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Clinical Assessment of the Vagina

Dr Helen Wemyss Obstetrician and Gynaecologist

Wikipedia

"vagina" Latin word meaning "a sheath or scabbard“

a scabbard into which one might slide and sheath a sword

( "sword" was the penis)

Wikipedia "vagina" • Latin word meaning "a sheath or scabbard“ • a scabbard into which one

Definitions of Vagina

Medical Definition

Muscular canal from the hymen (or remnants) to the cervix

Legal Definition Begins at the vulva between the labia

Clitoral Hood and Clitoris

Clitoral Hood and Clitoris Labia minora Urethral opening Vaginal Opening

Labia minora

Urethral opening

Vaginal Opening

Vaginal Functions

Pathway for menstruation Sexual and reproductive function Old fashioned way to have a baby Microbiota/ commensals

Microbiota

Dynamic ecosystem of mutually symbiotic flora of

microorganisms

Undergoes change over life time -neonate-puberty-menarche-menopause

-pH 7- 4-7

-influenced by glycogen, oestrogen and lactobacilli

-acidic environment helps keep pathogenic bacteria at bay

And cyclical change- fluctuating hormones

Vaginal Microbiome

Maybe important for gut colonisation of the baby and prevention of childhood disease

eg asthma

Seeding from vaginal swab for babies born by elective LUSCS

Normal Vaginal Secretions

White, non-irritant, mucoid Affected by

-life cycle prepubertal, reproductive, post- menopausal

-monthly cycle -pre or post ovulatory

  • - exogenous hormones contraception

  • - pregnancy

-disruption of normal microbiome

Physiological Reproductive Secretions

Physiological Reproductive Secretions
Physiological Reproductive Secretions
Physiological Reproductive Secretions
Physiological Reproductive Secretions

Abnormal Vaginal Discharge

“Normal” is highly variable in volume Discharge is a poor predictor of STI

Abnormal Vaginal Discharge 1

Creamy discharge Vulvitis/vaginitis

Abnormal Vaginal Discharge 1 Creamy discharge • Vulvitis/vaginitis •
Abnormal Vaginal Discharge 1 Creamy discharge • Vulvitis/vaginitis •

Candidiasis

Creamy discharge Vulvitis/vaginitis

Candidiasis Creamy discharge • Vulvitis/vaginitis •
Candidiasis Creamy discharge • Vulvitis/vaginitis •

Abnormal Vaginal Discharge 2

Offensive frothy discharge

+/- vulvitis/vaginitis

Abnormal Vaginal Discharge 2 • Offensive frothy discharge • +/- vulvitis/vaginitis
Abnormal Vaginal Discharge 2 • Offensive frothy discharge • +/- vulvitis/vaginitis

Trichomonas

Offensive frothy discharge

+/- vulvitis/vaginitis

Skin irritation

May well be asymptomatic

STI co-exists with chlamydia

Strawberry cervix

Trichomonas • Offensive frothy discharge • +/- vulvitis/vaginitis • Skin irritation • May well be asymptomatic
Trichomonas • Offensive frothy discharge • +/- vulvitis/vaginitis • Skin irritation • May well be asymptomatic
Trichomonas • Offensive frothy discharge • +/- vulvitis/vaginitis • Skin irritation • May well be asymptomatic

Trichomonas

Protozoa Treat with Metronidazole (Flagyl) Treat sexual partner (s)

Trichomonas • Protozoa • Treat with Metronidazole (Flagyl) • Treat sexual partner (s)

Abnormal Vaginal Discharge 3

Malodorous, grey, frothy discharge No vulvitis or vaginitis

Bacterial vaginosis

Malodorous, grey, frothy discharge No vulvitis or vaginitis

Increase in anaerobic bacteria, loss of lactobacilli (increase in pH)

Gardnerella vaginalis Treat with metronidazole

Bacterial vaginosis • Malodorous, grey, frothy discharge • No vulvitis or vaginitis • Increase in anaerobic

Normal Cervix

Normal Cervix
Normal Cervix

Cervicitis (Inflammation of Cervix)

Infective/STIs, Chlamydia, Gonorrhoea, HSV Douching/irritants HPV, warts Retained tampon

Cervicitis (Inflammation of Cervix) • Infective/STIs, Chlamydia, Gonorrhoea, HSV • Douching/irritants • HPV, warts • Retained

Nabothian Follicle

Nabothian Follicle
Nabothian Follicle

Blood Stained Discharge

Benign conditions -vaginal atrophy, uterine polyp, cervical polyp -infection or inflammation

Blood Stained Discharge • Benign conditions -vaginal atrophy, uterine polyp, cervical polyp -infection or inflammation
Blood Stained Discharge • Benign conditions -vaginal atrophy, uterine polyp, cervical polyp -infection or inflammation

Vaginal Intraepithelial Neoplasia (VAIN)

Can be picked up on a cervical smear

If colposcopy of cervix is normal need to look

elsewhere!

Vaginal Intraepithelial Neoplasia (VAIN) • Can be picked up on a cervical smear • If colposcopy

Vulval Warts

Vulval Warts
Vulval Warts

Vaginal Cancer

Vaginal Cancer

Thank You

Thank You