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48 Cards in this Set
- Front
- Back
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what are the typical symptoms of a vulvar disorder? |
itching, pain, irritation, white mucosal patches, lichenification, erosions, intertrigo |
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6 causes of vulval dermatitis |
atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, seborrhoeic dermatitis, corticosteroid induced dermatitis, psoriasis |
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causes of vulval white patches (5) |
lichen simplex, lichen sclerosis, lichen planus, leukoplakia, cancer |
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area of chronic, lichenified eczema/dermatitis. circumscribes, thickened and intensly itchy. what it is? |
lichen simplex (adult) - dermnet |
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what is this? what are the treatments? |
lichen simplex (paediatric) - dermnet its uncommon in children. treatments - topical steroid for 4-6 weeks until plaque resolved, moisturiser, coal tar, moisturiser, amitriptyline or antihistamine to help with sleep. also treat underlying CAUSE. |
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involves non hair bearing parts of vulva, never involves vagina mucosa. extremerly itchy and sore, blood blister may occur, dysuria and dysparenunia. what is it? |
lichen sclerosis. diagnose with biopsy, if clinically if you're experienced. most commonly affects women over 50 years of age. |
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another lichen sclerosis. what is non pharmacological advice on management? |
Wash gently once or twice daily. Use a non-soap cleanser, if any.Try to avoid tight clothing, rubbing and scratching.Activities such as riding a bicycle or horse may aggravate symptoms.If incontinent, seek medical advice and treatment.Apply emollients to relieve dryness and itching, and as a barrier to protect sensitive skin in genital and anal areas from contact with urine and faeces. |
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non genital lichen sclerosis. For GENITAL lichen sclerosis, what is the medication used? what are some side effects? |
ultrapotent topical corticosteroid eg. clobetasol propionate 0.05% daily for 1-3 months until good control, then 2 times a week to prevent it recurring. SE's - Red, thin skin, Burning discomfort, Periorificial dermatitis, Candida albicans infection (eg vulvovaginal thrush) |
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affects the labia minora (inner lips) and introitus (entrance to the vagina). The affected mucosa is bright red and raw, very painful, |
Lichen planus is a T cell-mediated autoimmune disease, in which inflammatory cells attack an unknown protein within skin and mucosal keratinocytes. |
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lichen planus |
The clitoral hood may disappear, and the labia minora can shrink and stick to each other or to the labia majora (the outer lips). It can also scar, closing over the vagina. |
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lichen planus |
Sometimes erosive lichen planus affects deep within the vagina where it causes inflammation and superficial ulceration (desquamative vaginitis). The surface cells in the vagina peel off and cause a mucky discharge. The eroded vagina may bleed easily on contact.
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what are some complications of long standing lichen planus? |
SCC, scarring as it is an erosive condition |
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what is the treatment for lichen planus? |
it can be quite difficult to treat. ultrapotent steroid ointment (eg clobetasol proprionate) should be applied to the affected area as a thin smear once daily, ointment hurts less than cream. Hydrocortisone foam can be used inside the vagina or anus. also PO steroids, methotrexte, Ab's and surgery. |
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7 causes of vulval erosions and ulcers |
HSV, lichen sclerosis, lichen planus, SCC, various uncommon dermatosies, excoriated scabies, apthous ulcers. |
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painful, last 2-3 weeks untreated, local LN's tender, associated flu like symptoms |
HSV |
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how do you treat this? |
HSV - valaciclovir 500mg BD for 5-10 days also aciclovir, famciclovir |
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not sexually acquired, non infectious. associated with URTI/Gastro/Tonsillitis/ EBV. Resolve in a couple weeks and rarely recur. |
