vosk exam med II vaginal disorders

pt has pain/tenderness, dyspareunia, trouble walking and adducting the thighs. a fluctuant tender mass is in the posterior introitus near 4 or 8 o clock position. surrounding erythema, edema, and inflammation. no systemic sx.

bartholins gland abscess

how to tx a bartholins gland abscess

I&D with marsupialization (suture edges open), insertion of ward catheter that has an inflatable bulb tipped catheter. excision of cyst can be needed if postmenopausal. abx if inflammation develops

the most common non neoplastic epithelial vulvar disorder. intense pruritis occurs, in women >60. vulvar skin gets thin, wrinkled, and white plaques form. areas of lichenification and hyperkeratosis. anterior labia minora agglutinate. erosions, fissures, subepithelial hemorrhages, and ulcerations from scratching. cigarette paper like appearance. need biopsy

lichen sclerosus

this dz is the most common valvular derm d/o. benign chronic inflammation. linked to genetics. assoc w human leukocyte antigen (HLA), vit a def = inc autoantibodies, inc elastase, dec 5-alpha-reductase enzyme which breaks down test = thin skin.

lichen sclerosus

how to dx lichen sclerosus

biopsy shows thin hyperkeratotic layer, thin epithelial layer, flat papillae, homogenous stroma, deep lymphocytic infiltration

complications of lichen sclerosus are

squamous cell ca. 

how to tx lichen sclerosus

clobetasol dipropionate and oral antihistamines (tacrolimus, retinoids, antimalarial agents, photodynamic therapy), also PRP

this dz is another term for a bunch of conditions that include dystrophy, squamous cell hyperplasia, atophic dermatitis, atopic eczema, and neurodermatitis. characterized by benign epithelial thickening and hyperkeratosis resulting from chronic irritation. constantly scratching it causes epithelial thickening and moist environment = maceration and raised white lesion.

lichen simplex chronicus.

what test do you need to conduct for suspected lichen simplex chronicus in order to rule out intraepithelial neoplasia and invasive tumor

biopsy

vesicles that erode rapidly creating painful erosions or ulcers. surrounded by a red halo. serpentine like lesions. recurrence is common. gold standard is viral culture. infection happens thru intimate contact. in half of pts asx viral shedding is identifiable in 1 yr of primary outbreak

herpes genitalis

how to diagnose herpes genitalis

viral culture

HSV erosions make a pt more prone to what other dz

STIs

how to prevent genital herpes

condoms, carrier consider suppressive antiherpetic meds.

pt has a feeling of tingling, burning, or itching and flu like sx. vesicles erode quickly and create painful erosions or ulcers, considered dew drop on a rose petal. 

herpes genitalis

complications of genital herpes

painful, neonatal herpes causing mortality, survivors have a neoro d/o. mother should go thru with c section to prevent vertical transmission

how to tx genital herpes

loose fitting undergarments, cool comnpress, tx options like acyclovir, valacyclovir, famciclovir. if initial episode then higher dose for longer

pt has involuntary leakage of urine with physical exertion or with coughing or sneezing. when intra abdominal pressure inc pressure isn’t equally transmitted to the urethra causing leakage of urine

stress urinary incontinence

how to tx stress urinary incontinence

weight loss, reduction of caffeine and alc, fluid restriction, timed voiding, pelvic floor muscle exercises, e stim, pessaries and surgical correction

involuntary leakage of urine with urgency. linked with overactive bladder leading to urgency and frequency with nocturia ± incontinence. strong urge or sense of impending urine loss, often occurring before reaching toilet. Key in lock syndrome = uncontrollable urge to void when unlocking the door after getting home

urge urinary incontinence

how to tx urge urinary incontinence

behavioral therapy like bladder training, timed voiding, pelvic floor exercises. pharmacologic like antimuscarinics or anticholinergics. or injecting botox into detrusor muscle, sacral neuromodulation, posterior tibial nerve stim.

stress + urge incontinence at the same time. preemptively urinate to avoid a full bladder and then condition the bladder to a low functional capacity creating premature signaling of a full bladder and urge sx

mixed incontinence

how to tx mixed incontinence

tx the condition that is more pressing to the pt, whether that be stress or urge related incontinence.

involuntary loss of urine associated with bladder overdistention in absence of detrusor contraction. usually in men with outlet obstruction bc of enlarged prostate. in women is uncommon but is due to inc resistance from vaginal prolapse causing urethral kink. pt has loss of urine without knowing or constant dribbling/wetness feeling. pts apply suprapubic pressure to help void.

overflow incontinence

how to tx overflow incontinence

tx underlying cause, may need to use catheterization. meds like alpha adrenergic blockers like tamsulosin facilitate bladder emptying by relaxing bladder neck

this defect is where bladder is frequently associated with this prolapse. if it does its called a cystocele.

anterior vaginal wall defect

uterine prolapse, vaginal vault prolapse post hysterectomy, enterocele (bowel prolapses)

apical prolapse

if prolapse includes rectum is a rectocele

posterior vaginal wall prolapse

what is the most common apical prolapse post hysterectomy

enterocele

braden walker system is what

prolapse system. stage 0 is no prolapse, stage 4 is complete eversion of length of lower genital tract

pt has a feeling of fullness, pressure, heaviness, vaginal discomfort or something coming out of them, or like they’re sitting on a ball. PE shows soft reducible mass bulging into vagina and distends thru introitus. on cough it bulges. also back pain/pelvic pain, incomplete emptying, urinary freq or hesitancy, need to push bladder to void (splinting). this dz is

pelvic organ prolapse

risk factors for pelvic organ prolapse

inc age, obesity, hx of pelvic surgery, always straining, heavy lifting with intra abdominal pressure. if pt is multiparous then more likely to occur

how to tx pelvic organ prolapse

pessaries can provide sx relief, if bad then surgery

after 12 mo of amennorhea with no cause. average 51yr old. estradiol <20 and FSH 21-100 to dx.

menopause

permanent cessation of menstruation after b/l oophorectomy or ablation of ovarian function

induced menopause

part of the aging process where a woman passes from reproductive to nonreproductive phase. irregular periods presented. high FSH is shown.

perimenopause

in women age 51 with high FSH what does that indicate

menopause

what modifiable lifestyle choice is assoc with early menopause

smoking

pt has flat vaginal rugae flatten and epithelium thins, leading to sx atrophic vaginitis. dec cervical mucus secretion = dryness. PE shows BP elevated from arterial vasoconstriction, weight gain, height dec, fatty breasts, arthralgias. pts also get hot flashes, night sweats, palpitations, migraines. can have anger/irritation, anxiety, tension, depression, sleep problems.

menopause

how to tx menopause

systemic hormonal therapy to tx vasomotor sx. HRT (estrogen/progestin) low risk in women. vaginal estrogen creams to tx dyspareunia from atrophic vaginitis