VULVAR DISEASES

BENIGN VULVAR LESIONS

Molluscum   contagiosum.    A   common  benign, viral   skin    infection.  Most

commonly    seen    in  children,   sexually    active  adults, and immunodeficient

patients.   The molluscipox virus   causes  spontaneously   regressing, umbilicated

tumors  of  the skin    rather  than    pox-like    vesicular   lesions.    Molluscum

contagiosum is  transmitted primarily   through direct  skin    contact with    an

infected    individual. Management  includes    observation,    curettage,  and

cryotherapy.

Condylomata acuminata.  These   are benign  cauliflower-like    vulvar  lesions

due to  HPV types   6   &   11. They    have    no  malignant   predisposition.

Condylomata are discussed   in  detail  in  chapter 7.  Management  is  treatment

of  the clinical    lesions only.

Bartholin   cyst.   If  the orifice of  the Bartholin   duct    becomes obstructed,

mucous  produced    by  the gland   accumulates,    leading to  cystic  dilation

proximal    to  the obstruction.    Obstruction is  often   caused  by  local   or  diffuse

vulvar  edema.  Bartholin   cysts   are usually sterile.    Management  is

conservative    unless  pressure    symptoms    occur   due to  size.

Bartholin   abscess.    An  abscess of  the Bartholin   gland   may occur   due to

infection   (mostly caused  by  E.  coli    and anaerobic   Bacteroides species,    and

seldom  due to  gonococcus).    Management. Outpatient  treatment   is  I&D with

placement   of  a   Word    catheter    under   local   anesthesia. The balloon is  inflated

and left    in  place   for a   month   to  allow   a   drainage    tract   to  form.   Antibiotic

treatment   is  usually not needed.