Non sexually acquired apthous ulcer. Looks similar to oral apthous ulcer. associated with crohn's and Behcet's disease. Treat with topical local anaesthetic/topical steroid/simple analgesia once infectious causes excluded. |
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what is intertrigo? |
rash that occurs in body flectures due to higher moisture (sweating) and friction. opportunistic fungal and bacterial infections result. inflammatory skin conditions can also cause intertrigo. |
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Ill-defined salmon-pink thin patches. Common in axilla and groin creases. Fluctuates in severity. May be asymmetrical. Often unnoticed. Red patches on face and scalp tend to be flaky |
seborroeic dermatitis. treat with ketoconazole to remove Malassezia. salycilic acid to remove scale. mild topical corticosteroid |
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First occurs in infancy. Common in elbow and knee creases. Characterised by flares. Very itchyAcute eczema is red, blistered, swollen. Chronic eczema is dry, thickened, lined (lichenified) |
atopic dermatitis, treat by removing stimulus, moisturise, PRN topical steroid. |
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Rapid development. Itchy moist peeling red and white skin. Small superficial papules and pustules |
Candida albicans. treat with miconazole +/- topical steroid |
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Slowly spreads over weeks to months. Irregular annular plaquePeeling, scaling |
tinea cruris (groin). treat with miconazole/ketoconazole/nilstat cream. treat for 2-4 weeks, or for 1 week after the last rash is gone |
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skin fold rash caused by Corynebacterium minutissimum. associated with obesity, poor hygeine, immunicompromise, diabetes, excessive sweating |
Erythrasma. Treat with Fusidic acid cream/ Clindamycin solution/ Whitfield ointment. if extensive can treat with PO erythromycin |
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symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds where the plaques often appear shiny and they may have a moist peeling surface. |
Psoriasis. Treat with Emollients/ Coal tar preparations / Dithranol / Salicylic acid / Vitamin D analogue (calcipotriol) / Topical corticosteroids / Calcineurin inhibitor (tacrolimus, pimecrolimus) |
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Most common causes of vulval irritation are... |
atopic dermaititis, chronic candidaisis, irritant contact dermatitis (panty liners, douches, bubble baths, toilet paper), allergic dermatitis (perfumes, topical antimicrobials, washing powder with enzymes), fissuring from above dermatitis, trauma. |
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5 items from the "seven masquerades checklist" that can cause vulval discomfort/irritation |
depression, diabetes, drugs, UTI, spinal dysfunction (dysaesthesia) |
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genital puritis + soreness + white wrinkled plaques = ? |
lichen sclerosis |
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redness, itching, discomfort on the vulva or a prepubescent girl - mild symtpoms |
vulvovaginitis. caused by wet bathers/lack of hygeine/ damp synthetic underwear/ soap residue/ chlorinated water/ bubble bath/ sand from the sandpit. treat with reassurance, soothing cream such as soft parrafin or zinc cream. |
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what is moderate vulvovaginitis ddx and treatment |
consider - skin disorders (atopic dermatitis and lichen scerosis - look on the rest of the body), forign body, candidaisis, sexual abuse, pinworms. take a swab if any discharge. treat the cause. dermatitis responds to 1% hydrocortisone ointment. |
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young female + nulliparous + dysparenunia = ? |
vulvar vestibular syndrome (VVS) |
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what is vulvar vestibular syndrome (VVS)? |
introital dysparenunia. severe pain with vestibular touch, even to light touch. can be triggered by irritant dermatitis. spontaneous resolution in 50%. difficult to treat - try pelvic floor exercises, oil based lubircants, biofeedback, TCA low dose, gabapentin |
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burning pain in the labia of a middle aged or elderly woman could be what? |
dysaesthetic vulvodynia. its a neuropathis problem, with not much to find on examination. can be caused by pudendal neuralgia, referred spine pain, or unknown cause. tx - antidepressants, gabapentin |
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what's the treatment if its painless? whats it treatment if its painful? |
