic pelvic pain, subfertility, ectopic pregnancy.