disease of vagina

BENIGN AND MALIGNANT DISEASE OF THE VAGINA
The vagina is a fibromuscular canal lined with stratified squamous epithelium that leads from the uterus to the vulva
Many of the disorders that affect the vagina are discussed in your lectures like congenital abnormalities; infections; atrophic changes of menopause; and also the prolapse.
In this lecture we will discuss benign and malignant conditions of the vagina.
Vaginal atrophy
This is seen following the menopause, prior to puberty and during lactation. Examination shows loss of rugal folds and prominent subepithelial vessels, sometimes with adjacent ecchymoses. The patient may present wit h vaginal bleeding, vaginal discharge, or vaginal dryness and dyspareunia. Superficial infection, may be associated. Treatment requires oestrogen to restore the vaginal epithelium and pH.

Fistula
A fistula may be due to trauma, carcinoma or Crohn’s disease

Benign tumours
Tumours in the vagina are uncommon but occur within the vaginal wall and include myoma, fibromyoma, neurofibroma, papilloma, myxoma and adenomyoma. Cystic lesions may be found within the vagina, like Gartner’s or Wolffian duct origin.

1. Condylomata acuminata are by far the commonest seen. The frond like surface is usually characteristic, but it is wise to await the result of a biopsy before instituting treatment, especially if the lesion is close to the cervix.
2. Occasionally deposits of endometriosis can be found beneath the vaginal epithelium, following surgery or episiotomy. They may cause abnormal vaginal bleeding or pain. Treatment can be by laser vaporization or excision, or by drug therapy as for endometriosis elsewhere.
3. Simple mesonephric (Gartner s) or ,paramesonephric cysts may be seen, especially higher near the fornices. if asymptomatic, they are best not treated. If treatment is required, marsupialization is effective and safer than excision.
4. Adenosis - multiple mucus-containing vaginal cysts - is a rare condition. A variety of abnormalities are reported in the daughters of women who took diethylstilboestrol during their pregnancy. Most of these are of no significance.