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Normal Variations
eChapter
Added: 28/02/2013
When performing an assessment of the female genital tract, it is essential not just to understand the appearance of the normal anatomy, but also the normal variations of this anatomy that may occur. W...hen these normal variations are identified, they may sometimes require treatment to improve quality of life, and this eChapter identifies and describes the most common normal variations of the female genital tract, provides criteria for diagnosis and outlines the preferred treatment of these variations. In the first section of the eChapter, the author describes four normal variations of the vulva. The first, Fordyce spots require no treatment but may generate confusion during the diagnostic phase for the inexperienced clinician. The second, the large labia majora rarely requires treatment, but women in which it is manifest may request surgical reduction for cosmetic reasons, or because the anatomy causes discomfort whilst walking. Vestibular papillomas once again are a normal variation to the anatomy, but the ability to distinguish them is crucial as they can be mistaken for genital warts and treated inappropriately. Finally, labial adhesions in infancy are discussed. The next section focuses on normal variations of the vagina and describes two common findings. The first is normal physiological discharge, and although treatment is not normally required, the importance of excluding more sinister causes is emphasised by the author. The second is a comprehensive examination of estrogen deficiency, and photographs are used to show it’s atrophic effects on the vagina. Management options such as estogen replacement are discussed, and the author emphasises the importance of considering the inclusion of psychosexual counselling as an important contribution to the treatment program. This eChapter forms part of the Ausmed publication The Vulva and Vaginal Manual, edited by Graeme Dennerstein, James Scurry, John Brenan, David Allen and Maria-Grazia Marin. A richly illustrated and comprehensive guide to the identification and treatment of over 275 vulvovaginal diseases The Vulva and Vaginal Manual is an invaluable resource especially suitable for: Gynecologists Dermatologists General Practitioners Obstetricians Midwives General nurses Practice nurses Nurse Practitioners There are also 14 additional eChapters from The Vulva and Vaginal Manual available for members to download from the Ausmed website. Subscription also entitles members to access the full range of resources that compliment and build upon the material described within The Vulva and Vaginal Manual, including a richly populated catalogue of Audio Lectures, Fast Facts and Video Learning Activities on the topics of gynecology, obstetrics, oncology, women’s health and a wide range of other healthcare topics. Both members and non-subscribers alike may also purchase a hard copy of this book of from the Ausmed Education Online Bookstore, along with hard copies of the complimentary publication Gynecological Cancer Care: A Guide to Practice.
The Gynecologist's Perspective
eChapter
Added: 28/02/2013
The eChapter begins by introducing a gynecological assessment methodology that is thorough, easy to understand and simple to apply in clinical practice. Starting with the presenting complaint, the aut...hor emphasizes the need to track back to the time of suspected onset, be it puberty, onset of menopause, incidence of first intercourse, surgery or even an episode of exceptional emotional stress, and what specifically about this complaint is disturbing the patient at the time of consultation. Detailed examples of this approach are described, including candidiasis and it’s relationship to puberty, atrophic vaginitis to ovarian failure, vulvar dermatoses to psychosexual disturbances, inflammatory disorders to fissure development and so on. The author then progresses to consider the importance of the related history, and stresses the need to incorporate parity, gravidity, mode of contraception, fertility requirements and a detailed menstrual history into the assessment. Once again, practical examples are given to illustrate the process, including the relationship between lactation and atrophic vaginitis, depression and infertility, and the importance of identifying intercurrent diseases such as vulvar psoriasis and extragenital lesions. The importance of identifying any topical treatment history is emphasised, as are systemic therapies such as HRT and contraception, and their relevance to diagnosis. The eChapter also describes in detail methods of physical examination, including appropriate positioning, the placement of hands, dealing with menstrual discharge, and the use of the Sims’ speculum, colposcopy, and the loupe. How to perform a Wright’s stain to identify host cell and microorganism morphology is described in detail, and normal, atrophic, infected and eroded slides are described with the support of color illustrations. This eChapter forms part of the Ausmed publication The Vulva and Vaginal Manual, edited by Graeme Dennerstein, James Scurry, John Brenan, David Allen and Maria-Grazia Marin. A richly illustrated and comprehensive guide to the identification and treatment of over 275 vulvovaginal diseases The Vulva and Vagina Manual is an invaluable resource especially suitable for: Gynecologists Dermatologists General Practitioners Obstetricians Midwives General nurses Practice nurses Nurse Practitioners There are also 14 additional eChapters from The Vulva and Vaginal Manual available for members to download from the Ausmed website. Subscription also entitles members to access the full range of resources that compliment and build upon the material described within The Vulva and Vaginal Manual, including a richly populated catalogue of Audio Lectures, Fast Facts and Video Learning Activities on the topics of gynecology, obstetrics, oncology, women’s health and a wide range of other healthcare topics. Both members and non-subscribers alike may also purchase a hard copy of this book of from the Ausmed Education Online Bookstore, along with hard copies of the complimentary publication Gynecological Cancer Care: A Guide to Practice.
