Gynecologic Disorders

VULVA
1. Cysts of Skenes or Bartholins glands
Asymptomatic swelling at the sides of
the urinary meatus or vestibule.
Such cysts are surgically incised to
prevent the blockage of gland sac.
2. Condylomata acuminate
Cauliflower-like lesion on vulva
This lesion tends to occur in women
with chronic vaginitis. Caused by the
epidermatrophic virus that causes
common warts. Removed by
cryocautery or knife excision.
3. Lichen scleresus
Whitish papules on the vulva;
asymptomatic.
There is no need for removal; the area
is biopsied because leukoplakia, a
potentially cancerous condition, has an
almost identical appearance.
4. Leukoplakia
Thick, gray, patchy epithelium that
cracks; possibly a premalignant state
and infects easily, accompanied by
pain and itching.
Therapy involves hydrocortisone and
frequent return visits to healthcare
personnel (every 6 months) for
observation to detect any changes
suggestive of carcinoma.
Vagina and Cervix
1. Adenosis
Asymptomatic vaginal cysts with
columnar rather than squamous
epithelium present on vaginal walls.
This condition is caused by DES
(diethylstilbestrol) administration
while in utero. Has the potential for
becoming malignant (clear cell
adenocarcinoma). If adenosis is
present, an examination two or three
times a year with a Pap test and
Lugols staining is necessary, and the
woman should not use estrogen
sources such as oral contraceptives. If
adenocarcinoma occurs local
destruction of atypical cells can be
achieved by excision, cautery or
cryosurgery. This condition is rarely
seen today because DES is no longer
prescribed during pregnancy.
2. Cervical polyp
Red, vascular, protruding
pedunculated tissue that bleeds
readily with trauma.
A polyp may be discovered because of
vaginal spotting on coitus, tampon
insertion, or vaginal infection.
Removed vaginally by excision. Often
associated with chronic cervical
inflammation.
3. Cervicitis (erosion)
Reddened cervical tissue with whitish
exudates.
Douching with a vinegar solution aids
in healing. May be treated with
cryosurgery if extensive.
4. Nabothian cysts
Clear shining circle on cervix from
blocked glands.
No therapy is necessary
Ovaries
1. Endometrial cyst
Chocolate brown cyst on tender
enlarged ovary; may cause acute pain
if rupture occurs.
Endometriosis is the cause; occurs in
women aged 20 to 40 years. Therapy is
surgical excision; ovary may or may not
be removed depending on the extent
of cysts.
2. Follicular cyst
Amenorrhea and possibly dyspareunia;
ovary tender and enlarged.
Cysts typically regress after 1 or 2
months; low dose oral contraceptive
may be prescribed for 6 to 12 weeks to
suppress ovarian activity; estrogen
may be continued for 6 months.
3. Polycystic disease
Multiple follicular cysts of both
ovaries.
Excess adrenal supply of estrogen
leads to inhibition of FSH and
anovulation. Clomiphene citrate
therapy to induce ovulation or wedge
resection of the ovaries is used as
therapy.
4. Corpus luteum cyst
Delayed menstrual flow followed by
prolonged bleeding; ovary enlarged
and tender.
A corpus luteum has persisted rather
than atrophied. Most regress in about
2 months; a low dose oral
contraceptive may be prescribed to
suppress ovarian activity.
5. Dermoid cyst
Asymptomatic; ovary enlarged on
examination.
Cyst originates from embryonic tissue;
may contain hair, cartilage and fat.
Most common ovarian tumor of
childhood; also occurs 30 to 50 years.
Therapy is surgical resection.
6. Serous cystadenoma
Bilateral; asymptomatic except for
signs of pelvic pressure.
This is the most common benign
ovarian cyst. High malignancy rate
20%-30%. Therapy is surgical resection.




Uterus
1. Endometrial Polyp
Intermenstrual bleeding
Polyp is removed by dilation and
curettage.
2. Leiomyomas
Asymptomatic or with increased blood
flow
Muscle and fibrous connective tissue
form in response to estrogen
stimulation. May increase in size
during pregnancy; may cause
interference with cervical dilation and
result in post partal hemorrhage.
Stress to the myometrium by uterine
contractions may be the original cause
of formation. Therapy is surgical
resection (myomectomy) or
hysterectomy if child bearing is
complete.