Pelvic Examination Atlas Part 2 Vulvovaginitis Skin and

Pelvic Examination Atlas Part 2: Vulvovaginitis, Skin and Cystic Disorders, & Sexually Transmitted Infections

• The following slides are for internal use by practitioners at Beth Israel Deaconess Medical Center. They are for educational purposes only. • These slides are NOT to be copied or disseminated. Slides compiled and edited by Jennifer Potter, MD, Jillian Catalanotti, MD, MPH, and Carol Bates, MD

Vulvovaginitis

Normal Wet Mount

Bacterial Vaginosis

Clue Cells (BV): Wet Mount Note decreased lactobacilli, and clue cell: epithelial cell stippled with bacteria and with unclear borders.

Candidal Vulvitis

Candidal Vaginitis

KOH Prep: Candida Albicans

Trichomonas Vaginitis

Trichomonas: Strawberry Cervix

Wet Mount: Trichomonas Sensitivity of wet mount for trichomonas = 62%

Non-infectious: Atrophic Vulvovaginitis

Non-infectious: Irritant Vulvitis

Not all vulvar discomfort is vulvovaginitis…

Pediculosis Pubis

Epidermal Inclusion Cyst Previously called sebaceous cysts. Typically asymptomatic unless inflamed or infected. May drain foul-smelling cheese-like material. If suspect infection, can I & D and give anti-staphylococcal coverage. Often recur if cyst lining not surgically removed.

Bartholin’s Abcess Exquisitely tender occluded Bartholin’s gland. Warm water soaks may cause to drain on own. If not draining, may require I & D with placement of small catheter for continued drainage.

Hidradenitis Suppurativa Tender, firm, nodular lesions which are occluded apocrine glands. (Often occur in groin or in axillae. ) May drain on own or (if very large and painful) require I & D. If moderate-to-severe, or if cellulitis or fever present, consider topical clindamycin.

Lichen Sclerosus Thin de-pigmented patchy skin that is itchy or painful. Unclear etiology but may be relative lack of sex hormones, as most common in post-menopausal women. Area is predisposed to skin cancers. Refer to gyn or derm for biopsy to r/o cancer. Treat with topical corticosteroids to prevent disabling scarring.

Psoriasis (1)

Psoriasis (2)

Vulvar Lentigines Asymptomatic pigmented lesions. Refer to gyn or derm for biopsy to exclude melanoma.

Cervical Prolapse Reduce prolapse in your office. Refer to gyn for discussion of pessary versus surgery. May have prolapsed cervix, uterus, or bladder all through vagina.

Sexually Transmitted Infections (STIs)

Condyloma Acuminata / Genital HPV (Low Risk Subtypes)

HPV Papillomatosis

HPV-Related Cervical Dysplasia High Risk Subtypes Normal Dysplasia Cancer

Genital Herpes (1)

Genital Herpes (2)

Chlamydia Cervicitis

Gonorrhea

Chancroid

Primary Syphilis (Chancre)