Women's Health: Vulvar & Vaginal Disorders Chapter 153 PDF

Women’s Health Chapter 153 Vulvar and Vaginal Disorders Defintion  Benign Vulvar Disorders encompass a broad range of dermatologic conditions. Women may delay treatment due to fear, embarrassment or confusion over which health care provider will best understand...

Women’s Health Chapter 153 Vulvar and Vaginal Disorders Defintion  Benign Vulvar Disorders encompass a broad range of dermatologic conditions. Women may delay treatment due to fear, embarrassment or confusion over which health care provider will best understand their problem.  Signs and symptoms of vulvar disorders include pruritis, pain, burning, irritation and a mass and/or growth.  Pruritis is often chief complaint, and skin breakdown is common form of scratching. This may be related to unrelated to vaginitis, STIs, Bartholin duct cysts, or neoplasms.  Visual inspection is essential in identifying vulvar changes for detailed inspection a colposcope may be used. Lichen Sclerosis  Lichen Sclerosis (LS) is a chronic condition with an unclear cause  LS can have an autoimmune component  Women with LS may develop other disorders such as thyroid disease, anemia, vitiligo, and alopecia  LS may be triggered by an infectious process, a genetic pre- disoposition and decreased estrogen levels.  LS is seen in perimenopausal and postmenopausal women  Incidence increases with age Clinical Presentation of LS  Sometimes asymptomatic  Severe vulvar pruritis and/or dyspareunia  Affects the labia minora, vulvar vestibule, perineum, and clitoris  Upon exam white papules, epithelium is thin, tissue elasticity decreased and edema is present  Fissures and secondary infection may develop  Papules may develop into large, hypopigmented , symmetric plaques which are hourglass shaped. Image of LS plaque Labs and Diagnostics  Obtain thorough History and Physical  CBC if infection is suspected  Autoimmune lab tests including thyroid function tests, antinuclear antibodies, and vitamin B12 can be ordered but are not routine.  A PUNCH BIOPSY of the affected area will confirm the diagnosis  Findings include hyperkeratosis, epithelial thinning, cytoplasmic vacuolation of the basal layer of cells, follicular plugging, homogenization of the subepithelial layer and inflammatory cell infiltration consisting of lymphocytes and with few plasma cells Treatment for LS  Topical steroids  Topical Antibiotic Ointment  Topical estrogen  Oral antihistamines  Immunosuppressant agents  Cool compressions and soaks  Loose fitting clothing Bacterial Vaginosis  A vaginal infection in which several species of bacteria interact to alter the vaginal flora  Common type of minor bacterial infection that happens when the pH balance inside the vagina measures outside of the normal range.  Cannot be sexually transmitted  Causes/ Incidence  Most pre valent vaginal infection in women of reproductive age  May be seen in prepubescent females  More common in females who use douches or scented or colored soap products  Other causes include: changes in diet Signs and symptoms of BV  May have pruritis (vaginal itching)  Malodorous “fishy” discharge, white to gray in color  Burning during urination  Most prominent around the menstrual period or after sexual intercourse  Some women with BV are asymptomatic Risk factors for BV  Multiple sex partners or a new sex partner  Douching  Natural lack of lactobacilli bacteria Laboratory/Diagnostics  Wet Mount  ClueCells: Epithelial cells covered with bacteria appear stippled (small dots or specks) with poorly defined borders  Decreased/ absent lactobacilli  Few or absent WBCs  Positive amine “WHIFF TEST” (fishy odor when potassium hydroxide (KOH) added to slide Barkley, T (2023) Image of BV under microscope Treatment  Metronidazole PO  A. Adults: 500 mg q12hrs x 7days  Intravaginal:  Metronidazole (0.75%), one applicator (5 grams) per day x 5 days OR  Clindamycin 2%, one applicator (5 grams) at bedtime x 7 days Barkley, T. (2023) Complications  BV generally does not cause complications, but may lead to :  Preterm birth  Sexually transmitted infections such as HIV, herpes simples virus, chlamydia, or gonorrhea  Infection risk after gynecologic surgery such as post op infections after hysterectomy or D&C  Pelvic Inflammatory Disease (PID) such as infection can increase the risk of infertility