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42 terms

Vagina / Vulva

STUDY
PLAY
CYSTOCELE
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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
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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
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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
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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
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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