Flashcards in ICSM Year 5 Gynaecology Deck (402)
What is Asherman's syndrome?
Presence of intrauterine adhesions that may partially/ completely occlude the uterine cavity
Recall 3 risk factors for Asherman's syndrome
Dilation and curettage (for miscarriage)
Recall 3 symptoms of Asherman's syndrome
Amenorrhoea, subfertility, cyclical abdo pain
Recall what investigations should be done in suspected Asherman's
Saline hysterosonography (HSG), TVUSS
What would be seen on TVUSS in Asherman's syndrome?
Sub-endothelial linear striations + 'boggy' uterus
How is Asherman's syndrome managed?
Initially: Hysteroscopic adhesionolysis + post-op copper IUD
Next: PO oestrogens and reasses cavity
Recall some complications of Asherman's
Infertility, miscarriage, oligomenorrhoea
What is atrophic vaginitis?
Vaginal irritation caused by thinning of the vaginal epithelium
What is the cause of atrophic vaginitis?
Reduction in circulating oestrogen ie. Post-menopause
Give 3 signs of atrophic vaginitis
Irritation, dyspareunia, discharge (may be bloody)
How does atrophic vaginitis appear O/E?
Pale, thin vaginal walls with loss of rugal folds, cracks or fissures
What investigations would you order in suspected atrophic vaginitis?
1. Clinical examination
2. Swabs for potential infection
3. Biopsy for potential malignancy/ ulcers
How is atrophic vaginitis managed?
1. Systemic HRT
2. If bleeding on intercourse --> water based moisturisers and lubricants
What 8 things should be checked for when doing a history for gynaecological infections?
Discharge (smell, consistency, colour, volume), Blood
What investigations should be done in a suspected gynaecological infection?
pH, swabs (double or triple) and blood tests (for HIV/ syphilis)
What is the normal pH for the lateral wall of the vagina?
3.5-4.5 (due to lactobacilii in vagina)
What is a low vaginal pH indicative of?
What is a raised vaginal pH indicative of?
Contamination, BV or TV
Describe the method of 'double swab'?
1. Endocervical swab - tests for gonorrhoea and chlamydia
2. High vaginal swab, "charcoal swab" - fungal and bacterial (BV, TV, candida, GBS)
Describe the method of 'triple swab'?
1. Endocervical (for chlamydia)
2. Endocervical charcoal swab (for gonorrhoea)
3. High vaginal charcoal swab (for fungal/ bacterial infection)
What type of testing is done on the endocervical swab?
NAAT (nucleic acid amplification testing) for chlamydia/ gonorrhoea
What type of testing is done on the high vaginal swab?
How does gonorrhoea appear under the microscope?
Gram neg diplococci
What is the most common cause of abnormal discharge?
How does discharge appear in BV?
Thin and watery, grey/ white - FISHY SMELLING ODOUR
What are the symptoms of BV?
Just the discharge
What is the cause of BV?
Overgrowth of anaerobic bacteria
What is the most commonly implicated microbe in BV?
What is required for BV diagnosis?
Clinical diagnosis + microscopy, can show high pH