Vulval and Vaginal Disorders Flashcards
(23 cards)
What is a Bartholin’s cyst?
Give a key complication
A fluid-filled sac within one of the Bartholin’s glands of the vagina
Bartholin’s cyst can become infected and develop into an abscess
How does a Bartholin’s cyst present?
- Asymptomatic (small cysts)
- If large: pain, dyspareunia
How is a Bartholin’s cyst diagnosed?
Clinical diagnosis
Describe the management of a Bartholin’s cyst
Conservative:
- If the cyst is small and asymptomatic, allow spontaneous rupture
- Warm baths can be recommended
Surgical:
- Marsupialisation of Bartholin’s gland
What is lichen sclerosus?
A chronic, inflammatory skin condition affecting the anogenital region in women
Lichen sclerosus most commonly affects which age group(s)?
Bimodal incidence - peaking in prepubescent girls and postmenopausal women
Give some risk factors for developing lichen sclerosus
- Family history of lichen sclerosus
- Autoimmune disease
What are the two main presenting symptoms of lichen sclerosus?
What are the four typical signs you may find on examination?
Symptoms:
- Pain
- Itchiness
Signs:
- White atrophic patches
- Clitoral hood fusion
- Fusion of labia minora to labia majora
- Posterior fusion resulting in loss of vaginal opening
How is lichen sclerosus diagnosed?
Clinical diagnosis
Describe the management of lichen sclerosus
Is follow-up necessary?
- Use of topical steroids, e.g. clobetasol proprionate
- Patients should be followed up as there is a small risk of developing vulval cancer
What is atrophic vaginitis?
Thinning, drying and inflammation of the vaginal walls
What causes atrophic vaginitis
Lack of oestrogen
Atrophic vaginitis typically affects which group of women?
Postmenopausal women
What are the clinical features of atrophic vaginitis?
- Vaginal dryness/itchiness
- Dyspareunia
- Abnormal vaginal bleeding
How is atrophic vaginitis diagnosed?
Clinical diagnosis
Describe the conservative and medical management of atrophic vaginitis
Conservative:
- Vaginal moisturisers/lubricants
Medical:
- Topical oestrogen
What is vulvar intraepithelial neoplasia (VIN)?
A precancerous condition affecting the skin of the vulva
What is the main risk factor for developing VIN?
HPV infection
Describe the natural history of VIN
A small number of cases of VIN will go on to become vulval cancer after a number of years
What age group does vulval cancer most commonly affect?
Older women
What are the clinical features of VIN/vulval cancer?
- Vulval pain/itchiness
- Skin changes (e.g. discolouration, lump/lesion)
Describe the investigation of VIN/vulval cancer
Biopsy and histological examination
Describe the management of VIN and vulval cancer
If low grade VIN:
- Close monitoring
- If symptomatic, use of topical steroid cream
If high grade VIN:
- Resection of abnormal tissue
Vulvar cancer:
- Vulvectomy
- Additional treatment may be required, e.g. radiotherapy/chemotherapy
