Genital disease NOS (female)

Female genital diseases encompass a broad range of conditions that can affect the external and internal genitalia. These conditions can be benign or malignant, infectious or non-infectious, and can have various implications for a woman’s overall health, reproductive health, and quality of life.

Common Female Genital Diseases

  • Vulvovaginitis: Inflammation of the vulva and vagina, often caused by infections (like yeast or bacterial vaginosis), irritants, or hormonal changes.
  • Cervical Dysplasia: Precancerous changes in the cervix detected during CST.
  • Polycystic Ovary Syndrome (PCOS): A hormonal disorder causing enlarged ovaries with small cysts, leading to irregular menstrual cycles, infertility, and other metabolic issues.
  • Endometriosis: A painful condition where tissue similar to the lining inside the uterus grows outside the uterus, leading to pain and infertility.
  • Uterine Fibroids: Noncancerous growths in the uterus that can cause heavy menstrual bleeding, pain, and, in some cases, fertility problems.
  • Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs, often caused by sexually transmitted infections (STIs).
  • Ovarian Cysts: Fluid-filled sacs within or on the surface of an ovary, often benign and asymptomatic but can cause pain and other complications.
  • Lichen Sclerosis: A chronic skin condition that primarily affects the genital and anal areas
  • Genital Cancers: Including cervical, ovarian, uterine, vaginal, and vulvar cancers.

Diagnosis

  • Clinical Examination: Including pelvic exams to evaluate the external and internal genitalia.
  • Pap Smear: For cervical cancer screening and detecting precancerous changes.
  • Ultrasound: To visualize the uterus, ovaries, and other pelvic structures.
  • Blood Tests: Hormone levels for conditions like PCOS, STI screenings.
  • Biopsy: To diagnose cancers or precancerous lesions.

Differential Diagnosis

It’s important to differentiate between various genital diseases as their presentations can overlap. For example, the pain of endometriosis must be distinguished from PID or ovarian cysts.

Management

  • Infections: Antibiotics for bacterial infections, antifungal medications for yeast infections.
  • Hormonal Therapies: Birth control pills to manage PCOS symptoms, endometriosis, and menstrual irregularities.
  • Lichen Sclerosis: Topical corticosteroids and oestrogen in post menopausal women
  • Surgical Interventions: For fibroids, severe endometriosis, or cancers.
  • Pain Management: NSAIDs or other pain relievers for conditions like endometriosis.
  • Lifestyle Modifications: Diet and exercise for PCOS management.
  • Cancer Treatment: Depending on the stage and type, this may include surgery, chemotherapy, and radiation therapy.
  • Regular Screenings: Pap smears for cervical cancer, pelvic exams, and possibly genetic screening for those at high risk of ovarian or breast cancer.

Conclusion

Female genital diseases require a comprehensive approach to diagnosis and management. Regular gynecological care and screenings are key components of prevention and early detection, particularly for conditions like cervical dysplasia and cancers. The treatment should be individualized, taking into consideration the patient’s symptoms, severity of the disease, age, and reproductive desires. Collaboration between the patient and a multidisciplinary medical team is essential for effective management.

 Paediatrics

Vaginal irritation and rash in children can be caused by a variety of factors. It’s important to approach this with sensitivity and thoroughness, considering both common and uncommon causes. The most typical causes include:

  • Causes
    • Irritation from Chemicals: Exposure to irritating substances such as soaps, bubble baths and other personal hygeine products
    • Irritation from clothing:  Fabrics themselves, fabric softeners, or laundry detergents can cause irritation.
    • Poor Hygiene: Inadequate cleaning or wiping, especially after bowel movements, can lead to irritation.
    • Infections:
      • Yeast Infections: Though less common in prepubertal children, yeast infections can occur, causing redness, itching, and a white vaginal discharge.
      • Urinary Tract Infections (UTIs): These may present with genital discomfort in addition to urinary symptoms.
      • Pinworms: A common childhood parasitic infection that can cause perianal and vaginal itching, especially at night.
      • Bacterial Vaginosis: Uncommon in young children but possible.
    • Foreign Body: Such as toilet paper or small toys in the vagina, can cause irritation, discharge, and sometimes infection.
    • Skin Conditions:
      • Eczema or Atopic Dermatitis: Can affect the genital area and cause itching and rash.
      • Psoriasis: Less common in the genital area but possible.
      • Lichen Sclerosus: A chronic skin condition that can affect the genital area, though it’s more common in postmenopausal women.
    • Non-specific Vulvovaginitis: A diagnosis of exclusion when no specific cause is found, common in prepubertal girls.
    • Sexual Abuse: Always consider this in the differential diagnosis, particularly if the presentation is atypical or if there are other concerning signs.
  • Diagnostic Approach:
    • History (Hx): Includes symptoms, onset and duration, hygiene practices, exposure to new products, recent infections, and any relevant medical history.
    • Examination (Ex): A gentle examination looking for signs of redness, discharge, lesions, foreign bodies, or signs of a skin disorder.
    • Investigations (Ix):
      • Lab Tests: Cultures or swabs for yeast, bacteria, or other pathogens.
      • Urinalysis and Urine Culture: If a UTI is suspected.
      • Stool Sample: For pinworms.
  • Management (Mx):
    • General Measures:
      • Encourage proper genital hygiene.
      • Avoid irritants such as bubble baths and harsh soaps.
      • Use hypoallergenic and fragrance-free products.
      • Ensure the child wears loose, breathable clothing.
    • Specific Treatments:
      • Antifungal creams for yeast infections.
      • Antibiotics for bacterial infections.
      • Anti-parasitic treatment for pinworms.
      • Topical steroids for certain skin conditions like eczema.
    • Follow-Up: Ensure follow-up to assess response to treatment and consider further evaluation if symptoms persist.

It’s important to handle these cases with care and sensitivity, ensuring the comfort and privacy of the child during examination and discussion. In cases where sexual abuse is suspected, it is crucial to follow local guidelines for reporting and further management.