GYNECOLOGY 16’-17’

BENIGN DISEASE OF VULVA & VAGINA  Satellite lesions

FAV 16’  ABCD
 Asymmetry
 Border irregularity
VULVAR LESION  Color variegation
URETHRAL CARUNCLE  Diameter
 Small, fleshy outgrowth of the distal end of the urethra
 Soft, smooth, bright red HEMANGIOMA
 Sessile or pedunculated – 1-2 cm  Rare malformation of the Blood vessel
 Post menopause – Rule out urethral carcinoma  Usually single, small, flat and soft
 Child – probably a urethral prolapsed  Brown to red to purple
 Arise from ectropion of posterior urethral wall  Diagnosis: inspection
 Growth is secondary to chronic irritation or infection  If bleeding or infected:
 Symptoms  Resection
 Asymptomatic  Cryosurgery
 Dysuria, frequency, urgency  Laser
 Ulcerative Lesion – spotting on contact
 Diagnosis – based on biopsy FIBROMA
 Management  MOST COMMON benign solid tumor of the vulva
 Oral or topical estrogen  Start small, slow grower
 Avoid irritation  May grow very large
 Surgery:  Some become pedunculated
 Cryosurgery  Often firm, sometimes cystic
 Laser therapy
 Excision LIPOMA
 Fulguration  Benign, slow growing circumscribed tumors of fat cells
 2ND MOST COMMON vulvar tumor
BARTHOLIN’S CYST  On cut section – soft, yellow, lobulated
 MOST COMMON large cyst of the vulva
 Unilateral ENDOMETRIOSIS
 Posterior/lower half of Labia majora  Rare – associated with pelvic endometriosis
 Tender (Abscess) Nontender (Cyst)  Cystic or solid
 Usually Small
SKENE’S DUCT CYST  Often misdiagnosed as a Bartholin’s cyst
 Anterior/upper half of Labia majora  Usually found in previous operative site
 Vulvodynia and introital dyspareunia
NEVUS
 AKA mole HEMATOMAS
 Localized nest or cluster of melanocyte  Secondary to blunt trauma, fall, VA, or physical assault
 One of the MOST COMMON benign neoplasm in females  Management
 Blue to dark brown to black/amelanotic  Usually conservative unless > 10 cm or rapidly expanding
 Flat, elevated or pedunculated  Venous – compression and application of ice pack
 Differentials  Surgical – ligate bleeders, and pack
 Hemangioma  Rule out injury to bowel and urinary balder
 Endometriosis
DERMATOLOGIC DISEASES
 Malignant melanoma
PRURITUS
 Vulvar intraepithelial Neoplasia
 Single MOST COMMON gynecological problem
 Seborrheic Keratosis
 Intense itch with desire to scratch and rub the area
MALIGNANT MELANOMA  Itch-scratch cycle
 5-10% of all malignant melanomas arise from the vulva  Itch  scratching  excoriation  healing  healing skin itches and
 50% arise from a nevus the cycle repeats
 Age – 50 and above  Differentials

DYSPLASTIC NEVUS Skin Infections Contact dermatitis

 Malignant transformation is 15x higher than general population STD Neurodermatitis
 Characterized by:
 > 5mm Dermatoses Atrophy
 Irregular borders Vulvar dystrophies Diabetes
 Patches of variegated pigment
 Management: Lichen Sclerosus Drug allergies
 Excision with 5-10 mm normal skin and include the dermis Premalignant and malignant lesions Pediculosis and scabies
 Indications:
Leukemia and uremia Psychological
 Recent changes in growth or color
 Ulceration, bleeding, pain

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 GYNECOLOGY 16’-17’
OTHER DERMATOLOGIC CONDITIONS  Symptoms
 Contact dermatitis, atopic dermatitis o Fever
 Lichen sclerosus – “Cigarette paper appearance” o Hypotension
 Psoriasis o diffuse erythroderma with desquamation of palms and soles
o Vaginal involvement -Mucous membrane inflammation at least 3
 Seborrheic dermatitis major organ system
 Squamous hyperplasia
3. Asymptomatic Vaginal Lesions - incidental findings
CONDYLOMA ACUMINATUM A. FIBROEPITHEALIAL POLYP
 Agent: HPV  Polypoid folds of CT, capillaries and stroma covered by vaginal
 Management: epithelium
 Single unilateral (topical)  Treatment: Office excision biopsy done only when:
 vascularity is troublesome
STD CAUSING ULCER  diagnosis is uncertain
HERPES SIMPLEX B. CYST OF EMBYRONIC ORIGIN
 lesions: small ulceration, multiple, painful with history of sexual contact  arise from:
1. Mesonephric Epithelium
SYPHILIS  GARNER'S Duct Cysts – presents on lateral vaginal
 Painless wall
 Do not require treatment
GRANULOMA INGUINALE 2. Urogenital Sinus Epithelium
 i.e cyst located near vulvar vestibule
DIAGNOSTIC WORKUPS: 3. Paraneoplastic epithelium
 VULVAR BIOPSY
 to distinguish benign from premalignant/ malignant vulvar lesions DISORDERS OF VAGINAL SUPPORT
 Bulging lesions of vaginal and vulvar areas with symptoms of pressure or discomfort
PRURITUS MANAGEMENT 1. Cystocoele
 Identify and treat the underlying cause 2. Recrocoele
 Improve local hygiene 3. Urethrocoele
 treat the itch

VAGINAL CONDITIONS
 most common vaginal symptom: Vaginal discharge
1. VAGINITIS
2. VAGINAL LESIONS
 conditions which cause vaginal discharge

Non-infectious causes of discharge:

1. RETAINED FOREIGN BODY
2. Ulceration
a. Tampon –induced
b. Lichen Planus
3. Malignancy
a. cervical malignancy
b. Vaginal malignancy
4. Post-menopausal Atrophic Vaginitis
5. Post radiation vulvovaginitis

ADOLESCENCE AND OLDER

1. Miroscopic and macroscopic ulceration
 assoc. with vaginal tampons
 treatment: Suspend tampon use
 ff up. Exam with biopsy of persistent ulcerations

2. Toxic Shock Syndrome

 Assoc with tampon use and vaginal S. aureus.
 Produce Exotoxins

PEDIATRIC
 Conditions with vaginal discharge:

1. Sexual Abuse
 Routine STD cultures
 culture for Gonorrhea and Chlamydia
2. Vulvovaginitis – can be recurrent
 Causes: Strep and shigella
 Tx: Focus on hygiene and cleaning measures
 Short term course (4 weeks) of the ff:
i. Topical Estrogens and Broad spec. AntiB

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