Benign Lessions of the vulva and vagina

Reff: GENERAL GYNECOLOGY AND INFERTILITY > 1 BENIGN LESIONS OF THE VULVA AND VAGINA

What is the vulva composed of?
The vulva is composed of the labia majora, labia minora, mons pubis, clitoris, vestibule, urinary meatus, vaginal orifice, hymen, Bartholin's glands, Skene's ducts, and vestibulovaginal bulbs.

Name the five disorders in which infectious agents cause lesions of the vulva.

• Chancroid (Haemophilus ducreyi)
• Syphilis (Treponema pallidum)
• Lymphogranuloma venereum (Chlamydia trachomatis serovar)
• Human papillomavirus
• Genital herpes 

 Describe the clinical features and treatment of each disorder listed in question 2.

Chancroid: Sexually transmitted with an incubation period of 3-10 days. Presents as small, tender papules that soon break down to form ragged, tender, nonindurated ulcers usually located on the labia, fourchette, perineum, and perianal areas. May be single, but are more often multiple.▪ Treatment-current drug of choice is erythromycin.

Syphilis: Sexually transmitted with an incubation period of about 2 weeks. The first lesion is a macule, which soon becomes papular, then ulcerates to form a primary chancre. Classic description of the primary chancre is an indurated, painless ulcer with a dull red base. If untreated, primary stage typically lasts 3-8 weeks and then the ulcer spontaneously heals. In secondary syphilis, skin rashes may be macular, papular, papulosquamous, or pustular, and any of these may occur on the vulva. Condyloma lata are seen in secondary syphilis and are characterized by confluent, spongy, gray masses with flat tops and broad bases located at the periphery of the vulva. In late syphilis, vulvar lesions termed gummas appear as squamous lesions or subcutaneous nodules that sometimes ulcerate.▪ Treatment-remains penicillin for all stages.

Lymphogranuloma venereum (LGV): Rare in temperate climates. Incubation period is between 3 days and 3 weeks. The primary lesion is a small, painless papule, vesicle, or ulcer, typically located on the fourchette but may also occur on the labia or cervix. The secondary stage is characterized by enlargement of the inguinal glands to form a painful mass, which tends to suppurate and form sinuses.▪ Treatment-early LGV responds to tetracycline. Prolonged treatment may be necessary.

Human papillomavirus: Sexually transmitted with incubation periods ranging from 3 weeks to 8 months. Manifest on the vulva as genital warts. Commonly are papular, appearing as small, raised, rounded lesions, usually multiple. However, may present as condylomata acuminata, which are irregular, fleshy, vascular tumors affecting any part of the vulva.▪ Treatment-repeat application of trichloroacetic acid, podophyllin, topical imiquimod (Aldara), cryotherapy, or laser surgery.

Genital herpes virus: Sexually transmitted with incubation period of first attack usually 2-10 days. Lesions are initially vesicular, but rupture to form single, multiple, or grouped shallow, tender, ulcers, 1-2 mm in diameter. Lesions are most common on the labia majora and minora, clitoris, perineum, and perianal areas.

Treatment-acyclovir is the drug of choice for the treatment of outbreaks. However, it does not influence the rate of recurrence. List the common cystic lesions of the vulva and vagina Cysts of epidermal origin: sebaceous cysts, epidermal inclusion cysts, hidradenoma Cysts of embryonic origin: Gartner's duct cysts (arise from vestigial remnants of the vaginal portion of the Wolffian ducts) Duct cysts: Bartholin's gland Cysts of urethral and paraurethral origin: Skene's duct cysts, urethral or suburethral diverticulum

.