GYNAECOLOGY

BY DUBE L
SUPERVISOR MS NHEMA
CONDITIONS OF THE VULVA
 
Bartholins abscess and cyst
By the end of the lesson students should be able to:
Define bartholin’s abscess
Outline the aetiology and pathophysiology
State the pathophysiology of bartholin’s abscess
State the possible complications of bartholin’s abscess.
Describe the medical, surgical and nursing
management of bartholin’s abscess
Bartholins abscess and cyst

Bartholin cyst or abscess, also called bartholinitis, is

an infection of the greater vestibular gland, causing
cyst or abscess formation.
CAUSES
Most are sterile or abscess/cellulitis caused by mixed
vaginal flora.
May also be caused by sexual transmission of infection
(gonorrhea or chlamydia).
PATHOPHYSIOLOGY
These glands lie on both sides of the vagina at the base
of the labia minora; they lubricate the vagina.
If they become obstructed secondary to infection,
abscess or cyst formation may occur
Abscess or cyst may spontaneously rupture or enlarge
and become painful
CLINICAL MANIFESTATIONS
Asymptomatic cyst.
Pain, erythema, tenderness, swelling.
Edema, cellulitis, possible abscess formation.
DIAGNOSTIC PROCEDURES
Culture, if draining, to identify infectious organisms.
If older than age 40, or recurrent, carcinoma must be
ruled out by biopsy.
COMPLICATIONS
Scarring from recurrent infection and rupture
MANAGEMENT
May be treated conservatively with warm soaks or sitz
baths; antibiotics used if cellulitis is present.
May need incision and drainage; provides immediate
relief, but may recur.
Marsupialization, for recurrent abscesses.
Contents are opened and drained, Ward catheter is
inserted to keep cavity open.
Healing occurs from within the area of the abscess.
Complete excision under general anesthesia if
carcinoma is suspected.
NURSING MANAGEMENT
Acute pain related to infection, enlargement of gland
REFERENCES
Phipps, W. J, Monahan F. D, Sands J K and Marek J. F
(2003) Medical Surgical Nursing. Health and Illness
Perspectives. 7th Edition, Mosby, St Louis.
Smeltzer, S. C and Bare, B (2004) Brunner and
Suddarth’s Textbook of Medical Surgical Nursing. 10th
Edition. Lippingcott. Williams and Wilkins.
Philadelphia.
Waston, J (2000) Medical Surgical Nursing and
Related Physiology, Sanders, Philadelphia.
 
Vulvitis

By the end of the lecture students should be able to:

Define vulvitis
State the causes of vulvitis
Describe the pathophysiology of vulvitis
Outline the clinical manifestations of vulvitis
Describe the management of vulvitis
VULVITIS
Inflammation of the vulva.
CAUSES
Infections Trichomonas, molluscum contagiosum,
bacteria, fungi.
Irritants.
Urine, feces, vaginal discharge.
Close-fitting, synthetic fabrics.
Chemicals, such as laundry detergents, vaginal sprays,
deodorants, perfumes, some soaps, chlorine, dryer sheets,
and bubble bath.
Carcinoma.
Chronic dermatologic conditions.
CLINICAL MANIFESTATIONS
Pruritis more acute at night, aggravated by warmth.
Reddened, oedematous tissue and ulceration.
Pain, burning sensation and dyspareunia.
Exudate which may be profuse and purulent.
Lesions of molluscum contagiosum are multiple, from
1mm to 1 cm in size, and filled with white material.
DIAGNOSTIC PROCEDURES
Vulvar smears and cultures may show infectious
organism.
Biopsy of vulvar tissue may be necessary to rule out
malignancy and chronic dermatologic conditions.
COMPLICATIONS
Scarring and chronic discomfort
MANAGEMENT
Oral or topical anti-infectives (antibiotics, antifungals)
to treat infectious agents.
Topical steroids to treat inflammation.
Topical or systemic estrogen to treat atrophy.
Treatment of underlying disorder.
Molluscum contagiosum may be treated by scalpel
excision or silver nitrate or electrical cautery.
NURSING DIAGNOSES
Acute Pain related to vulvar inflammation
REFERENCES
Phipps, W. J, Monahan F. D, Sands J K and Marek J. F
(2003) Medical Surgical Nursing. Health and Illness
Perspectives. 7th Edition, Mosby, St Louis.
 
