There are benign and malignant diseases of the external female genital organs:
inflammatory processes (vulvovaginitis, bartholinitis, vaginosis); retention formations (Bartholin gland cyst, Hartner course); benign tumors (fibroma, fibroids, adenoma, vascular tumors);
background diseases (leukoplakia, erythroplakia); precancerous conditions (dysplasia);
malignant tumors (cancer of the vulva and vagina, sarcoma).
In women of all age groups, inflammation of the vulva and vagina is most common.
Of the retention formations of the vulva, the Bartholin gland cyst, or the large gland of the vestibule of the vagina, is most common, which develops when the outflow of secretions from the gland secretion is disturbed as a result of stenosis, fusion, blockage of the excretory duct. This occurs in chronic inflammatory processes, less often as a result of traumatic damage (the intersection of the duct of the gland during episiotomy during childbirth). In the lumen of the gland accumulates liquid mucous contents. Cysts are with a diameter of 3 to 7 cm; as their size increases and intracavitary pressure increases, the glandular epithelium atrophies. Bartholin gland cysts are localized in the thickness of the labia majora, the upper pole reaching the lower third of the vagina, often one-sided. With small cysts of the Bartholin gland, the patient does not experience any discomfort, except for the increase of the labia majora, with a large education, a feeling of heaviness in the region of the labia may appear, inconvenience when walking. With bilateral cysts there is no secretion of mucus during sexual intercourse.
Bartholin gland cysts diagnosed when viewed from the external genital organs. Echography allows you to specify the size of the cyst, the presence of partitions, the nature of the contents (hypoechoic, with a suspension).
Usually these tumors are small in size, although they can reach several kilograms. As it grows, the tumor stretches the tissues of the labia and protrudes outward in the form of a rounded dense tuber or an extensive polypous proliferation. Circulatory disorders (edema, hemorrhage and even necrosis) may occur in the tumor. In such cases, there is pain in the external genitalia.
With a significant size of the tumor, the patients have a foreign body sensation in the area of the vulva that interferes with walking and sitting.
Diagnosis of fibroids and vulvar fibroids is not difficult.
Background and precancerous processes of the vulva
Background diseases of the vulva include kraurosis, leukoplakia and genital warts (papillomas) of the vulva.
Krauroz and leukoplakia – clinical concepts. Morphologically, they can be detected dermatosis, hyperkeratosis, dysplasia of the skin and mucous membranes. Vulvar cancer on the background of these diseases occurs in 20-50% of observations. Kraurosis and leukoplakia of the vulva are more common in women in the pre- and postmenopausal period. The etiology and pathogenesis of these diseases are not definitively established, but many researchers have noted hypoestrogenism and (or) metabolic endocrine disorders (diabetes mellitus) in these patients.
Vulvar Kraurosis – atrophy of stratified squamous epithelium (from the Greek. Craurosis – dry, shriveled).
The vulvar leukoplakia is characterized by proliferation (hyperplasia) of squamous epithelium, a violation of its differentiation and maturation.
With kraurosis and vulvar leukoplakia, the main complaint of the patients is a painful persistent itching, worse at night, with overheating and exercise. Itching often lasts for years and leads to neuropsychiatric disorders, loss of ability to work, and sometimes to suicidal thoughts.
The skin-mucous membranes of the vulva in kraurosis become thinner, shiny, dry, depigmented, easily hurt, resemble parchment.
Clinically, with leukoplakia, dry plaques of a whitish or yellowish color are found, which are located in limited areas or spread to the entire vulva. Often visible scratching in the area of the vulva, sometimes joins the infection (in this case there is a pronounced hyperemia and edema).
Diagnosis and examination of patients with Kraurosis and vulvar leukoplakia begin with a detailed examination with vulvoscopy (using a colposcope). All patients are shown determination of blood sugar, отпечат cytological examination of prints or superficial scrapings from ulcerated sites. In doubtful cases or with the results of cytological examination, indicating cell atypia, a tissue biopsy is necessary, followed by histological examination. The biopsy site is determined by vulvoscopy.