DISEASES OF VULVA

DR M INDIRA MBBS DGO

ANATOMY
Bounded Mons veneris-anteriorly Labia majora-laterally Perineum-posteriorly Includes Prepuce,clitoris,bartholins gland,external urethral orifice,vestibule,vaginal introitus,fourchette.

Anatomy of vulva

Benign conditions of vulva

INFLAMMATORY LESIONS Skin diseases STDS Contact vulvitis Vulvar infections ATROPHY DYSTROPHY CYSTS AND NEOPLASM

SYMPTOMS OF VULVAR LESION

Itching Swelling Ulceration Altered pigmentation Pain bleeding

INFLAMMATORY LESIONS
INTERTRIGO&FOLLICULITIS Predisposing factors-obesity,tight under garments. TRT Unmedicated dusting powder,antimicrobial ointments,steroids 0.5% hydrocortisone ointment.

Contd
TINEA CRURIS Trichophyton rubrum Thigh,groin,vulva Erythematous circumscribed areas,skin flexures of thigh outer aspect of labia Intense itching ,scratching secondary infection TRT-dusting with fungicidal powder,anti fungal ointment,oral griseofulvin

Tinea cruris of vulva

Contd
PARASITIC INFECTION Enterobius vermicularis Secondary infection Antihelminthics Pediculosis pubis Most contagious 5% permethrin cream Scabies itch mite Papules, vesicles 5% permethrin lotion

Filariasis Wuchereria bancrofti Elephantiasis vulva Diethyl carbamazine Surgical excision

Elephantiasis of vulva

Molluscum contagiosum. Viral infection, pox virus. Close sexual or non sexual contact. Crop of domed vesicles with central. umblication 1-5 mm size. Cryotherapy.

Condyloma acuminata- venereal warts. Human papilloma virus 6,11,16,18,31,33,32 STD. Discrete verrucous growth ,coalese to form cauliflower like growth. Colposcopy after 1% toludine blue. Pregnancy cs. Podophyllin 25%,intralesional interferon,cryosurgery,laser.

INFLAMMATORY LESION
Psoriasis of vulva . Plaques of scaly well defined patches . Silvery scale can be easily scraped off to reveal red papular underlying surface. Aetiology unknown. TRT--local steroids.

Psoriasis of vulva

INFLAMMATORY LESION
CONTACT VULVITIS Local reaction to synthetic under garments ,soaps ,deodorants. Oedema &reddening of vulva without vaginitis. TRT-- avoid offending agents,oral anti histamines,local steroid ceams.

ULCERS OF VULVA
GENITAL HERPES Herpes simplex virus . IP -7 days . Constituional symptoms present,crops of vesicles appear which later ulerates shallow & painful.heal without scarring. Recurrence very high. Acyclovir 200mg 5 times a day for 5 days.

ULCERS OF VULVA
GRANULOMA INGUINALE. Calymmatobacterium granulomatis. Gram negative bacillus. Painless nodule later ulcerates to painless beefy red ulcers. Intracytoplasmic donovan bodies & clusters of bacteria with safety pin appearance. Tertracycline 500mg every 6 hours.

Herpes of vulva

ULCERS OF VULVA
LYMPHOGRANULOMA VENEREUM. C.TRACOMATIS. STD. Painless vesicular eruption. Spreads through lymphatics to rectum, inguinal nodes. Buboes ulcerates sinus. Doxycycline 100mg bd.

ULCERS OF VULVA
CHANCROID- SOFT SORE Haemophilus ducreyi STD.broken skin required. Small papule-painful pustule shallow painful ulcer.unilateral lymphadenopathy. School of fish appearance. Azithromycin 1gm single dose.

ULCERS OF VULVA
SYPHILIS Treponema pallidum . Primary syphilis chancre painless firm punched out base rolled edges.painless lymphadenopathy. Secondary syphilis wide spread dissemination of spirochetes. Condyloma lata-exophytic broad excrecences that ulcerate. Contagious. VDRL POSITIVE.MHA- TP specific. Benzathine penicillin 2.4 million units.

ATROPHY OF VULVA
MENOPAUSE. Oestrogen deficiency. Loss of subcutaneous fat. Labia flat skin hangs loose. Introitus narrowed. Prevented by timely administration of oestrogen ,progesterone.

DYSTROPHY OF VULVA
Represents a spectrum of atrophic and hypertrophic lesion caused by variety of stimuli resulting in circumscribed or diffuse white lesions. 10 -30% develop malignancy.malignancy may exist in the same lesion. Malignancy ruled out by toluidine blue test,colposcopy, biopsy.

Dystrophies of vulva
CAUSES: Trauma of scratching Allergy Folicacid and B12 deficiency Chronic infection,diabetes,thyroid deficiency Immuno suppression Auto immune diseases

Vulvar dystrophy
Histological classification HYPERPLASTIC(SQUAMOUS CELL HYPERPLASIA)pruritus thick grey/white plaques on skin. Looks rubbery Hyperkeratosis and acanthosis microscopically 30% show malignant changes Treatmentoral conjugated equine estrogen 0.625 mg and 1% hydrocartisone,calamine lotion and zinc oxide paste. LICHEN SCLEROSUS(ATROPHIC DYSTROPHY)aging,estrogen decreased,atrophy of the vulval skin,narrowing of introitus. Vaginal mucosa becomes thin. Skin is papery thin and wrinkled Labia minora blends with majora Malignancy in 1-5% of cases Pruritus,dysuria,dyspareunia and local discomfort. Biopsy shows thinning of epidermal epithelium Flattening of the rete pegs Treatment0.05% clobetasol for 8-12 wks followed by clobetasol plus nystatin plus oxytetracycline for symptomatic releif. MIXED

Cysts of vulva
Sebaceous cystresults from blockage of duct of sebaceous gland. Contains cheesy material Can get infected Treatmentexcision Bartholins cystduct is blocked by inflammation or inspissated secretion Swelling at the jn of antr2/3 with postr 1/3 of labia majora Dyspareunia,dyscomfort and infection Excision or marsupialization

Bartholin cyst of vulva

Sebaceous cyst of vulva

Ulcers of vulva
Tuberculous ulcerthin serpiginous ulcer,undermined edge,thin yellowish discharge,painful. Biopsytuberculous granulomas seen TreatmentATT

Tuberculosis of vulva