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What is a common chief complaint associated with vulvar disorders?
What is a common chief complaint associated with vulvar disorders?
Which of the following conditions is commonly associated with Lichen Sclerosis?
Which of the following conditions is commonly associated with Lichen Sclerosis?
What characteristic is often observed during the clinical examination of Lichen Sclerosis?
What characteristic is often observed during the clinical examination of Lichen Sclerosis?
In which population is Lichen Sclerosis incidence most likely to increase?
In which population is Lichen Sclerosis incidence most likely to increase?
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What type of lab tests may be ordered for Lichen Sclerosis if an autoimmune component is suspected?
What type of lab tests may be ordered for Lichen Sclerosis if an autoimmune component is suspected?
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What is the best method to confirm the diagnosis in suspected cases of Lichen Sclerosus (LS)?
What is the best method to confirm the diagnosis in suspected cases of Lichen Sclerosus (LS)?
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Which of the following is NOT a treatment option for Lichen Sclerosus?
Which of the following is NOT a treatment option for Lichen Sclerosus?
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What is a common symptom of Bacterial Vaginosis?
What is a common symptom of Bacterial Vaginosis?
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Which factor is NOT considered a risk factor for Bacterial Vaginosis?
Which factor is NOT considered a risk factor for Bacterial Vaginosis?
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What laboratory finding is characteristic of Bacterial Vaginosis?
What laboratory finding is characteristic of Bacterial Vaginosis?
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Which of the following treatments for Bacterial Vaginosis is administered intravaginally?
Which of the following treatments for Bacterial Vaginosis is administered intravaginally?
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Which symptom is most prominent during the menstrual period in women with Bacterial Vaginosis?
Which symptom is most prominent during the menstrual period in women with Bacterial Vaginosis?
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In what setting is Bacterial Vaginosis most commonly seen?
In what setting is Bacterial Vaginosis most commonly seen?
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What demographic is more likely to experience Lichen Sclerosis as the incidence increases with age?
What demographic is more likely to experience Lichen Sclerosis as the incidence increases with age?
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Which symptom is frequently associated with Lichen Sclerosis during clinical presentation?
Which symptom is frequently associated with Lichen Sclerosis during clinical presentation?
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What is a common reason women may delay seeking treatment for vulvar disorders?
What is a common reason women may delay seeking treatment for vulvar disorders?
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Which of the following findings is typical upon examination of Lichen Sclerosis?
Which of the following findings is typical upon examination of Lichen Sclerosis?
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Which test may be ordered to investigate potential autoimmune involvement in Lichen Sclerosis?
Which test may be ordered to investigate potential autoimmune involvement in Lichen Sclerosis?
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What is one common histological finding in a punch biopsy for Lichen Sclerosis?
What is one common histological finding in a punch biopsy for Lichen Sclerosis?
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Which treatment option is typically used for Bacterial Vaginosis?
Which treatment option is typically used for Bacterial Vaginosis?
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Which symptom is typically associated with Bacterial Vaginosis?
Which symptom is typically associated with Bacterial Vaginosis?
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What is a known risk factor for developing Bacterial Vaginosis?
What is a known risk factor for developing Bacterial Vaginosis?
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Which laboratory test is useful for diagnosing Bacterial Vaginosis?
Which laboratory test is useful for diagnosing Bacterial Vaginosis?
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What action is typically recommended for relief in cases of Lichen Sclerosis?
What action is typically recommended for relief in cases of Lichen Sclerosis?
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What underlying bacterial change is associated with Bacterial Vaginosis?
What underlying bacterial change is associated with Bacterial Vaginosis?
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Which topical treatment is NOT typically used for Lichen Sclerosis?
Which topical treatment is NOT typically used for Lichen Sclerosis?
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Which demographic group is more likely to develop Lichen Sclerosis?
Which demographic group is more likely to develop Lichen Sclerosis?
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What is one possible trigger for Lichen Sclerosis?
What is one possible trigger for Lichen Sclerosis?
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Which of the following symptoms is commonly associated with Lichen Sclerosis?
Which of the following symptoms is commonly associated with Lichen Sclerosis?
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What is an essential method for identifying vulvar changes in suspected vulvar disorders?
What is an essential method for identifying vulvar changes in suspected vulvar disorders?
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What is a characteristic laboratory test when an infection is suspected in vulvar disorders?
What is a characteristic laboratory test when an infection is suspected in vulvar disorders?
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Which laboratory test is indicative of Bacterial Vaginosis due to the presence of clue cells?
Which laboratory test is indicative of Bacterial Vaginosis due to the presence of clue cells?
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What is a common histological finding noted in a punch biopsy for Lichen Sclerosis?
What is a common histological finding noted in a punch biopsy for Lichen Sclerosis?
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What symptom is most commonly associated with Bacterial Vaginosis?
What symptom is most commonly associated with Bacterial Vaginosis?
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Which treatment is recommended for Bacterial Vaginosis to combat the infection?
Which treatment is recommended for Bacterial Vaginosis to combat the infection?
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Which factor is likely to increase the risk of developing Bacterial Vaginosis?
Which factor is likely to increase the risk of developing Bacterial Vaginosis?
