Female Genital Diseases Overview

Female Genital Diseases - Overview

• Diseases of the vulva include infectious vulvitis, inflammatory dermatoses, and neoplasms.

Diseases of Vulva

• Infectious Vulvitis: Key infectious agents include:

  • Human papillomavirus (HPV), causing condylomata acuminata (warts) and vulvar intraepithelial neoplasia.
  • Herpes simplex genitalis (HSV 1 or 2), causing vesicular eruptions.
  • Gonococci, causing suppurative infection of the vulvovaginal glands.
  • Syphilis, causing primary chancre at inoculation site.
  • Candida, causing itchy rash on vulva and surrounding skin.

• Inflammatory Dermatoses of Vulva:

  • Contact dermatitis: a reactive inflammatory response to irritants (e.g., urine, chemicals) or allergens (contact allergic dermatitis).
  • Lichen sclerosus (lichen sclerosus et atrophicus): a chronic inflammatory dermatosis affecting genital areas, characterized by itchy, smooth white to gray plaques. It is thought to be an autoimmune disease, most common in postmenopausal women

• Neoplasms of Vulva:

  • Papillary hidradenoma: arises from apocrine sweat glands, typically a circumscribed nodule located in the labia; microscopically characterized by irregularly shaped tubular structures, dilated duct-like structures, and intraluminal papillary projections, all lined by two layers (columnar cells internally, cuboidal cells externally).
  • Condylomata acuminatum (genital warts): a wart-like verrucous lesion caused by HPV types 6 or 11, commonly found on the vulva, perineum, and vagina; composed of sessile or pedunculated epithelial proliferation of stratified squamous epithelial cells, some showing perinuclear cytoplasmic clearing.
  • Vulvar intraepithelial neoplasia (VIN): caused by HPV 16; occurs in the 4th or 5th decades, and can progress to invasive carcinoma in the sixth decade.
  • Invasive squamous cell carcinoma (SCC): typically well-differentiated squamous cell carcinoma with keratin pearls or nests, and obvious intracellular bridges; prognosis depends on tumor size, invasion depth, and lymph node status.
  • Paget's disease of vulva: carcinoma in situ, mostly on labia majora, appearing as a red crusted area; composed of large anaplastic cells; no underlying intraductal carcinoma.
  • Other vulvar carcinomas: include basal cell carcinoma, adenocarcinoma of Bartholin or sweat glands, and malignant melanoma.

Vaginal Diseases

• Vaginal Infectious Inflammation: A common, usually sexually transmitted condition, often causing vaginal discharge; major organisms include:

  • Gardenella vaginalis
  • Neisseria gonorrhoeae
  • Candida albicans
  • Trichomonas vaginalis

• Vaginal Neoplasia (Vaginal Intraepithelial Neoplasia - VaIN): Defined by squamous cell atypia without invasion; classified by depth of epithelial involvement:

  • VaIN 1 and 2: involve the lower one-third and two-thirds of the epithelium, respectively.
  • VaIN 3: involves the full thickness of the epithelium. All are related to HPV infection.

• Invasive vaginal squamous cell carcinoma: uncommon, predominantly HPV-associated, and preceded by VaIN 3.

• Clear cell adenocarcinoma: occurs in young women whose mothers were treated with diethylstilbestrol during pregnancy (discontinued); composed of glands lined by vacuolated clear cells.

• Embryonal rhabdomyosarcoma: a rare, polypoid tumor in young female children.

Cervix Disease

• Infectious Cervicitis: Extremely common; common organisms are Chlamydia trachomatis, N. gonorrhoeae, and Trichomonas vaginalis; either chronic or acute, with acute cases often resulting in purulent discharge; sometimes not due to infection, but chemical or mechanical irritation.

• Chronic Cervicitis: In chronic cases, the cervical tissue is infiltrated by inflammatory cells; causes metaplasia of endocervical columnar epithelium into squamous epithelium, sometimes obstructing cervical gland crypts and causing Nabothian cysts.

• Endocervical Polyps: Common, occurring at any age; usually small but can be large; composed of connective tissue stroma (blood vessels) covered by endocervical glandular or metaplastic squamous epithelium; no definite etiology, but chronic inflammation may play a role; typically have no malignant potential.

• Cervical Intraepithelial Neoplasia (CIN): Caused by HPV, typically begins at squamo-columnar junction in adolescents; presents with squamous metaplasia, maturation, and cytologic atypia; nuclear atypia features include hyperchromasia, pleomorphism, increased mitotic activity, and increased N/C ratio. Graded:

  • CIN I: mild dysplasia (lower 1/3 of epithelium)
  • CIN II: moderate dysplasia (lower 2/3 of epithelium)
  • CIN III: severe dysplasia (more than 2/3 to full epithelial thickness)

• These lesions can persist for up to 10 years before potentially progressing to invasion.

• Invasive Squamous Cell Carcinoma of the Cervix: Peak incidence around age 45, usually in multiparous women; frequently preceded by CIN 3; can cause pain, bleeding, and painful intercourse; predisposing factors include early sexual activity, high parity, infection with herpes simplex type II and HPV, and high and prolonged estrogen levels.

• Grossly, appear as: polypoid (most common), ulcerative, or infiltrating within the cervix wall

• Microscopically, there are keratinizing (keratin pearls, abundant keratohyaline granules, intercellular bridges, large and hyperchromatic nuclei) or nonkeratinizing forms (polygonal sheets or nests with intercellular bridges but no keratin pearls), papillary forms (thin or broad papillae with fibrovascular cores lined by multilayered epithelium), and basaloid forms (defined nests of immature basaloid cells).

• Stages of SCC: Stages I to IV based on extent of invasion, with Stage IV having reached the bladder and rectum, sometimes with distant metastases.

• Other Malignant Tumors of the Cervix: Include adenocarcinoma (classic type 0), adenosquamous carcinoma, clear cell adenocarcinoma, small cell carcinoma, sarcomas, and melanoma.

• Effects and complications of cancer cervix: include local spread to surrounding structures, lymphatic spread to regional lymph nodes (iliac, sacral, hypogastric), blood spread to liver, lungs, and bone, and fistulas (vesico-vaginal and rectovaginal) or pyometra.

This quiz provides an overview of female genital diseases, particularly those affecting the vulva. It covers infectious vulvitis caused by various agents, inflammatory dermatoses such as contact dermatitis and lichen sclerosus. Test your knowledge on the symptoms and causative factors related to these conditions.