Examination; cuscoe or sims’ speculum. Size, shape and consistency should be noted aswell as any discharge

Examination; cuscoe or sims’ speculum. Size, shape and consistency should be noted aswell as any discharge.

• Examination; cuscoe or sims’ speculum. Size, shape and consistency should be noted aswell as any discharge.

• Ectocervix; stratified squamous epithelium

• Endocervical canal; columnar epithelium

• Junction; squamocolumnar

• and adjacent is the

• Transformation Zone

Endocervical epithelium advances on ectocervix- bright red velvety appearance

• Endocervical epithelium advances on ectocervix- bright red velvety appearance

• Occurs more in adolescence, pregnancy, use of OCP. Can also result from labour

• Most cases asymptomatic

• Can cause leucorrhoea and post-coital bleeding

• Treatment- only if symptomatic

• radial diathermy or cryosurgery

Complications- secondary haemorrhage and infection

• Complications- secondary haemorrhage and infection

• - cervical stenosis

• Cervicitis

• Non-specific condition difficult

• to define. Common clinical

• diagnosis

Develop from endocervix and protrude into vagina

• Develop from endocervix and protrude into vagina

• Usually asymptomatic

• Can cause intermenstrual

• and postcoital bleeding

• Rarely malignant

• Treat by avulsing and send for histology

• Base should be cauterised-prevents regrowth

Cervical leiomyomas similar to fibroids in other sites of uterus

• Cervical leiomyomas similar to fibroids in other sites of uterus

• Pedunculated, sessile or grow to fill vagina and distort pelvic organs

• Symptoms similar to other polyps

• Attempted extrusion can cause

• colicky uterine pain

• Treatment by excision

If process of squamous metaplasia results in obstruction of cervical glands, retention cysts form- Nabothian follicles/cysts

• If process of squamous metaplasia results in obstruction of cervical glands, retention cysts form- Nabothian follicles/cysts

• Linked to chronic

• cervicitis

Arise from embryological remnants of the Wolffian duct.

• Arise from embryological remnants of the Wolffian duct.

• Not rare, occur in antero-lateral wall

• of vagina

• Asymptomatic

• Surgical excision if needed

• Vaginal Septum

• Failure of transverse septum loss between paramesonephric system and urogenital sinus

Rare but represent any of the tissues found in the vagina.

• Rare but represent any of the tissues found in the vagina.

• Therefore they would include fibromyomas, myomas, fibromas, papillomas and adenomyomas

• Treated by surgical excision

• Vaginal Inclusion Cysts

• Arise from inclusion of small parts of vaginal epithelium under surface. Commonly in episiotomy scar. Treated by excision

Atrophic- usually postmenopausal and treated only if symptomatic

• Atrophic- usually postmenopausal and treated only if symptomatic

• INFECTIVE-MANY CAUSES!!

• Candidia albicans

• White discharge, more common in pregnancy, diabetics, recent abx usage, immunocompromised

• Treat with clotrimazole pessarys and cream, oral treatment can be used but systemic side effects

Lactobaccilli replaced by anaerobes

• Lactobaccilli replaced by anaerobes

• Offensive green/grey discharge

• pH raised to 5.5

• ‘Clue’ cells on wet microscopy

• Treat with oral or vaginal metronidazole or clindamycin

Commonest sexually transmitted infection

• Commonest sexually transmitted infection

• Often asymptomatic but may cause urethral discharge, dysuria

• Diagnosed on endocervical swabs or from urine PCR/LCR

• Treat with azithromycin or doxycycline for 7-10 days

• Contact tracing important

• Strong association with PID and infertility

Usually caused by HPV 6 and 11

• Usually caused by HPV 6 and 11

• 25% have other demonstrable STD’s

• Treat with Podophyllin paint, cryotherapy for large warts

• Herpes

• Classically type 2, incubation 2-14 days

• Multiple ulcers and very painful

• Treat with acyclovir

Majority women asymptomatic

• Majority women asymptomatic

• Men have urethritis and penile discharge

• Gram stained- gm –ve diplococci

• Treat with ampicillin or ciprofloxacin

• Syphilis (treponema pallidum)

• Primary chancre resolves within 3-8wks

• Diagnosis made serologically

• Treat with procaine benzylpenicillin for 10-21 days

Offensive purulent discharge with dysuria and vulval soreness

• Offensive purulent discharge with dysuria and vulval soreness

• Diagnose by identifying flagellate on a wet film

• Treat same as for bacterial vaginosis- metronidazole

Bartholin’s glands situated in posterior part of the labia

• Bartholin’s glands situated in posterior part of the labia

• Lymphatics drain to inguinal nodes

• Secrete mucus, particularly during intercourse

• Can block causing retention

• cyst and if superimposed

• infection-an abcess. Can be

• I&D

Infection- candida, threadworms

• Infection- candida, threadworms

• Eczema

• Dermatitis

• Lichen sclerosis

• Lichen planus

• Medical problems; diabetes, liver failure, uraemia

Vulvodynia- chronic vulvar discomfort characterised by burning and irritation, may respond to topical steroids or tricyclics

• Vulvodynia- chronic vulvar discomfort characterised by burning and irritation, may respond to topical steroids or tricyclics

• Urethral Caruncle- polypoidal outgrowth from edge of urethra. Some cause dysuria, frequency. Treat with excision

• Ulcers- apthous, herpetic, syphilitic, crohns, Behcets, lichen planus

• Simple atrophy- dysuria and dyspareunia, if severe labia minora fuse and bury clitoris. Treat with oestrogen replacement

Lichen Sclerosis

• Lichen Sclerosis

• Squamous cell hyperplasia

• Allergic/irritant dermatosis

• Psoriasis

• Lichen Planus

• THE END!!