Benign conditions of the lower genital tract

1. Big picture

The lower female genital tract includes the vulva, vagina, and cervix. Benign conditions here are extremely common and usually present with one of five patterns:

1. Vulvar itching or pain
2. Vaginal discharge or odour
3. Vulvar/vaginal mass or cyst
4. Cervical lesion or postcoital bleeding
5. Childhood/adolescent vulvovaginal bleeding or discharge

The examiner wants you to manage these cases safely:

Lower genital tract symptom
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Exclude pregnancy if relevant
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Look for infection, inflammation, cyst, trauma, dermatological disease, cervical lesion
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Do speculum/pelvic exam when appropriate
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Take swabs / microscopy / pH / STI tests if discharge or cervicitis
        ↓
Biopsy suspicious, persistent, pigmented, ulcerated, or treatment-resistant lesions
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Treat cause + partner treatment when STI is likely

Most important exam principle: A lesion can look “benign,” but persistent vulvar ulceration, pigmentation, induration, bleeding, or non-healing lesions must be biopsied to exclude vulvar intraepithelial neoplasia or cancer.

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