Vulval Itching/Lesion Flashcards

Question

Describe Vulvar dysaesthesia (vulvodynia) (S&S, RF)

Answer 1

Vulval pain syndrome Diagnosis of exclusion Provoked or Spontaneous Local (vestibular) or generalised - Generalised: burning pain, older patients - Localised: superficial dyspareunia or pain on tampons, younger patients RF: Hx genital tract infections, former oral contraceptive use, psychosexual disorders

Answer 2

amitriptyline OR gabapentin

Answer 3

all procedures that involve partial or total removal of the external female genitalia, or injury to the female genital organs for non medical reasons. It is a violation of the rights of the child and woman. It is child abuse and illegal in the UK

Answer 4

Type 1: Clitoridectomy: partial/total removal of the clitoris and sometimes the prepuce (clitoral hood) Type 2: Partial/total removal of the clitoral glans and the labia minora, with or without removal of the labia majora Type 3: . Pharaonic: the labia majora are removed and the skin is stitched together (vaginal opening no longer exposed) Type 4: All other harmful procedures to the female genitalia for non-medical purposes e.g. pricking, piercing, incising, cauterizing, nicking

Answer 5

200 million girls and women worldwide living with the consequences of FGM, 5% global female population. Occurs mainly in North/central-Africa (Somalia, Egypt, Sudan, Ethiopia), Malaysia, Indonesia, India, Yemen, Syria but occurs globally, practiced in over 28 African countries Age of FGM varies from a few days old to adulthood depending on the geographical area and community, but usually averages 5-14 years old. 18% of all FGM is performed by healthcare providers.

Answer 6

Deinfibulation The opening procedure for women with type 3 FGM. It can help alleviate some physical symptoms but cannot replace the tissue that has been removed. It can be done under local, spinal or general anaesthetic The incision should be made along the vulval incision scar and the urethra identified before surgery commences to reduce damage Screen for UTI and consider Abx prophylaxis Offered to those unable to have sex comfortably, pass urine, or pregnant women at risk during delivery Clitoral/labial reconstruction Not currently available in the UK.

Answer 7

Re-closure of a woman with Type 3 FGM, usually after childbirth. It is illegal in the UK. This can happen multiple times with the birth of each child.

Answer 8

Haemorrhage Severe pain and shock Urine retention Injury to adjacent tissue Tetanus, HIV, hep B/C Fracture or dislocation of limbs as a result of being restrained Death through severe bleeding → haemorrhagic shock, neurogenic shock, infection, septicaemia

Answer 9

Dysuria/recurrent UTIs Renal failure Recurrent candida infections Abscesses due to infected cysts/horns Dysmenorrhoea Dyspareunia Sexual dysfunction and lack of sexual pleasure Infertility Acute/chronic pelvic infections Clitoral neuroma

Answer 10

May not be identified antenatally Difficulty with Vaginal examinations Scarring and stricture of the vaginal canal Possible obstructed labour Psychological trauma Flashbacks Increased risk of caesarean sections, PPH< foetal asphyxia/anoxia Perineal trauma/tears -> scar tissue, fistulae

Answer 11

1. Safeguarding and reporting 2. Document FGM in notes (name, DoB, address, type, in red book if young) 2. Women should be identified and referred to specialist gynaecology/ FGM clinic 3. Counsel on FGM and its risks 4. Offer and recommend deinfibulation 5. Mental health support

Answer 12

<18: report to the police (serious crimes 2015) via 101 non-emergency within 1 month + inform the FGM specialist midwife or the safeguarding team + social care referral >18: safeguarding and assess risk to female children or younger siblings, reporting not required, must document in notes If a mother discloses that her daughters or siblings have had FGM, the MR duty does NOT apply - but you must do a normal safeguarding referral to children's social care.