Vaginal and vulvar disorders: Pathology review

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Vaginal and vulvar disorders: Pathology review



Vaginal and vulvar disorders: Pathology review

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A 45-year-old woman presents to a women's health clinic for evaluation of vaginal and vulvar itching. She also reports thick vaginal discharge for two days. Past medical history is significant for type II diabetes mellitus. The patient was recently hospitalized for a complicated urinary tract infection. Vitals are within normal limits. The pelvic examination is shown below. Evaluation of the vaginal swab shows a vaginal pH of 4.0. Which of the following best describes the features of the causative pathogen for this patient’s condition?
Reproduced from Wikimedia Commons


62-year-old Tess comes to the emergency department with vaginal bleeding for the past couple of hours. She also mentions that she has occasionally noticed some watery, foul-smelling vaginal discharge. After ensuring that she is hemodynamically stable, history reveals that her last menstrual period was about 10 years ago and she has had multiple sexual partners. On speculum examination, a suspicious-looking mass is identified in the upper third of the posterior vaginal wall.

Later that day, 69-year-old Oshun comes to the physician's office complaining of an intense burning sensation, itching and pain in her genital region. Her last menstrual period was at the age of 48. On further history, she has been smoking 1.5 packs daily for 40 years. On examination, a white, asymmetrical lump with irregular borders and 1.2 cm in size is seen in the right labia majora.

All right, both Tess and Oshun have some type of vaginal or vulvar condition. Let’s take a look at the Anatomy real quick. The external sex organs, together referred to as the vulva, contain the labia majora, which cover the labia minora, and between the two labia minora there is a space called the vulvar vestibule that includes the opening of the vagina and the the urethral opening. Now, vaginal and vulvar conditions are classified into non- neoplastic ones including bartholin cyst, lichen sclerosus, lichen simplex chronicus, and imperforate hymen and neoplastic ones, which are relatively rare cancers of the female genital tract.

Okay, let’s start with the first non-neoplastic condition, which is the Bartholin cyst. The Bartholin glands are two small glands that lie underneath the vestibule and on each side of the vaginal opening. Normally, they secrete a mucus- like fluid that drains through ducts into the vestibule in order to lubricate the vagina. But when their ducts get blocked, the fluid builds up, causing cystic dilation of the gland. For your exams, remember that blockage typically occurs in females of reproductive age as a result of a mucus plug or a sexually-transmitted infection, and especially, Neisseria gonorrhoea. If the cyst itself gets infected, an abscess occurs.


Vaginal and vulvar disorders refer to a wide range of conditions affecting the female reproductive system. Common vaginal and vulvar disorders include bartholin's cysts, where a blockage of the bartholin's gland duct results in cystic dilation and may lead to an abscess; lichen sclerosus which is a benign condition characterized by thinning of the epidermis and sclerosis of the dermis. There's also imperforate hymen which classically presents as primary amenorrhea with hematocolpos.

Other conditions include vaginal cancers, like squamous cell carcinoma, and clear cell adenocarcinoma, and vulvar cancers like melanomas and adenocarcinomas. There may also be infections like vaginal yeast infections, bacterial vaginosis, and genital warts. Diagnosis of these disorders involves a physical examination, medical history review, and potentially laboratory tests or biopsies. Treatment depends on the underlying cause and can range from topical creams and medications to surgery. Regular gynecological exams and good hygiene practices can help prevent and detect these conditions early.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathology of the Vulva and Vagina" Springer Science & Business Media (2012)
  4. "DC Dutta's Textbook of Gynecology" JP Medical Ltd (2014)
  5. "Bartholin Duct Cyst and Gland Abscess: Office Management" Am Fam Physician (2019)
  6. "Lichen sclerosus" International Journal of STD & AIDS (2005)
  7. "Imperforate Hymen: A Comprehensive Systematic Review" Journal of Clinical Medicine (2019)

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