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Womens Health Exam 1 > Vulvovaginal disorders > Flashcards

Vulvovaginal disorders Flashcards

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1
Q

The Normal Healthy Vaginal Environment is due to

A

· Symbiotic relationship of multiple aerobic, facultative anaerobic and obligate
anaerobic species

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2
Q

Vaginal Mucosa is made up of

A

stratified squamous non-keratinized epithelium
- relatively anerobic habitat

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3
Q

pH of the Normal Healthy Vaginal Environment

A

pH between 4.0 - 4.5
* Alkaline environment thanks primarily to Lactobacillus species (gram-
positive species that produces H 2O 2 , bacteriocins compounds, organic
acids including lactic and fatty acids)

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4
Q

Glycogen function in the vaginal environment

A

Glycogen present in vaginal mucosal cells – provides nutrients to the
ecosystem, metabolized to lactic acid (low in childhood and diminishes after
menopause = lower prevalence of lactobacillus species à rise in pH à altered
environment à risk of infections)

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5
Q

What things can cause vaginal dysbiosis?

A

· Hormone levels (age, pregnancy, menstrual cycle)
· Sexual activity
· Chronic stress
· Medications, soaps, detergents
· Regional disparities (local biome) & hygiene/
cultural practices
· Genetic factors such as immune system

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6
Q

What is Vulvovaginitis?

A

inflammation of the vulva and vagina

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7
Q

Vulvovaginitis etiology & risk factors

A

Etiology: pathogens (infection) or non-pathogenic sources causing
skin reaction (soaps, detergents, intercourse)
* candida albicans
* Trichomonas vaginalis
* Bacterial vaginosis
* Condylomata acuminata

Risk Factors: recent sexual activity, hormone changes, use of
contraceptives, tampons or douches

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8
Q

Vulvovaginitis presentation & eval?

A

HPI – onset, location, duration of sx,
character of sx, ?triggers (ask about risk factors), palliating and alleviating
factors, LMP date, recent medications

PE – external exam of vulva, speculum exam of vagina & cervix

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9
Q

Diagnostic evaluation of vulvovaginitis

A

Labs – obtain cultures for yeast, BV, trichomonas
UA for GC/Chlamydia
pH
Wet mount prep
+/- STI testing

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10
Q

Treatment of vulvovaginitis

A

infections (covered later), pt education of risk factors: avoid/stop offending agent, sitz bath, ?short course of topical steroids

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11
Q

What is Vulvar Dermatoses?

A

benign and neoplastic disorders of the lower vaginal tract

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12
Q

Lichen Sclerosus

A

a chronic skin condition that results in thin white patches on the skin, usually associated with vulva & perineum

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13
Q

Vulvar Dermatoses: Lichen Sclerosus etiology & risk factors

A

Etiology: unknown (Theories: Autoimmune, vitamin A deficiency, pathogen)
* Not a/w LS of pregnancy, hysterectomy or hormone replacement
Risk Factors: age; a/w a higher risk of vulvar malignancy
(squamous cell ~5%)

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14
Q

Clinical features and eval of Vulvar Dermatoses: Lichen Sclerosus

A

HPI - Pruritis, dysuria, dyspareunia, sx often
worse at night

PE – ivory-white, circumscribed atrophic patches, skin appears thin and
crinkled texture is generally pathognomonic; may involve perineum.

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15
Q

Treatment of Vulvar Dermatoses: Lichen Sclerosus

A
  • symptom control – topical corticosteroids, gentle cleansers, avoidance of harsh chemicals, abrasion like sex or panty liners;
  • Estrogen cream – used only to help with epithelial integrity
  • prevention of anatomical changes – surgeryC
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16
Q

Complications & referral considerations of vulvar Dermatoses: Lichen Sclerosus

A

Complications: skin thins over time risking infection, labia minora
regression, clitoral concealment, urethral obstruction
Referral: derm or gyn for biopsy, in long-standing cases to rule out
malignancy

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17
Q

Dermatoses: Lichen Simplex Chronicus etiology

A

vulvar skin changes resulting from chronic-
trauma from scratching/irritation; skin responds by thickening –> lichenification
* Irritation from any number of precipitating causes:
* Yeast infections, STIs, etc.
* Dermatitis (moisturizers, tight clothing, over-
washing, sweat, etc.)