The Dermatologist's Perspective
eChapter
Added: 28/02/2013
It is increasingly common for gynaecologists and dermatologists to work in partnership in the diagnosis and management of diseases of the vulva and vagina. This is because understanding the funda...mentals of dermatology applicable to the vulva and vagina has repeatedly been shown to be a valuable adjunct to the rationalisation of diagnosis, classification, investigation and management of disease. This eChapter describes these fundamentals in detail, describes the common dermatological conditions of the vulva, and provides guidance regarding contemporary treatment options. The eChapter begins by describing the scope of concern for dermatologists, and breaks the skin down into three distinct components: the epidermis, comprised of keratinocytes, melanocytes and Langerhans’ cells; the Dermis, comprised of the upper papillary dermis and the reticular dermis and the Basement Membrane Zone. The importance of obtaining a correct dermatological history is emphasised, and the author then progresses to discuss the interpretation of the macroscopic pathology of the skin of the vulva. How disease affects the functions of the various components of the vulval skin is then reviewed, with specific emphasis placed upon alterations in keratinocyte function, oedema of the dermis and coagulation of tissue fluid, and how these may be manifest in clinical signs such as surface scale, blisters, ulcers, scaly skin and crust. This discussion is then extended to include an overview of the processes that lay behind such diseases as erythema, wheals, lichenification, erythemato-squamous lesions, hypo-pigmentation, atrophy blisters, and ulcers. The chapter concludes by providing guidelines for treatment options, including non-pharmacological approaches such as saline soaks and lubricant creams, and pharmacological options such as corticosteroids in their various forms. This eChapter forms part of the Ausmed publication The Vulva and Vaginal Manual, edited by Graeme Dennerstein, James Scurry, John Brenan, David Allen and Maria-Grazia Marin. A richly illustrated and comprehensive guide to the identification and treatment of over 275 vulvovaginal diseases The Vulva and Vagina Manual is an invaluable resource especially suitable for: Gynecologists Dermatologists General Practitioners Obstetricians Midwives General nurses Practice nurses Nurse Practitioners There are also 14 additional eChapters from The Vulva and Vaginal Manual available for members to download from the Ausmed website. Subscription also entitles members to access the full range of resources that compliment and build upon the material described within The Vulva and Vaginal Manual, including a richly populated catalogue of Audio Lectures, Fast Facts and Video Learning Activities on the topics of gynecology, obstetrics, oncology, women’s health and a wide range of other healthcare topics. Both members and non-subscribers alike may also purchase a hard copy of this book of from the Ausmed Education Online Bookstore, along with hard copies of the complimentary publication Gynecological Cancer Care: A Guide to Practice.
Developmental Abnormalities
eChapter
Added: 28/02/2013
Developmental abnormalities of the vulva and vagina are commonly manifest at birth but may also present during delayed puberty, sexual intercourse or during an obstructed labour. Divided into conditio...ns where the gender of the genitalia is not in question, and those where there are various degrees of clitoral enlargement, labial fusion and where gonadal abnormalities show one or more facets of male genitalia, this chapter describes the conditions associated with each of these conditions in turn, and describes contemporary management options. The first section- malformations that do not lead to sexual ambiguity- begins by describing the very rare phenomena of the double vulva and the more common condition of cysts of the canal of Nuck. Dermoid cysts are then discussed, followed by vascular malformations, dilatations and their treatment. The author then moves on to the topics of congenital lymphedema and the imperforate hymen, cautioning that complications of an imperforate hymen may become especially worrying with the onset of menstruation. Transverse, longitudinal and non-midline longitudinal and oblique vaginal septa are the next topic for consideration, and the author makes good use of medical imagery to illustrate his discussion. Double vaginas, vaginal hypoplasia, atresia and agenesis are then briefly outlined and the section concludes with the topics of DES associated abnormalities, Gartner’s duct cysts, epispadias, hypospadias and vaginal fistulas. The second sectioned is concerned with malformations that are associated with ambiguous external sexual organs, where gender cannot be easily assigned by visual inspection. Topics covered include gonadal dysgenesis, ovarian dysgenesis, testicular dysgenesis and true hermaphroditism. The eChapter concludes with a brief discussion on the investigation and treatment of intersex. This eChapter forms part of the Ausmed publication The Vulva and Vaginal Manual, edited by Graeme Dennerstein, James Scurry, John Brenan, David Allen and Maria-Grazia Marin. A richly illustrated and comprehensive guide to the identification and treatment of over 275 vulvovaginal diseases The Vulva and Vagina Manual is an invaluable resource especially suitable for: Gynecologists Dermatologists General Practitioners Obstetricians Midwives General nurses Practice nurses Nurse Practitioners There are also 14 additional eChapters from The Vulva and Vaginal Manual available for members to download from the Ausmed website. Subscription also entitles members to access the full range of resources that compliment and build upon the material described within The Vulva and Vaginal Manual, including a richly populated catalogue of Audio Lectures, Fast Facts and Video Learning Activities on the topics of gynecology, obstetrics, oncology, women’s health and a wide range of other healthcare topics. Both members and non-subscribers alike may also purchase a hard copy of this book of the from the Ausmed Education Online Bookstore, along with hard copies of the complimentary publication Gynecological Cancer Care: A Guide to Practice.
