Disorders of Vulva & Vagina Flashcards Preview

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Flashcards in Disorders of Vulva & Vagina Deck (15)
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1

Normal vulva epithelium

Normal vagina epithelium

Vulva: keratinized squamous epithelium, occasionally breast tissue which can get swollen and tender after delivery

Vagina: Non-keratinized squamous epithelium - pH 4.0-4.5

-Lactobacillus, aerobic, anaerobic bacteria

-No odor w/ secretions

2

Vaginitis

Change in volume/odor/color discharge, pruritus, burning, dyspareunia

Always determine etiology w/ lab documentation before treatment

Bimanual exam to check for cervical motion and uterine tenderness

3

pH

3.5-4.5

5.0-6.0

>4.5

4.0-4.5

Pregnancy

3.5-4.5: normal in premenopause

5.0-6.0: trichomoniasis

>4.5: bacterial vaginosis

4.0-4.5: Candida

Pregnancy: raises pH

4

Bacterial Vaginosis (BV)

Most common, abnormal vaginal flora - vulva will appear normal

Decreased lactobacilli, increased Gram-negative rods

Fishy odor, clue cells, thin white/gray discharge - main complaint

Tx: Metronidazole (Flagyl) TOC - cannot drink ETOH while taking tablet, make you ill

-intravaginal gel available 

Clindamycin alternative

5

Amsel Criteria for BV

Homogeneous thin grayish-white discharge

pH >4.5

Positive whiff-amine test

Clue cells on wet mount

>20% epithelial cells

6

Vulvovaginal Candidiasis

2nd most common, not an STI - usually C. albicans

Dx: Thick cottage cheese discharge, +/- gray membrane

pH 4.0-4.5, culture is rare

Tx: Uncomplicated - OTC or Fluconazole - one time dose stays in vaginal secretions for 72 hours

Complicated - Fluconazole 150 2-3 dose, or topical clotrimazole, intravaginal boric acid tablets (fatal w/ ingestion)

7

Trichomonas Vaginitis

Most common STI - flagellated protozoan

Male sx: asx w/ 90% spontaneous resolution, burning w/ urination

Female sx: ax to severe inflammatory dx

-Malodorous, thin green/yellow discharge, urethritis, pruritis, post-coital bleeding

Dx: Strawberry cervix

Tx: non-pregnant: Tinidazole (Tindamax) or Flagyl, Flagyl if pregnant or nursing

7 day course for HIV

Treat all partners, abstain from sex

8

Genital Herpes

Painful ulcers, itching, dysuria, tender inguinal lymphadenopathy, HA, fever

Dx: PCR

Herpes simplex, Condylomata acuminata - anogenital warts

Tx: Podophyllin - CI w/ pregnancy

9

Atrophic Vaginitis

Estrogen stimulation to prevent/maintain pH & blood flow

Sx: Dryness, burning, itching, decreased lubrication, dyspareunia, vaginal discharge

Tx: moisture & estrogen therapy

10

Lichen Sclerosis

Genetics or AI - peak in pubertal girls & postmenopausal women

Dx: biopsy

Sx: Vulvar pruritis, may interfere w/ sleep, pruritus, painful defecation, anal fissures

Tx: clobetasol propionate for 6-12 wks - high potency topical steroids

11

Bartholin Gland Cyst

Most common large vaginal cyst - usually asx <40 yo

->40 yo - do a bx and drainage to exclude carcinoma

If infected, usually polymicrobial, STI less likely, MRSA a risk

Tx: I&D, Marsupialization under local anesthesia

Complications: hematoma, scarring, dyspareunia

12

Cystocele

Prolapsed bladder - usually from weak supporting muscles

Tx: kegels, avoid heavy lifting, Pessary

13

Paget's Disease

Intraepithelial adenocarcinoma - extramammary disease involved genitals and perianal, axillary

Sx: brick red, scaly, velvety eczematoid plaque w/ sharp border and itchy, burning, bleeding

Tx: excision w/ >3 mm

-recurrent: laser, 5-FU, radiotherapy

14

Vulvar Cancer

unifocal vulvar plaque/ulver/mass

- secondary malignancy cervical CA in 22%

90% SCC - keratinizing, differentiating, simplex type

Spreds directly to adjacent structure

-lymphatic embolization to regional nodes early on

-Hematogenous dissemination late stage

15

Vaginal Intraepithelial Neoplasia (VAIN)

HPV detected in 80% cases

Tx: ablation, excision, 5-FU, vaginectomy

Squamous cell atypical w/o invasion

Associated w/ prior/concurrent neoplasia in lower genital tract

50-90% have neoplasia or carcinoma of cervix or vulva