painless - leave it alone. may resolve spontaneously. painful - infected cyst. may resolve with PO ab's and discharhe spontaneously. if it becomes large, will need I&D. If it persists and becomes large, will need marsupialisation to allow permanent drainage. |
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bubbly, profuse, fishy vaginal discharge is caused by what? |
bacterial vaginosis (grey, or yellow-green). Gardnerella and Haemophilius causes 40-50% of cases, CAndida causes 20-30% of cases, and trichomonas causes about 20% of cases. treat with metronidazole 2g stat or 400mg BD x 5 days |
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what are other causes of PV discharge? |
physiological - whiteish or clear, oxidises to yellow. exageratted by contraceptives endometriosis - bloody or brownish d/c PID - chlamydia and gonorrhoea candida (white, thick) |
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post menopausal woman, yellowish non ofensive d/c, tenderness and dysparenunia, post coital spotting. what condition is this? how is it treated? |
atophic vaginitis. vagifem tablet (local oestrogen) use nightly for 2 weeks then twice a week. or replens daily until it feels better then 2 times a week for maintainence. |
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what are 8 causes of acute pelvic pain in females? |
ectopic pregnancy, acute PID, rupture or torsion of ovarian cyst, acute appendicitis, cystitis, ureteric colic, bowel obstruction, primary dysmenorhoea. |
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what are 8 causes of chronic lower abdominal pain in females? |
endometriosis/adenomyosis, chronic PID, ovarian neoplasm, diverticulitis, bowel adhesions, irritable bowel, secondary dysmenorrhoea (polyp, IUD), pelvic congestion syndrome |
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what are some features of pelvic congestion syndrome? |
woman usually para 3 or 4, typical age 35-40yrs, unilateral pain, increased with standing or walking, relief with lying down, deep dysparenunia, postcoital aching |
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ammenorhoea + lower abdominal pain + abnormal vaginal bleeding = ? |
ectopic pregnancy |
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onset of pain mid cycle, deep pain in one side of iliac fossa and tends to move centrally. can last minutes to hours. relieved by sitting. woman otherwise well.... |
mittelschmerz. rupture of graafian follicle which causes a litlle bleeding and some mild peritonism. treat with simple analgesia, hot water bottle. |
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Ovarian cancer causes 5% of cancers in women and 20% of gynae cancers. It has an incidence of 10 per 10 000 women/year. what are some risk factors for ovarian cancer? what are some protective factors? |
risk factors - increasing age, family history of breast/ovarian (and sometimes prostate due to BRCA gene). Protective factors - COCP, pregnancy |
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some symptoms of ovarian cancer? |
fatigue, anorexia, lower abdo ache, abdominal bloating, sensation of pelvic heaviness, genitouriary symptoms, bloating, postmenopausal bleeding, palpable ovary n examination. note there are NO recommended guidelines for ovarian cancer screening. |
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dysmenorhoea + menorrhagia + abdominal/pelvic pain = ? |
endometriosis |
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diagnositc criteria for PID |
all 3 of - lower abdo tenderness + cervical motion tenderness + adnexal tenderness PLUS ONE OF THE FOLLOWING: temp >38C, WCC >10, purulent fluid in vagina, ESR >15 or CRP >2, isolation of gonorrhoea or chlamydia, histological evidence of infection, inflammatory mass on bimanual examination |
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causes of PID |
if sexually active - gonorrhoea and chlamydia other causes - E. coli and bacteroides - PID from these occur with cervical manipulation eg. IUD insertion, termination of pregnancy, recent pregnancy, D&C Actinomyocosis - due to prolonged IUD. look for this on culture. |
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PMS is a group of symptoms that generally start 2-14 days before menstruation and are relieved by menstruation. What are some of the PMS symptoms? |
depression (71%), irritability (56%), tiredness (35%), headache (33%), bloating (31%), breast tenderness (21%), tension (19%), aggression/violence (13%) |
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treatment of PMS |
- reassurance and lifetyle modification (eat healthy, exercise, keep and diary of the symptoms, relax) - mild symptoms - vitamin B6 - moderate/severe symptoms - CBT first, fluoxetine 20mg mane for 14 days before period, or sertraline 50mg daily for 14days before period |
