Women’s Health Gynecology Exam 2: Vulva, Vagina, Vulvovaginitis Graded A+

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lichen sclerosis: - burning, itching, irritation - white, thin skin around vulva (tears easily) & may extend to anus causing halo dx: punch biopsy tx: high dose topical steroid (clobetasol) - ... txs symptoms but doesn’t resolve increased risk for squamous cell cancer of vulva - ANSWER how do you diagnose and treat lichen sclerosis? what does this condition increase your risk of? lichen simplex chronicus - itching that leads to a rash (diffuse redness around vulva) dx: only need punch biopsy if no improvement in 3 months tx: low potency topical steroid cream (1-2% hydrocortisone cream) - ANSWER A 22 yo patient presents with vaginal itching and irritation. She states that it started as itchiness, which was relieved by scratching, but overtime this caused a rash to develop and the skin of the vulva became diffusely inflamed/red. What do you suspect? How is this diagnosed and treated? lichen sclerosis: - burning, itching, irritation - white, thin skin around vulva (tears easily) & may extend to anus causing halo dx: punch biopsy tx: high dose topical steroid (clobetasol) - txs symptoms but doesn’t resolve -increased risk for squamous cell cancer of vulva - ANSWER A 24 yo patient comes in complaining of vaginal itching, burning, and irritation. What do you suspect? How is this treated and diagnosed? lichen simplex chronicus dx: only need punch biopsy if no improvement in 3 months tx: low potency topical steroid cream (1-2% hydrocortisone cream) - curative treatment (if used for lichen planus it is not curative, just treats symptoms) - ANSWER A 22 yo patient presents with vaginal itching and irritation. She states that it started as itchiness, which was relieved by scratching, but overtime this caused a red rash to develop around the vulva. She states that she recently started a using a new soap in the shower around her private parts. What do you suspect? How is this diagnosed and treated? lichen planus - tx: low dose topical steroid (1-2% hydrocortisone cream) - will not have atypical cells with cytology (normal pap) *treatment is symptomatic (not curative, chronic skin condition) - ANSWER A 22 yo patient presents with chronic vulvar burning with profuse amounts of vaginal discharge. She also states that sex is painful. You note desquamative lesions around the vagina that appear diffusely raw/red. What is this? How is it treated? lichen planus - causes whole top layer of vulva to peel off (becomes diffusely red) - vulvar burning, painful sex, profuse vaginal discharge (chronic) tx: low dose topical steroid (1-2% hydrocortisone cream) - treats symptoms but doesnt cure - ANSWER A rare, chronic inflammatory skin condition that causes desquamative lesions and sometimes wickham straie of the vagina is called ______. what are the symptoms? lichen planus - wickham striae (white lacy bands of keratosis around ulcers) - chronic condition so just treating symptoms tx: low dose topical steroid (1-2% hydrocortisone cream) - ANSWER If a patient presents with vaginal burning, large amounts of discharge and painful sex, what do you suspect? Vestibulitis (localized vulvodynia) - suspect in new onset insertional dyspareunia - will have redness/inflammation between 4 and 8 oclock dx: physical exam (do not use speculum) - cotton tip application will cause pain tx: topical steroids (1-2% hydrocortisone) and topical lidocaine jelly - ANSWER A 22 yo patient presents complaining of pain with sex that has recently developed. How is this treated and diagnosed? vestibulitis (vulvodynia) - will have redness/inflammation around 4 and 8 oclock dx: physical exam (do not use speculum) - cotton tip application will cause pain tx: topical steroids (1-2% hydrocortisone) and topical lidocaine jelly *chronic insertional pain could be this or lichen planus, etc. - ANSWER If a patient presents with newly onset insertional dyspareunia, what should you suspect? bartholian gland cyst - no pain or itching dx: culture - biopsy if solid (doesnt transilluminate) - biopsy if fixed to surrounding tissue and immobile - biopsy if no response to tx - biopsy if patient is postmenopausal tx: 1. I&D with word catheter (left in place for 4-6 weeks) 2. marsupialization (new outlet for gland secretions, do iif reoccurence after 2 word catheters are placed) *if bartholian gland abscess it would be painful and have swelling (cause: ecoli) - ANSWER If a 22 yo patient presents with this and states that there is no pain, what do you suspect? How is it treated? bartholian gland cyst - no pain or symptoms with mass bartholiian gland abscess - painful and swelling mass (ecoli) dx: culture, biopsy if.... - solid component, doesnt resolve with tx, women is postmenopausal, is fixed to surrounding tissue tx: I&D with word cathetor placement (left in place 4-6 weeks) - do marsulialization if reoccurance after 2 word cathetors are placed - ANSWER What are bartholian gland masses and how do you tell the difference between them? how are they treated? LSIL: - very little atypia of cells (not pre-cancerous) - usually occurs in condyloma acuminate (genital warts) dx: punch biopsy tx: same as condyloma - ANSWER What is low-grade squamous intraepithelial lesion (LSIL) of the vulva? How is this diagnosed? LSIL usually occurs with condyloma acuminate (genital warts) - ANSWER If a patient presents with this, what do they have a high chance of getting? HSIL - HPV related lesion -white, red, or brown patches - true neoplasia with high risk for carcinoma if left untreated dx: colposcopy (using 3-5% acetic acid solution) if lesions are not visible + biopsy in multiple spots tx: surgical (wide local excision or laser ablation) - ANSWER A patient presents with irritation and vaginal itchiness, you note this. What do they have? HSIL - HPV related lesion -white, red, or brown patches - true neoplasia with high risk for carcinoma if left untreated dx: colposcopy (using 3-5% acetic acid solution) if lesions are not visible + biopsy in multiple spots tx: surgical (wide local excision or laser ablation) - ANSWER A patient presents with irritation and vaginal itchiness, what is this? HSIL -white, red, or brown patches - vaginal irritation and itchiness dx: colposcopy (using 3-5% acetic acid solution) if lesions are not visible + biopsy in multiple spots tx: surgical (wide local excision or laser ablation) - ANSWER these HPV-related lesions are considered true neoplasia, as they are high risk for progressing to severe intraepithelial lesions and eventua [Show More]

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