720 likes | 1.02k Vues
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
E N D
Volvo Pathology November 22, 2011 Swedish FHFM GYN Didactic
Vulvar Pathology November 22, 2011 Swedish FHFM GYN Didactic
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
How Would You Start Your Evaluation? • Yes … I know this is basic stuff but we have to start somewhere!
Differential Diagnosis • It’s really long!
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?
Vulvar Dermatitis • Most common vulvar dermatosis in women • Symptoms: Itching, chronic irritation • Ask about hygiene practices, clothing, application of perfumes or lotions • Physical Exam
Management of Vulvar Dermatitis • Treat any underlying infection • General Measures • Mild Symptoms • Moderate to Severe Symptoms • Recalcitrant Cases
Vulvar Lichen Simplex Chronicus • Progression of vulvar dermatitis from chronic irritation leading to squamous cell hyperplasia
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
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.
Vaginal/Vulvar Atrophy • 70% of women do not discuss this with their PCPs! • Symptoms • Physical Exam
Management of Vulvovaginal Atrophy • General Measures • Topical Estrogen • Contraindications
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
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.
Bartholin Gland Cyst/Abscess • Occurs in about 2% of women • Cyst vs. Abscess
Management of Bartholin Cyst/Abscess • Simple I&D • Word Catheter • Marsupialization • Silver Nitrate Ablation
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
What Is This? • 55 year old female • CC: New onset of vulvar pain with painful urination. No discharge, vaginal bleeding, fever, chills, nausea, vomiting.
Genital Herpes • Symptoms • Diagnosis • Treatment
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
What Is This? • 30 year old female • CC: Felt a sore on her labia but the sore does not hurt. Denies any other symptoms.
Syphilis • Average incubation period is 21 days before clinical manifestations • Usually heals within 3-6 weeks • Treatment • Monitoring
Take Home Points • Don’t get it!
What Is This? • 26 year old female • CC: Just came back from Kenya and developed a very painful ulcer
Chancroid • Rare STD in the US with only 24 cases in 2010 • Incubation period is 4-10 days • Clinical Manifestations • Diagnosis • Management
Take Home Points • Don’t get it!
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.
Vulvovaginal Warts • Clinical Manifestations • Diagnosis • Treatment
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
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
Vulvovaginal Varicosities • Most common in pregnant patients • Management