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Which of the following is NOT considered a treatment option for Lichen Sclerosis?
Which of the following is NOT considered a treatment option for Lichen Sclerosis?
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What finding on the wet mount is associated with a Bacterial Vaginosis diagnosis?
What finding on the wet mount is associated with a Bacterial Vaginosis diagnosis?
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What is an unlikely characteristic finding in a punch biopsy for Lichen Sclerosis?
What is an unlikely characteristic finding in a punch biopsy for Lichen Sclerosis?
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Study Notes
Women's Health: Vulvar and Vaginal Disorders (Chapter 153)
- Benign Vulvar Disorders: A broad range of dermatologic conditions. Women may delay treatment due to fear, embarrassment, or confusion about which healthcare provider is best suited.
- Signs and Symptoms: Pruritus (itching), pain, burning, irritation, and masses/growths are common. Skin breakdown from scratching can occur, potentially related to vaginitis, STIs, Bartholin duct cysts, or neoplasms.
- Diagnosis: Visual inspection is key. A colposcope may be used for detailed inspection of vulvar changes.
Lichen Sclerosis (LS)
- Description: A chronic condition with an unclear cause. May have an autoimmune component.
- Associated Conditions: Women with LS may also develop thyroid disease, anemia, vitiligo, and alopecia.
- Triggers: Possibly triggered by infectious processes, genetic predisposition, and decreased estrogen levels.
- Prevalence: Seen in perimenopausal and postmenopausal women. The incidence increases with age.
- Clinical Presentation: Sometimes asymptomatic. Severe vulvar pruritis (itching) and/or dyspareunia (painful sex) are common. Exam shows white papules, thin epithelium, decreased tissue elasticity, and edema. Fissures and secondary infections may occur. Papules can evolve into large, hypopigmented, hourglass-shaped plaques.
Laboratory and Diagnostics (LS)
- History & Physical: Essential for assessment.
- CBC: If infection is suspected.
- Autoimmune tests: Including thyroid function tests, antinuclear antibodies (ANA), and vitamin B12. Not routinely needed.
- Punch Biopsy: The definitive diagnostic procedure to confirm LS. Shows specific histological features such as hyperkeratosis, epithelial thinning, cytoplasmic vacuolation of basal cells, follicular plugging, homogenized subepithelial layer, inflammation with lymphocytes and some plasma cells.
Treatment for LS
- Topical Steroids: Ointments are a common approach.
- Topical Antibiotic Ointment: Used in cases of secondary infection.
- Topical Estrogen: Can be beneficial.
- Oral Antihistamines: Might provide some relief from itching.
- Immunosuppressants: Used in some cases.
- Cool Compressions/Soaks: Can alleviate discomfort.
- Loose-fitting Clothing: Helps reduce irritation.
Bacterial Vaginosis (BV)
- Definition: A vaginal infection where multiple bacterial species interact to alter the vaginal flora. The pH balance inside the vagina is outside of the normal range.
- Transmission: Not sexually transmitted.
- Causes/Incidence: Common in women of reproductive age, and occasionally in prepubescent females. Associated with douching, scented/colored soaps, and dietary changes.
- Signs and Symptoms: Thin, whitish, grayish, or greenish vaginal discharge; increased vaginal discharge; foul "fishy" odor, especially after intercourse; itching; burning during urination; symptoms usually most pronounced around menstrual periods and after sex. Many women are asymptomatic.
- Risk Factors: Multiple sex partners, new sexual partners, douching, and a natural lack of lactobacilli bacteria.
Laboratory/Diagnostics (BV)
- Wet Mount: Clue cells (epithelial cells covered in bacteria); decreased or absent lactobacilli; few or no white blood cells (WBCs).
- WHIFF Test: A positive test (fishy odor upon adding potassium hydroxide (KOH) to the sample) is another important diagnostic indicator.
Image of BV under Microscope
- Microscopic Findings: Visual comparisons of healthy vs. BV samples are crucial to observe differences in microbial flora.
Treatment for BV
- Metronidazole: Oral (500 mg BID for 7 days), or vaginal (0.75% gel, 5 grams daily for 5 days).
- Clindamycin: Vaginal (2% cream, 5 grams at bedtime for 7 days).
Complications (BV)
- General: BV is rarely life-threatening.
- Specific: Can predispose women to preterm birth and sexually transmitted infections (STIs). Higher risk of infection after gynecologic procedures like hysterectomy or D&C. Increased risk of pelvic inflammatory disease (PID), which may lead to infertility.
Bacterial Vaginosis Do's and Don'ts
- Do's: Gentle hygiene; loose-fitting, cotton underwear; avoiding perfumed products; changing out of wet clothes; avoiding douching.
- Don'ts: Using perfumed products in the vagina; over-washing; using harsh detergents on underwear; frequent use of douches; prolonged exposure to heat.
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Description
Explore the various aspects of vulvar and vaginal disorders, including benign conditions, signs and symptoms, and diagnostic approaches. This chapter delves into conditions like Lichen Sclerosis and their associated health issues. Gain insights into underlying causes and the prevalence of these disorders in women, particularly during hormonal transitions.