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18
Q

Risk factors of Dermatoses: Lichen Simplex Chronicus

A

poor adherence to treatments for
precipitating causes; worse with stress

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19
Q

Clinical features of Dermatoses: Lichen Simplex Chronicus

A

thickened vulvar skin with increased
skin markings, no loss of anatomical structure

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20
Q

Diagnosis of Dermatoses: Lichen Simplex Chronicus

A

Evaluation: Rule out candidiasis/other possible precipitating causes
Biopsy to rule out psoriasis which can contribute to malignancies

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21
Q

Treatment & Management of Dermatoses: Lichen Simplex Chronicus

A

STOP THE SCRATCH CYCLE!
* oral antihistamines, topical steroids, treatment of underlying condition

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22
Q

Dermatoses: Contact Dermatitis

A

inflammatory response to a primary irritant or allergen

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23
Q

Etiology & Risk Factors of Contact Dermatitis

A

based on allergy profile; about 54% of
unexplained cases of vulvar puritus and inflammation

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24
Q

Clinical Presentation of Contact Dermatitis

A

immediate itching/burning
sensation (irritant); delayed onset of itching, localized erythema, edema, and possibly vesicle/bullae formation if due to allergen

Evaluation: consider patch testing, look for associated conditions: candidiasis, psoriasis, SCC