Endocrine and Metabolic Disorders and Di...sorders of Pigmentation
eChapter
Added: 28/02/2013
This eChapter is part of the Vulva and Vaginal Manual, and draws together two important areas associated with the treatment of diseases of the vulva and vagina: diseases cause by endocrine and metabol...ic disorders, and diseases caused by disorders of pigmentation. A range of disorders are described, including their clinical features, diagnosis and treatment, and this illustrated eChapter will be a valuable resource for anyone wishing to refresh their knowledge of this complex aspect of women’s health. The author begins by describing the clinical features, diagnosis and treatment of both disorders of excess estrogen and estrogen deficiency, including precocious puberty. Adrenocortical syndromes (such as Addison’s disease), iatrogenic virilisation and the glucagonoma syndromes are also examined, with photographs provided to illustrate key characteristics of the disorders. The author then progresses to discuss Acanthosis nigricans (AN), with particular emphasis on its pathology. Disorders such as dermatitis eneteropathica that are mediated by zinc deficiency are then reviewed, as are amyloidosis and ligneous vagainits, with both topics supported by copious photographs of related histopathology. The eChapter then covers calcinosis, verruciform xanthoma and hypopigmentation before progressing to vitiligo, which affects about 1% of the population and has generally has a familial lineage. The eChapter concludes with an illustrated description of hyperpigmentation, or, as it is referred to by gynecologists, pigment incontinence. This eChapter forms part of the Ausmed publication The Vulva and Vaginal Manual, edited by Graeme Dennerstein, James Scurry, John Brenan, David Allen and Maria-Grazia Marin. A richly illustrated and comprehensive guide to the identification and treatment of over 275 vulvovaginal diseases The Vulva and Vaginal Manual is an invaluable resource especially suitable for: Gynecologists Dermatologists General Practitioners Obstetricians Midwives General nurses Practice nurses Nurse Practitioners There are also 14 additional eChapters from The Vulva and Vaginal Manual available for members to download from the Ausmed website. Subscription also entitles members to access the full range of resources that compliment and build upon the material described within The Vulva and Vaginal Manual, including a richly populated catalogue of Audio Lectures, Fast Facts and Video Learning Activities on the topics of gynecology, obstetrics, oncology, women’s health and a wide range of other healthcare topics. Both members and non-subscribers alike may also purchase a hard copy of this book from the Ausmed Education Online Bookstore, along with hard copies of the complimentary publication Gynecological Cancer Care: A Guide to Practice.
The Pathologist’s Perspective
eChapter
Added: 28/02/2013
Good pathology is crucial to the management of vulvovaginal disease, but how is good pathology obtained? There are two clinical situations in which a tissue sample is sent for pathology: rashes and di...screte lesions. Rashes are sent for accurate pathological diagnosis, but lesions require in addition to confirmation of clinical diagnosis, the pathological assessment of prognostic factors and margins. This eChapter describes both approaches in detail, including biopsy techniques, and tips on how to read and understand a pathologist’s report. The eChapter begins by considering three critical components that ultimately influence the pathologist’s contribution to the diagnosis of vulvovaginal disease: the clinical history and diagnosis, the site of the biopsy, and the type of biopsy. Biopsy techniques are described for maculpapular rashes, erosive or ulcerative rashes and discrete lesions, and illustrations are provided. The next section outlines the contents of a typical pathologist’s report, including an interesting explication of how pathologists work by pattern recognition. The limitations of pathological diagnosis are then discussed, using the context of specific diseases such as psoriasis, fungal infections and non-infectious inflammatory disoreders to illustrate the key concepts of the section. The author then begins an extended discussion on the importance of communication between the clinician and the pathologist, and provides guidance on the avoidance of confusion with pathological terms, with specific examples such as squamous cell hyperplasia given to illustrate the problem. The chapter concludes with an explanation of the dermatological classification system. This eChapter forms part of the Ausmed publication The Vulva and Vaginal Manual, edited by Graeme Dennerstein, James Scurry, John Brenan, David Allen and Maria-Grazia Marin. A richly illustrated and comprehensive guide to the identification and treatment of over 275 vulvovaginal diseases The Vulva and Vaginal Manual is an invaluable resource especially suitable for: Gynecologists Dermatologists General Practitioners Obstetricians Midwives General nurses Practice nurses Nurse Practitioners There are also 14 additional eChapters from The Vulva and Vaginal Manual available for members to download from the Ausmed website. Subscription also entitles members to access the full range of resources that compliment and build upon the material described within The Vulva and Vaginal Manual, including a richly populated catalogue of Audio Lectures, Fast Facts and Video Learning Activities on the topics of gynecology, obstetrics, oncology, women’s health and a wide range of other healthcare topics. Both members and non-subscribers alike may also purchase a hard copy of this book of from the Ausmed Education Online Bookstore, along with hard copies of the complimentary publication Gynecological Cancer Care: A Guide to Practice.
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