Clinical images: common gynaecology presentations

Case studies and pictures by Dr Philip Marazzi.

Cervical polyp

This patient presented for a routine cervical smear in the well woman clinic. In visualising the cervix, this polyp was noted, although the patient had no symptoms. She was referred to the gynaecology outpatient clinic and the polyp was removed. Histology confirmed its benign nature. Polyps can grow quite large and their cause is uncertain. They may result in various problems, including heavy or intermenstrual bleeding, and excessive vaginal discharge.


Herpes simplex

This 57-year-old woman developed a severe primary infection of type 2 herpes simplex. She was treated with oral antivirals and a subsequent swab confirmed the diagnosis. The infection recurs intermittently, but she has not had such a severe attack again.


Vulval trauma

This 50-year-old woman was a serious sportswoman. While training for a triathlon, she was caught by surprise when her normal cycling route was unexpectedly altered by forestry staff. This caused her to crash her bicycle. In doing so, she straddled the frame, sustaining this painful laceration to the vulva. She did not require sutures and the wound healed well.


Anterior prolapse

This elderly woman presented with urinary tract symptoms that had been bothering her for some time. This included a couple of episodes of infection, as well as a degree of stress incontinence. These were associated with the awareness of the large swelling in her vagina. She was treated with physiotherapy, topical estrogen and a ring pessary, because she did not want to undergo surgery. She had considerable relief with this treatment regimen.


Perianal abscess

This 38-year-old woman presented with severe pain in the perineum. She had a history of a Bartholin's abscess and assumed the other side was now affected. In fact, this was a large perianal abscess. She was admitted for incision and drainage. She was also checked to ensure there were no predisposing factors that led to the infection, but nothing was found.


Lichen sclerosis

This 48-year-old woman had a serious accident, fracturing her pelvis. She subsequently had several episodes of urinary retention requiring catheterisation. Over time, she became aware of a change in her vagina and examination revealed this loss of the normal vaginal architecture due to lichen sclerosis. She was treated with a strong topical steroid and vaginal estrogen. This improved her condition and she has had no further episodes of retention.


 

Posterior vaginal wall prolapse and piles

This 68-year-old woman presented with two swellings. Examination revealed a vaginal wall prolapse and a rectal prolapse. The appearance of the rectal mucosa was a little alarming and she was referred for an urgent surgical opinion. The mucosa was biopsied and it was subsequently confirmed that there was nothing abnormal present. No further action was required.

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