Vagina / Vulva

42 terms by krbond 

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CYSTOCELE

...

Cystocele

Decent of a portion of the posterior bladder wall and trigone into the vagina.

Typically due to the trauma of parturition.

Clinical Manifestations of Cystocele

Small = no significant symptoms
Large = vaginal pressure or protruding mass
Urinary incontinence
Aggravated by prolonged standing, coughing, or straining

Physical examination of Cystocele

Relaxed vaginal outlet with a thin-walled, smooth bulging mass involving the anterior vaginal wall.

Straining may cause the mass to project through the vaginal introitus.

Treatment of Cystocele

Kegel exercises
Vaginal Pessary
Estrogens
Surgery if cystocele is large enough -- Anterior vaginal colporrhaphy

VAGINAL NEOPLASM

...

Vaginal neoplasm

Peak incidence in 50s.
Epithelial type is most common.
Increased risk for clear cell adenocarcinoma of vagina with exposure to DES.

Clinical manifestations of vaginal neoplasm

Many are asymptomatic
May present with vaginal discharge, bleeding, and vaginal pruritis.

Diagnosis of vaginal neoplasm

Screen for with Pap smear and colposcopy
Confirmed by biopsy

Treatment of vaginal neoplasm

Surgical resection and radiation therapy
5-year survival varies with clinical stage.

VULVA NEOPLASM

...

Vulva neoplasm

Peak incidence in 60s.

Clinical manifestations of vulva neoplasm

Vulvar pruritis and vulvodynia
May present with vulvar bleeding or mass

Diagnosis of vulva neoplasm

confirmed with biopsy

Treatment of vulva neoplasm

Wide, local excision with regional lymphadenectomy - treatment of choice.
Pelvic radiation for metastatic disease.

RECTOCELE

...

Rectocele

Herniation into the vaginal vault
Due to injury of the endopelvic fascia of the rectovaginal septum

Clinical manifestations of rectocele

Small = typically asymptomatic
Larger = vaginal pressure, rectal fullness, and incomplete evacuation

Physical exam of rectocele

Soft, thin-walled rectovaginal septum projecting into the vagina.

Diagnosis of rectocele

Based on history and physical exam findings

Treatment of rectocele

Medical = increasing fluids and laxatives
Surgical = posterior colpoperineorraphy

VAGINITIS - YEAST INFECTION

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Yeast infection

C. Albicans
Predisposing factors - antibiotic use, DM, decreased cellular immunity
20-25% of all causes of vaginitis

Clinical manifestations of yeast infection

Vulvar and vaginal pruritus, burning, dysuria, dyspareunia, and vaginal discharge

Physical examination of yeast infection

Vulvar edema with erythema and thick white vaginal discharge

Diagnosis of yeast infection

Branching hyphae and spores noted on KOH prep
Gram stain and culture also used

Saline preparation positive for yeast and mycelia

Treatment for yeast infection

Azole agents via topical application
Oral fluconazole also effective

VAGINITIS - TRICHOMONAS VAGINALIS

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Trichomonas vaginalis

STI caused by unicellular flagellated protozoan
15-20% of all causes of vaginitis

Clinical manifestations of trichomonas vaginalis

Profuse unpleasant-smelling discharge - yellow or green in color and frothy
May note vulvar erythema, edema, and pruritis.

Physical examination of trichomonas vaginalis

Erythematosus, punctate epithelial papillae, or a strawberry appearance of the cervix.

Diagnosis of trichomonas vaginalis

Wet prep reveals motile protozoan

Trichomonas vaginalis

Treatment of trichomonas vaginalis

Metronidazole for 7 days

VAGINITIS - GARDNERELLA VAGINALIS

...

Gardnerella vaginalis

Risk factors include low SE status, IUD usage, multiple sexual partners, and smoking
Make up 40-50% of all causes of vaginitis

Clinical manifestation of gardnerella vaginalis

May be asymptomatic
Symptomatic = profuse, nonirritating discharge with a fishy odor.

Diagnosis of gardnerella vaginalis

On wet prep, note epithelial cells covered by bacteria (clue cells)
The fish odor can be enhanced by adding KOH to the vaginal prep (whiff test)

Clue cells

Vaginal squamous epithelial cells covered in G. vaginalis, giving the cells a granular appearance.

Clue cells seen in bacterial vaginosis

Treatment of gardnerella vaginalis

Metronidazole or clindamycin

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