Vulvar Disorders

Question 1

What is Lichen Sclerosus?

Answer 1

Autoimmune: autoantibodies attack extracellular matrix and basement membrane. Immune dysfunction affecting all levels of skin.

Lymphocytic infiltrate of skin. Assoc w/ thyroid disorder and HLA.

Question 2

What Koebner’s phenomenon? How does this effect Lichen Sclerosus

Answer 2

Trauma to an area makes the condition worse

Question 3

Who is Lichen Lichen Sclerosus mostly seen in?

Answer 3

Post menopausal women

Question 4

What is the most common symptom seen in Lichen Sclerosus

Answer 4

Pruritus*

Also pain and pyspareunia

Question 5

What are physical exam findings in Lichen Sclerosus

Answer 5

Sharp well demarcated white plaques, figure 8

Cellophane paper appearance (waxy and hyperkaerototic

Question 6

What is a hallmark findings in Lichen Sclerosus ?

What is a seen in severe cases

Answer 6

Fragility

Loss of anatomical landmarks

Question 7

How is Lichen scleorosus diagnosed

Answer 7

Vulvar biopsy

Question 8

Treatment for Lichen Sclerosus

Answer 8

1. Topical ultrapotent steroid OINTMENT

Known as Clobetasol (Temovate)

Question 9

What is important to know when applying treatment towards Lichen sclerosus

Answer 9

Educate patient to apply only to affected area

Question 10

What can occur if Lichen sclerosus is left untreated?

Answer 10

Squamous cell cancers

RF: elderly and hyperkeratotic lesions

Question 11

Does lichen sclerorus go away?

Answer 11

no, chronic condition

Question 12

Who is likely to aquire Lichen Simplex Chronicus

Answer 12

Patients with hx of atropy

Question 13

What is a precipitating factor that will trigger Lichen Simplex chornicus

Answer 13

Vulvar pruritis

Question 14

How does Lichen Simplex chronicus typically present

Answer 14

Initially poorly marginated red, scaling papules and plaques

Chronic:
Lichenification (callus)
Hypopigementation with moisture

Question 15

What is first line treatment for Lichen simplex complex

Answer 15

Identify underlying triggers

Question 16

Causes of Lichen planus?

Answer 16

autoimminue disorder

Question 17

Clinical presentation of Lichen planus

Answer 17

Introital irritation-superficial dyspareunia

Burning and /or pruritis

Vaginal dis harge

Question 18

Slide 23

Answer 18

slide 23

Question 19

Treatment for Lichen planus

Answer 19

Topical steroids - Hydrocortione (like lichen simplex complex)

Question 20

Definition of Vulvar Intraepithelial Neoplasia

Answer 20

neoplastic cells confined to squamous epithelium

Question 21

Which types/grades of Vulvar Intraepithelial neoplasia are most concerning that lead to cancer?

How are they further differentiated

Answer 21

VIN 2
VIN 3

VINu or VINd

Question 22

Which HPV types are VINu associated with?

Answer 22

type 16, 18, 31

Question 23

Clinical presentation for VINu?

Answer 23

Most are asymptomatic

Vulvar burning and pruritus in 50% of cases

Associated often with high grade CIN therefore colposcopy / Pap smear is mandatory

Biopsy all pigmented lesions

Question 24

How is VINu diagnosed?

Answer 24

Vulvar Colposcopy

Question 25

Physcial exam findings for VINu?

Answer 25

Hypo and Hyperpigmentation

Question 26

Treatment for VINu?

Answer 26

None provided are guaranteed due to failure to include all lesions

Question 27

What is the standard care for VINu

Answer 27

Surgical- CO2 laster vaporization

Question 28

Who is VINd seen mos commonly in? Is it related to HPV

Answer 28

Seen in older women (70 or older) No relation to HPV

Question 29

How is VINd caused?

Answer 29

− Associated with squamous cell hyperplasia (Lichen Sclerosis) − Unidentified carcinogenic agents combined with local environment of chronically irritated/inflamed skin lead to dysplastic cell

Question 30

How is VINd treated?

Answer 30

Prevention- proper treatment of underlying conditions Treatment: surgical exision of lesions

Question 31

How is VINu prevented during follow up?

Answer 31

Vaccination- Gardasil

Question 32

What are post treatment follow up recommendation for VINu and VINd

Answer 32

colposcopic vulvar inspection at 6 and 12 months and then annually thereafter

Question 33

The incidence of vulvar cancer has ________ what type of peak?

Answer 33

Bimodal peak Women 20-40 years is HPV related (VINu) Women 60-70 years is due to chronic irritation and poorly understood co-factor (VINd)

Question 34

What are clinical presentations for Vulvar cancer?

Answer 34

ASYMPTOMATIC is MC Pruritus is the second most common condition Vulvar bleeding Vulvar pain Need to inspect the vulva

Question 35

Treatment for Vulvar Cancers?

Answer 35

Staging based on FIGO Surgical removal of tumor with inguinal node dissection

Question 36

What is the MCC type of vulvar cancer?

Answer 36

Squamous cell carcinomas

Question 37

What are clinical presentations of Behcet's disease?

Answer 37

Genital ulcers

Question 38

What is the criteria to diagnose Behcet's disease?

Answer 38

o Recurrent oral aphthae at least 3 times in 1 year plus 2 of the following: ``` " Recurrent genital ulcers " Uveitis " Skin lesions " (+) Pathergy test " 2mm papule at injection site w/in 48hr ```

Question 39

Treatment for Behcet's disease?

Answer 39

High dose steroid Temovate 0.05% ointment

Question 40

What are Bartholin Cysts?

Answer 40

Bilateral glands found at the 4 and 8 clock positions

Question 41

How do Batholin cysts present?

Answer 41

Acute, painful unilateral labial swelling - less pain with cyst Dyspareunia Pain with sitting or walking Drainage

Question 42

Different between Batholin Cysts and abscess?

Answer 42

slide 52

Question 43

Treatment for Bartholin Cysts

Answer 43

Incision and drainage and instertion of Word catheter Cultures and empirical antibiotic therapy Sitz baths 2-3 days after I&D No intercourse until cather is removed

Question 44

What is the cause of Vuvlodynia?

Answer 44

Unknown | but onset usually is around menopause

Question 45

Clinical presentation of Vulvodynia?

Answer 45

Absent clinical findings Vulvar "burning" Raw or stabbing sensation

Question 46

On physical exam how can you differentiate and diagnose Vulvodynia

Answer 46

Use a q-tip to palpate the vestibule where we expect the pain

Question 47

Treatment for Vulvodynia

Answer 47

slide 62 and slide 63