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Volvo Pathology

Volvo Pathology. November 22, 2011 Swedish FHFM GYN Didactic. Whoops … I mean …. Vulvar Pathology. November 22, 2011 Swedish FHFM GYN Didactic. Objectives. To learn about the proper evaluation of a patient with vulvar complaints

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Volvo Pathology

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  1. Volvo Pathology November 22, 2011 Swedish FHFM GYN Didactic

  2. Whoops … I mean …

  3. Vulvar Pathology November 22, 2011 Swedish FHFM GYN Didactic

  4. Objectives • To learn about the proper evaluation of a patient with vulvar complaints • To broaden our list of differential diagnoses for vulvar lesions • To discuss some common vulvar complaints and their treatments

  5. How Would You Start Your Evaluation? • Yes … I know this is basic stuff but we have to start somewhere!

  6. What Do You See In Clinic?

  7. Random Pictures of Vulva

  8. Random Pictures of Vulva

  9. Random Pictures of Vulva

  10. Random Pictures of Vulva

  11. Differential Diagnosis • It’s really long!

  12. What Is This? • 30 year old female • CC: Vaginal Itching • HPI: 6 month history of itching, no bleeding, no discharge, no pain, leathery feel to her vulvar skin • Any other questions?

  13. Physical Exam

  14. Vulvar Dermatitis • Most common vulvar dermatosis in women • Symptoms: Itching, chronic irritation • Ask about hygiene practices, clothing, application of perfumes or lotions • Physical Exam

  15. Management of Vulvar Dermatitis • Treat any underlying infection • General Measures • Mild Symptoms • Moderate to Severe Symptoms • Recalcitrant Cases

  16. Vulvar Lichen Simplex Chronicus • Progression of vulvar dermatitis from chronic irritation leading to squamous cell hyperplasia

  17. Vulvar Dermatitis & LSC

  18. Vulvar Dermatitis & LSC

  19. Vulvar Dermatitis & LSC

  20. Take Home Points • Benign process but need to rule out more serious pathology • Consider external factors that may contribute to this form of dermatitis • Remember to discuss vulvar hygiene

  21. What Is This? • 60 year old female • CC: Vaginal burning and pain with sexual activity • HPI: Has noticed significant amount of decreased lubrication with sex since onset of menopause with more pain during sex. No vaginal discharge but some bleeding with intercourse.

  22. Physical Exam

  23. Vaginal/Vulvar Atrophy • 70% of women do not discuss this with their PCPs! • Symptoms • Physical Exam

  24. Management of Vulvovaginal Atrophy • General Measures • Topical Estrogen • Contraindications

  25. Vulvovaginal Atrophy

  26. Take Home Points • 70% of women do not discuss this with their PCPs! Ask them about these problems so we can help them! • Topical estrogens are contraindicated in those with a history of breast cancer • Topical estrogens will not help vasomotor symptoms

  27. What Is This? • 26 year old female • CC: Swelling at one side of her labia for the last 4 days that makes it difficult to sit down, walk, stand or have sexual intercourse.

  28. Physical Exam

  29. Bartholin Gland Cyst/Abscess • Occurs in about 2% of women • Cyst vs. Abscess

  30. Management of Bartholin Cyst/Abscess • Simple I&D • Word Catheter • Marsupialization • Silver Nitrate Ablation

  31. Take Home Points • Asymptomatic women may be watched • Consider I&D in women > 40 as some recommend cytology to rule out cancer • Simple I&D is not recommended

  32. What Is This? • 55 year old female • CC: New onset of vulvar pain with painful urination. No discharge, vaginal bleeding, fever, chills, nausea, vomiting.

  33. Physical Exam

  34. Genital Herpes • Symptoms • Diagnosis • Treatment

  35. Take Home Points • Incubation period is 4 days and resolution takes an average of 19 days • The partner may be at risk as viral shedding occurs even when the source is asymptomatic • Consider serology to determine if the partner has antibodies • Barrier protection • Viral prophylaxis

  36. What Is This? • 30 year old female • CC: Felt a sore on her labia but the sore does not hurt. Denies any other symptoms.

  37. Physical Exam

  38. Syphilis • Average incubation period is 21 days before clinical manifestations • Usually heals within 3-6 weeks • Treatment • Monitoring

  39. Take Home Points • Don’t get it!

  40. What Is This? • 26 year old female • CC: Just came back from Kenya and developed a very painful ulcer

  41. Physical Exam

  42. Chancroid • Rare STD in the US with only 24 cases in 2010 • Incubation period is 4-10 days • Clinical Manifestations • Diagnosis • Management

  43. Take Home Points • Don’t get it!

  44. What Is This? • 30 year old female • CC: Felt multiple small leathery lesions along her vulva that are usually painless but itchy on occasion. She has had some bleeding when she scratches.

  45. Physical Exam

  46. Vulvovaginal Warts • Clinical Manifestations • Diagnosis • Treatment

  47. Take Home Points • Avoid podophyllin and podofilox in pregnant patients! • May take repeated treatments to remove lesion • Treatment only removes lesions and not viral infection • No role in cesarean delivery to prevent vertical transmission to infant

  48. What Is This? • 26 year old pregnant female • CC: G2P1 female at 34 weeks with increasing amounts of pelvic pain when standing or sitting but gets better when she lies down

  49. Physical Exam

  50. Vulvovaginal Varicosities • Most common in pregnant patients • Management

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