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Benign lesions of the cervix, vagina and vulva
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    Benign lesions of the cervix, vagina and vulva Benign lesions of the cervix, vagina and vulva Presentation Transcript

    • Benign Lesions of the Cervix, Vagina and Vulva Dr J Romain
    • 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
    • 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
    • Cervical Ectopy
      • Complications- secondary haemorrhage and infection
      • - cervical stenosis
      • Cervicitis
      • Non-specific condition difficult
      • to define. Common clinical
      • diagnosis
    • 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
    • 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
    • Nabothian Follicles
      • If process of squamous metaplasia results in obstruction of cervical glands, retention cysts form- Nabothian follicles/cysts
      • Linked to chronic
      • cervicitis
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Pruritis Vulvae
      • Infection- candida, threadworms
      • Eczema
      • Dermatitis
      • Lichen sclerosis
      • Lichen planus
      • Medical problems; diabetes, liver failure, uraemia
    • 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
    • Yet more vulval conditions
      • Lichen Sclerosis
      • Squamous cell hyperplasia
      • Allergic/irritant dermatosis
      • Psoriasis
      • Lichen Planus
      • THE END!!