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25
Dermatoses: Contact Dermatitis diagnosis
primarily based on H&P and evaluation for other conditions
26
Treatment of Dermatoses: Contact Dermatitis
* remove offending agent, * restore skin barrier function (sitz bath plain water, plain petrolatum), * treat any underlying infection, * Consider topical steroids * Cool packs (NOT COLD) * Antihistamine (hydroxyzine)
27
Bartholin’s Gland Abscess etiology
Bartholin gland is obstructed secondary to either trauma or inflammation
28
Clinical Presentation of Bartholin’s Gland Abscess
pain, swelling, erythema, dyspareunia, difficulty walking
29
Management &Treatment of a Bartholin’s Gland Abscess
depends on size and if it is self-draining * Small: sitz baths, warm compresses * Moderate-Large: I&D, culture, Word catheter placement, +/- antibiotic if systemic sx
30
Complications of a Bartholin’s Gland Abscess
large abscesses or cyst formations may require marsupialization vs. complete excision
31
Cystocele
weak vaginal wall à protrusion of bladder into vaginal vault
32
Risk Factors for a cystocele
multiparous, age, hysterectomy, obesity/increased abdominal pressure, genetics
33
Clinical Presentation of Cystocele
dyspareunia, incomplete bladder emptying à recurrent UTIs and/or incontinence, discomfort with coughing/lifting/standing
34
Evaluation & Diagnosis of a cystocele
PE – clinical, bladder studies
35
Treatment & Management of a cystocele
Mild – pelvic floor PT/kegels, vaginal estrogen Mod/Severe – pessary, surgery (refer to urology, GYN)
36
Rectocele etiology & risk factors
Etiology: Increased pelvic floor pressure Risk Factors: multiparous, age, repeated heavy lifting, chronic constipation, straining, cough
37
Clinical presentation & evaluation of a rectocele
Clinical Presentation: sensation of hernia, constipation or fecal incontinence, dyspareunia Evaluation & Diagnosis: PE (clinical)
38
Management & Treatment of a rectocele
Expectant: pelvic floor training, avoidance of risk factors Referral: for pessary or surgery if severe, worsening
39
Vaginal/Uterine Prolapse etiology and risk factors
Etiology: Stretched/weakened pelvic floor muscles and ligaments Risk Factors: Multiparous, age, genetics, obesity
40
Clinical Presentation & evaluation of Vaginal/Uterine Prolapse
dyspareunia, incomplete bladder emptying à recurrent UTIs and/or incontinence, discomfort with coughing/lifting/standing Evaluation & Diagnosis: PE – clinical, bladder studies
41
Treatment & Management of Vaginal/Uterine Prolapse
Mild – pelvic floor PT/kegels, vaginal estrogen Mod/Severe – pessary, surgery (refer to urology, GYN
42
Supportive measures for Pelvic Organ Prolapse
* High-fiber diet and laxatives to improve constipation * Weight reduction in persons with obesity * Limitation of straining and lifting are helpful
43
The only cure for symptomatic cystocele, rectocele, or enterocele is _____
corrective surgery
44
Vaginal Candidiasis etiology
C. albicans normal resident of the human body * imbalance between this yeast and its host à candidiasis. * Other species: C tropicalis and C glabrata, * Sexual transmission is uncommon, and treatment of sexual partners is unnecessary
45
Risk factors for Vaginal Candidiasis
mmunosuppression, diabetes mellitus (some meds), pregnancy, and recent broad-spectrum antibiotic use
46
Clinical presentation & eval of Vaginal Candidiasis
Clinical Presentation: vulvar pruritus, burning, erythema, and edema, Evaluation & Diagnosis: On PE you may see excoriations (common), * Ivory-white vaginal discharge “cottage cheese–like” * Microscopic examination with saline and 10% KOH prep --> yeast
47
Treatment & Management of Vaginal Candidiasis
Consider probiotic products (lactobacillus) Uncomplicated = sporadic, immunocompetent pts, and likely C albicans * Azoles very effective * Fluconazole 150 mg PO x 1 Complicated = frequent recurrence, severe symptoms, immunosuppressed pts and/or non-albicans species * Fluconazole 100-mg, 150mg or 200 mg PO q72h (once every 3 days) x 3 doses * Consider suppression therapy with fluconazole
48
MOST COMMON CAUSE of vaginal discharge among reproductive age women
Bacterial Vaginosis
49
Bacterial Vaginosis etiology
overgrowth of anaerobic species, usually Gardnerella, but also Prevotella, Mobiluncus, and Bacteroides species; Atopobium vaginae. There is also a significant reduction in Lactobacillus.
50
Risk Factors for Bacterial Vaginosis
not considered an STI * multiple or new sexual partners, female partners, oral sex, douching, Black race, smoking, and intrauterine device (IUD) use * condom use lowers the risk
51
Clinical presentation of Bacterial Vaginosis
* nonirritating, malodorous vaginal discharge but not always present. * examination reveals no abnormalities: vagina is not erythematous, cervix is normal in appearance
52
Evaluation & Diagnosis of Bacterial Vaginosis
PE Wet Prep: swab-collected sample of discharge mixed with drops of saline on a microscope slide
53
_____ are the most reliable indicators of BV
Clue cells
54
Bacterial Vaginosis complications
observed in women with BV include: * vaginitis, endometritis, post-abortal endometritis, * pelvic inflammatory disease (PID) unassociated with Neisseria gonorrhoeae or Chlamydia trachomatis, * susceptibility to human immunodeficiency virus (HIV) acquisition, and * acute pelvic infections following pelvic surgery, especially hysterectomy
55
Vaginal Chlamydia etiology & risk factors
Etiology: sexually transmitted C trachomatis infection Risk factors: unprotected sex (of any kind), multiple partners
56
Vaginal Chlamydia clinical features and eval
Clinical Features: pelvic pain, vaginal discharge (white), dysuria Evaluation & Diagnosis: Nucleic Acid Amplification Test (NAAT) of urine sample, vaginal or cervical swab, reportable disease
57
Complications of vaginal chlamydia
Pelvic Inflammatory Disease abstinence until woman/partners treated and asymptomatic
58
Vaginal Gonorrhea etiology & risk factors
Etiology: sexually transmitted N. gonorrheae infection Risk Factors: unprotected sex (all kinds), multiple sexual partners and MSM
59
Most frequently reported ID in the US
Vaginal Chlamydia
60
Women are often asymptomatic who have _____
Vaginal Gonorrhea
61
Clinical Presentation & eval of Vaginal Gonorrhea
Clinical Presentation: often asymptomatic, yellowish discharge, pelvic pain, dysuria Evaluation & Diagnosis: NAAT endocervical swab
62
Complications of vaginal gonorrhea
Pelvic Inflammatory Disease abstinence until woman/partners treated and asymptomatic

Womens Health Exam 1 (7 decks)

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