Smeltzer, S. C and Bare, B (2004) Brunner and Suddarth’s
Textbook of Medical Surgical Nursing. 10th Edition.
Lippingcott. Williams and Wilkins. Philadelphia.
 
Waston, J (2000) Medical Surgical Nursing and Related
Physiology, Sanders, Philadelphia.
 
Carcinoma of the vulva
By the end of the lesson students should be able to:
Define carcinoma of the vulvar
DEFINITION
Cancer of the vulva is most commonly carcinoma of
the labia majora, labia minora, or clitoris; it may also
originate as a urethral tumor.
CAUSES
Most common in women older than age 60; many new
cases have increased because of increase in older
population.
Represents 3% to 5% of gynecologic cancers.
The cause is unknown, but associated with history of
infections, such as HPV or HSV.
PATHOPHYSIOLOGY
Spread primarily through direct extension and
lymphatic system; rare distant metastasis.
CLINICAL MANIFESTATIONS
Lump or mass present for several months first is
leukoplakic (white plaque or mild ulceration);
becomes reddened, pigmented, ulcerated.
Vulvar pruritus, pain.
Discharge or bleeding; may be foul-smelling because
of secondary infection.
Dysuria because of invasion of urethra with bacteria.
Edema of tissues.
Lymphadenopathy.
DIAGNOSTIC EVALUATION
Biopsy of lesion and lymph nodes. If small, lesion may
be excised at time of biopsy. Most lesions are
squamous cell carcinoma.
MANAGEMENT
Choice of surgical methods depends on the site and extent of the
primary lesion and the risk of lymph node involvement. P.841

The most conservative operation that is consistent with cure of
disease is chosen.
Precancerous lesions—vulvar intraepithelial neoplasia.
Simple vulvectomy
Skinning vulvectomy
Local excision
Laser therapy
Carcinoma in situ—noninvasive
Radical local excision
Radical vulvectomy or modified radical vulvectomy
Invasive carcinoma radical or modified radical
vulvectomy with bilateral groin lymph node resection.
Pelvic nodes may also be removed if involvement is
suspected.
If cancer is confined to the vulva, there is an 80% to
90% 5-year survival rate after surgery.
Advanced carcinoma pelvic exenteration or surgery
and radiation as a palliative measure.
Radiation therapy has an increased role in the
preoperative and postoperative management.
Preoperative radiation therapy can decrease the volume
of disease and decrease need for radical surgery.
Postoperative radiation therapy is used for patients with
positive lymph nodes and close surgical margins.
Long-term outcomes of treatment compared to morbidity
associated with treatment are being studied.
Chemotherapy alone or in combination with radiation
may shrink lesion so surgery can be less extensive.
COMPLICATIONS
Lymphatic spread.
Complications after vulvectomy are common wound
infection, wound breakdown, lymphedema, leg
cellulitis, and introital stenosis.
NURSING PROCESS
Fear related to cancer and radical surgery
Impaired Tissue Integrity related to surgery
Sexual Dysfunction related to vulvectomy
REFERECES
Phipps, W. J, Monahan F. D, Sands J K and Marek J. F
(2003) Medical Surgical Nursing. Health and Illness
Perspectives. 7th Edition, Mosby, St Louis.
 
Smeltzer, S. C and Bare, B (2004) Brunner and Suddarth’s
Textbook of Medical Surgical Nursing. 10th Edition.
Lippingcott. Williams and Wilkins. Philadelphia.
 
Waston, J (2000) Medical Surgical Nursing and Related
Physiology, Sanders, Philadelphia.
 
Female genital mutilation
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