Conditions of the Vulva and Vagina

Conditions of the Vulva and Vagina
By:Marjorie Greenfield MD
Department of Reproductive Biology
a.k.a
Obstetrics and Gynecology

Learning Objectives
* Know surface anatomy of vulva and vagina
* Name and describe common vulvar conditions—skin, subcut, glandular
* Understand the concept of the vagina as an ecosystem influenced by hormones
* Use the ecosystem model to describe four types of vaginitis

Vaginal structure
The vaginal wall
Vaginal function: sexual
Vaginal function: reproductive
Benign conditions of the vagina
The vagina as ecosystem
Where are the bacteria?
Lactobacilli are the good guys because they make acids
The vaginal ecosystem: estrogen present
The vaginal ecosystem
Vaginitis: Why do you need to know?
Common causes of vaginal symptoms
Bacterial vaginosis: a synergistic bacterial infection
Amsel’s criteria for BV:
Repercussions of BV
Bacterial vaginosis:
Is BV a sexually transmitted infection?
Candida vulvovaginitis
Candida likes an estrogenized environment
Asymptomatic yeast carriage
What determines symptomatic candida vulvovaginitis?
Microscopic diagnosis
Wet prep
KOH prep
Role of culture in the diagnosis
Trichomonas vaginitis
Comparative exudates
Atrophic vaginitis
Approach to the Evaluation of Vaginitis
Evaluation of Vaginitis Symptoms
The Vulva
Vulvar function
Vulvar Tissue Types
Vulvar conditions
Skin processes Vulvar dermatoses
Vulvar dystrophies:
Non-neoplastic epithelial disorders
Lichen sclerosis
child
Squamous cell hyperplasia
Other skin processes
* Infections—mostly STDs
* Neoplasms
Subcutaneous processes
* Inclusion cysts
* Fibroma, lipoma, hernia, female hydrocele
* Breast tissue
endometriosis
lipoma
Gland processes
* Skenitis
* Bartholin gland cyst or abscess
Summary
Pathology correlation
Lichen sclerosus
Normal skin
Squamous cell hyperplasia
Normal skin

Conditions of the Vulva and Vagina.ppt