Benign lesions of the cervix, vagina and vulva

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  • 1. Benign Lesions of the Cervix, Vagina and Vulva Dr J Romain
  • 2. Cervix
    • Examination; cuscoe or sims’ speculum. Size, shape and consistency should be noted aswell as any discharge.
    • Ectocervix; stratified squamous epithelium
    • Endocervical canal; columnar epithelium
    • Junction; squamocolumnar
    • and adjacent is the
    • Transformation Zone
  • 3. Cervical Ectopy or Erosion
    • Endocervical epithelium advances on ectocervix- bright red velvety appearance
    • Occurs more in adolescence, pregnancy, use of OCP. Can also result from labour
    • Most cases asymptomatic
    • Can cause leucorrhoea and post-coital bleeding
    • Treatment- only if symptomatic
    • radial diathermy or cryosurgery
  • 4. Cervical Ectopy
    • Complications- secondary haemorrhage and infection
    • - cervical stenosis
    • Cervicitis
    • Non-specific condition difficult
    • to define. Common clinical
    • diagnosis
  • 5. Cervical Polyps
    • Develop from endocervix and protrude into vagina
    • Usually asymptomatic
    • Can cause intermenstrual
    • and postcoital bleeding
    • Rarely malignant
    • Treat by avulsing and send for histology
    • Base should be cauterised-prevents regrowth
  • 6. Cervical Fibroids
    • Cervical leiomyomas similar to fibroids in other sites of uterus
    • Pedunculated, sessile or grow to fill vagina and distort pelvic organs
    • Symptoms similar to other polyps
    • Attempted extrusion can cause
    • colicky uterine pain
    • Treatment by excision
  • 7. Nabothian Follicles
    • If process of squamous metaplasia results in obstruction of cervical glands, retention cysts form- Nabothian follicles/cysts
    • Linked to chronic
    • cervicitis
  • 8. Vagina- Gartners Cyst
    • Arise from embryological remnants of the Wolffian duct.
    • Not rare, occur in antero-lateral wall
    • of vagina
    • Asymptomatic
    • Surgical excision if needed
    • Vaginal Septum
    • Failure of transverse septum loss between paramesonephric system and urogenital sinus
  • 9. Solid Benign Tumours
    • Rare but represent any of the tissues found in the vagina.
    • Therefore they would include fibromyomas, myomas, fibromas, papillomas and adenomyomas
    • Treated by surgical excision
    • Vaginal Inclusion Cysts
    • Arise from inclusion of small parts of vaginal epithelium under surface. Commonly in episiotomy scar. Treated by excision
  • 10. Vaginitis
    • Atrophic- usually postmenopausal and treated only if symptomatic
    • INFECTIVE-MANY CAUSES!!
    • Candidia albicans
    • White discharge, more common in pregnancy, diabetics, recent abx usage, immunocompromised
    • Treat with clotrimazole pessarys and cream, oral treatment can be used but systemic side effects
  • 11. Bacterial Vaginosis
    • Lactobaccilli replaced by anaerobes
    • Offensive green/grey discharge
    • pH raised to 5.5
    • ‘Clue’ cells on wet microscopy
    • Treat with oral or vaginal metronidazole or clindamycin
  • 12. Chlamydia
    • Commonest sexually transmitted infection
    • Often asymptomatic but may cause urethral discharge, dysuria
    • Diagnosed on endocervical swabs or from urine PCR/LCR
    • Treat with azithromycin or doxycycline for 7-10 days
    • Contact tracing important
    • Strong association with PID and infertility
  • 13. Genital Warts
    • Usually caused by HPV 6 and 11
    • 25% have other demonstrable STD’s
    • Treat with Podophyllin paint, cryotherapy for large warts
    • Herpes
    • Classically type 2, incubation 2-14 days
    • Multiple ulcers and very painful
    • Treat with acyclovir
  • 14. Gonorrhoea
    • Majority women asymptomatic
    • Men have urethritis and penile discharge
    • Gram stained- gm –ve diplococci
    • Treat with ampicillin or ciprofloxacin
    • Syphilis (treponema pallidum)
    • Primary chancre resolves within 3-8wks
    • Diagnosis made serologically
    • Treat with procaine benzylpenicillin for 10-21 days
  • 15. Trichomonas Vaginalis
    • Offensive purulent discharge with dysuria and vulval soreness
    • Diagnose by identifying flagellate on a wet film
    • Treat same as for bacterial vaginosis- metronidazole
  • 16. Vulva- Bartholin’s Cyst
    • Bartholin’s glands situated in posterior part of the labia
    • Lymphatics drain to inguinal nodes
    • Secrete mucus, particularly during intercourse
    • Can block causing retention
    • cyst and if superimposed
    • infection-an abcess. Can be
    • I&D
  • 17. Pruritis Vulvae
    • Infection- candida, threadworms
    • Eczema
    • Dermatitis
    • Lichen sclerosis
    • Lichen planus
    • Medical problems; diabetes, liver failure, uraemia
  • 18. Further vulval conditions
    • Vulvodynia- chronic vulvar discomfort characterised by burning and irritation, may respond to topical steroids or tricyclics
    • Urethral Caruncle- polypoidal outgrowth from edge of urethra. Some cause dysuria, frequency. Treat with excision
    • Ulcers- apthous, herpetic, syphilitic, crohns, Behcets, lichen planus
    • Simple atrophy- dysuria and dyspareunia, if severe labia minora fuse and bury clitoris. Treat with oestrogen replacement
  • 19. Yet more vulval conditions
    • Lichen Sclerosis
    • Squamous cell hyperplasia
    • Allergic/irritant dermatosis
    • Psoriasis
    • Lichen Planus
  • 20.
    • THE END!!