Gynaecological Problems 3

Question 1

How does vulva pruritus present?

Answer 1

itching of the vulva
persistent
causes distress
particular bad at night and may disturb sleep

Question 2

What are the causes of vulva pruritus?

Answer 2

candidiasis 
vulval warts 
public lice, scabies 
any derm disease 
carcinoma 
premalignant disease

Question 3

What is endometriosis?

Answer 3

presence and growth of tissue similar to endometrium outside the uterus

Question 4

What are the clinical features of endometriosis?

Answer 4

none 
dysmenorrhoea 
chronic pelvic pain 
dysmenorrhoea (before menstruation)
subfertility 
pain on passing stool during menstruation
cyclical bowel and bladder symptoms 
dysuria 
tenderness behind uterus/adnexa

Question 5

what are the differentials of endometriosis?

Answer 5

adenomyosis
chronic pelvic inflammatory disease
chronic pelvic pain
IBS

Question 6

What is chronic pelvic pain? CPP

Answer 6

defined as intermittent or constant pain in lower abdomen or pelvis of >6 months duration, not exclusively with menstruation or intercourse

Question 7

How does chronic pelvic pain present?

Answer 7

migraine

low back pain

Question 8

What are the differentials for CPP?

Answer 8

endometriosis 
adenomyosis 
malignancy 
gynae or pelvic adhesions 
IBS 
interstitial cystitis 
psychological factors 
pelvic congestion syndrome 
myofacial syndrome

Question 9

What are the causes of pelvic infection?

Answer 9

usually ascending infection of bacteria in the vagina and cervix
more common with multiple partners
can also be descending infection

Question 10

How does pelvic infection present?

Answer 10

asymptomatic
subfertility 
menstrual problems 
bilateral lower abdomen pain 
abnormal vaginal bleeding

Question 11

What are the basic investigations for pelvic infection?

Answer 11

endocervical swabs for chlamydia and gonococcus blood cultures if fever
WBC and CRP may be raised
Pelvic US to exclude abscess or cyst
Laparoscopy with biopsy and culture

Question 12

How would pelvic infection present on examination?

Answer 12

tachycardia/high fever/signs of lower abdo peritonism with bilateral adnexal
tenderness + cervical excitation (pain on moving cervix)/palpable mass (pelvic abscess)

Question 13

How is pelvic infection managed?

Answer 13

analgesics and abx
admit for IV if febrile
abscess may need drainage

Question 14

Why do endometriotic cysts develop?

Answer 14

endometriotic cysts

• endometriosis causes blood to accumulate in ‘chocolate cysts’
• in the ovary that are called endometriomas

Question 15

What are the causes if functional cysts?

Answer 15

Persistently enlarged follicles (follicular cysts) + corpora lutea (lutein cysts)
Only found in premenopausal women#
Combined pill protects against functional cysts by inhibiting ovulation
Lutein cysts cause more symptoms

Question 16

How do ovarian cysts present?

Answer 16

pain and discomfort in the lower abdomen
severe pain from torsion or rupture
discomfort (deep) with intercourse
changes in bowel movements
menstrual irregularities
pelvic pressure causing tenesmus or urinary frequency
abdominal fullness and bloating

Question 17

What are the basic investigations for ovarian cysts?

Answer 17

urinary pregnancy tests 
FBC
Urinalysis 
Endocervical swabs if infectious aetiology suspected 
CA125

Question 18

How do Bartholin’s abscess/cysts develop?

Answer 18

Two glands behind the labia minora secrete lubricating mucus for coitus
Blockage causes cyst formation
Infection with E.coli/Staph leads to abscess formation

Question 19

What are the differentials when thinking about a diagnosis of Bartholins abscess/cyst?

Answer 19

batholin gland malignancy 
endometriosis 
genital warts 
haematoma 
lipoma 
syphilis