Benign Gynecologic Conditions

by Lynae Brayboy, MD

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    00:01 Hi. Let's discuss benign gynecologic conditions that are often confused with malignant pathology.

    00:08 One, let’s discuss urethral prolapse. In young, young girls who are hypoestrogenic or in older women who are post-menopausal, this is a common sometimes finding. Instead of having a normal pink urethra, you can see that the urethra is prolapsed in this picture. This is commonly treated with estrogens and it usually resolves. Let’s now talk about a different form of prolapse, uterine prolapse.

    00:36 Really, the failure here is in the pelvic viscera, so the organs of the pelvis can actually prolapse to the anterior or posterior vagina. This is what it looks like on exam and MRI.

    00:51 Here, you can see that instead of the normal vaginal mucosa leading to the cervix, you can see that there's a protrusion of tissue at the hymen or at the introitus of the vagina.

    01:03 This is another picture showing that the prolapse is actually getting worse. Now, it’s past the introitus or the hymen and you can see that there is a noticeable bulge. This is what it looks like when the bulge has now exited completely and you have total proxidenture or complete prolapse.

    01:24 Here, what you can see here is the cervix. Instead of being in the vagina, it’s exterior.

    01:29 Now, let’s talk about Bartholin’s abscesses. This is a common presentation to the emergency room.

    01:37 The Bartholin’s ducts actually are at the entrance of the vagina at 5 o’clock and 7 o’clock.

    01:43 They're in a groove between the hymen and the labia minora. The most common cause is a cystic dilation of the Bartholin’s duct. It’s usually caused by some type of distal obstruction usually due to inflammation or trauma. This is what it looks like on exam. You can see that there is likely pus here. We typically manage this by draining it but the management does change depending on the age of the patient. These cysts usually recur. So, we use a special surgical intervention called marsupialization to actually treat them. Again, let’s now review the management.

    02:21 The treatment of enlargement or infection depends on the symptomatology.

    02:26 Usually, asymptomatic cysts in women who are younger than 40 do not need to be treated.

    02:31 Again, simple incision and drainage of a Bartholin gland cyst or abscess is not recommended because the recurrence after such incision and drainage is frequent. The surgical treatment of choice again is marsupialization to help develop a fistulous tract from the dilated duct to the vestibule so you don’t have that reaccumulation again and again. Now, let’s talk about nabothian cysts.

    02:55 Nabothian cysts are very common. They are cysts that are retention of endocervical columnar cells.

    03:01 These are so common that they’re considered a normal feature of the adult cervix and should not suggest pathology. Nabothian cysts look like this. You can see here in the lower corner a diagram of what the cervix should look like. When we communicate cervical findings, we communicate via the diagram either via drawing or standard diagrams within the medical record.

    03:27 We can communicate whether a finding whether it be benign or malignant is in the up, upper or lower quadrants and on the right or the left. Here, you can see a nabothian cyst which is again a common, non-pathological finding. Let's now review vulvar hematomas.

    03:46 Vulvar hematomas can obviously occur from any trauma to the vulva and it's bleeding into the loose connective tissue. When the pressure from the expanding hematoma exceeds the venous pressure, mostly the hematomas will stop growing. However, they can continue to expand.

    04:02 They’re usually managed with the expected management as long as a hematoma does not continue to expand.

    04:10 This patient would typically be admitted overnight for observation with a CBC upon admission and the next day to make sure her hemoglobin is not dropping. Let's now discuss hidradenitis suppurativa.

    04:24 This is a chronic, unrelenting, refractory infection of the skin and the apocrine glands.

    04:30 The apocrine glands are normally found in the axilla and the anogenital region.

    04:36 This is a picture of what it looks like. These patients can have multiple incision and drainage of multiple abscesses over the course of their life. It can be very disfiguring and painful.

    04:49 Thank you for listening.

    About the Lecture

    The lecture Benign Gynecologic Conditions by Lynae Brayboy, MD is from the course Female Pelvic Medicine.

    Included Quiz Questions

    1. Estrogen
    2. Progesterone
    3. Pessaries
    4. Surgery
    5. Observation
    1. Cystic dilation of the Bartholin duct secondary to inflammation
    2. Bacterial translocation from the bloodstream
    3. Retrograde flow through the Bartholin duct
    4. Local bacterial overgrowth due to immunosuppression
    5. Bacterial translocation from the urinary tract
    1. Marsupialization
    2. Incision alone
    3. Excision
    4. Placement of drain
    5. Incision and drainage

    Author of lecture Benign Gynecologic Conditions

     Lynae Brayboy, MD

    Lynae Brayboy, MD

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