Benign lesions of the cervix, vagina and vulva

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Benign lesions of the cervix, vagina and vulva

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

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