3 Benign itchy vulval skin conditions
-what they look like
- Lichen SCLEROSIS (itch + white thickened plaques on skin)
- Lichen SIMPLEX (itch + hyper/hypo pigmentation)
- Lichen PLANUS (pain/itch + flat purple papules)
Which vulval skin condition may be associated with vulval intra-epithelial neoplasia
Lichen sclerosis
Explain in histological terms what a cervical ectropion is
Cells normally found on the inside of the cervix (glandular) are present on the outside of the cervix (normally squamous epithelial)
Symptoms of cervical ectropion/ polyp
- heavy flow periods
- intermenstrual bleeding
- prolapse through cervix
Non-infective pathological causes of vaginal discharge
- Cervical polyps
- Vulval dermatitis
- Erosive lichen planus
- Cancer (cervix/ uterus/ ovary)
- Fistula
5 Non-infective pathological causes of vaginal discharge
- Cervical polyps
- Vulval dermatitis
- Erosive lichen planus
- Cancer (cervix/ uterus/ ovary)
- Fistula
5 Infective causes of vaginal discharge
- BV (most common)
- Candida
- Chlamydia
- Gonorrhoea
- Trichomonas vaginalis
Risk factors for bacterial vaginosis
- IUD
- Vaginal douching
- Sexually active
Type of discharge in BV
- Grey-watery discharge
* Strong fishy smell
Type of discharge in candida
- Thick white/ watery discharge (cottage-cheese like)
* Odourless
Type of discharge in trichomonas vaginalis
- Thick, yellow-green
* Strong fishy odour
What is the most common pelvic tumour
Fibroids
4 sites where fibroids are found.
Which is the most common?
- Intramural (most common)
- Submucosal (under lining)
- Subserosal (under perimetrium)
- Pedunculated (growing on a stalk)
Symptoms of fibroids
- Abnormal bleeding
- Abdo pain/ pressure
- Urinary urgency (from compression)
- Constipation (from compression)
4 pregnancy-related complications of fibroids
- Recurrent spontaneous abortion
- Premature contractions
- Abnormal foetal presentation
- Block cervix, making C section necessary
Bimanual palpation is normally enough to examine fibroids.
In what 4 cases would imaging also be necessary?
- New finding
- Increase in size
- Fibroids causing symptoms
- Exclude differentials eg ovarian masses
What 2 hormonal treatments may be given for fibroids
- GnRH agonists
- Exogenous progestins
(both would suppress oestrogen)
What is adenomyosis?
Symptoms?
Endometrium grows into myometrium
-Causes menstrual cramps, bloating before periods
Cellular origin of fibroids
Monoclonal
What is endometriosis
Presence and growth of tissue similar to endometrium outside the uterus
What is a chocolate cyst/ endometrioma
Growth of endometrial tissue within ovary
Appearance of chocolate cyst/ endometrioma on USS
Ground glass appearance (due to abnormal blood)
What gynae conditions respond to oestrogen?
When will they be biggest?
Larger during reproductive years
Smaller after menopause
- Fibroids
- Endometriosis
On laparoscopy to diagnose endometriosis, what are signs of
-active disease
Red vesicles
