Vagina -brief

Vagina -brief

1. VAGINA

2. ANATOMY DEFINITION : IT IS A MUSCULO MEMBRANOUS TUBE EXTENDING FROM VULVA OUTSIDE TO THE UTERUS SITUATION : Between bladder and rectum DIRECTION :In the erect position, vagina is directed upwards and backwards .It is slightly curved posteriorly SIZE AND SHAPE : Vaginal canal is H shaped slit with lower end narrower than upper end . anterior wall measures 6-8cm posterior wall 7-9 cm respectively.

3. Vaginal furnices ANTERIOR FORNIX : Close in relation to bladder POSTERIOR FORNIX: Related to pouch of douglas & rectum RIGHT & LEFT FORNIX: Ureter and urinary artery

4. RELATIONS: ANTERIOR: bladder and urethra POSTERIOR: pouch of douglas, rectum, perineal body LATERAL: levator ani muscles

5. Blood supply: venous drainage: venous plexus int.iliac veins and lymphatic drainage: iliac, int.iliac, inguinal lymph nodes

6. VAGINAL EXAMINATION INSPECTION : vagina is first inspected by separating labia minora with left hand and next the speculum examination is done to inspect the cervix and vaginal vault PALPATION : by PV digital examination Anteriorly : urethra , bladder & pubic symphysis Posteriorly : rectum , pouch of douglas Laterally : ovary, tube , lat. Pelvic wall , thickened ligaments ,ureter Superiorly : cervix Bimanual examination : to assess size & position uterus, enlargement of ovaries, f.tubes and other pelvic masses

7. CLINICAL MANIFESTATIONS VAGINAL DISCHARGE VAGINITIS VAGINAL PROLAPSE VAGINAL LACERATION VAGINAL CANCER

8. Vaginitis Common in Vaginal pH - doderlein’s bacilli glucogon , oestrogen Causes: bacterial , fungal , protozoal , viral .. Symptoms : itching or burning malodourous discharge . Signs : vulvar erythema ,swollen and tender vagina, oliguria, dysuria

9. Vaginal discharge Ask about colour , consistency, amount , foul smelling / not Purulent discharge bacterial vaginosis Thick Curdy white discharge candida vulvovaginitis Profuse frothy yellowish discharge  trichomonas vaginitis Watery ,fishy smelling discharge  gardnerella vaginalis

10. Vaginal prolapse Weakness of supports of uterus can give rise to different degree of prolapse . Causes : ligamentary weakness, multiparous women, prolong labour stress, pudendal nerve damage, raised IAP, spinal deformity, Anterior wall drags bladder or urethra cystocoele or urethrocoele Posterior wall drags rectum rectocoele Trauma to anterior & posterior walls of vagina vesicovaginal , urethrovaginal , rectovaginal fistula. Vaginal carcinoma Primary carcinoma of vagina Invasive carcinoma of vagina includes 2 main types Squamous cell carcinoma Adenocarcinoma  endometrial and mucinous type

11. Other inflammatory conditions of vagina Oestrogen deficiency vaginitis Senile vaginitis Secondary vaginitis Ulceration of vagina , granulations,cysts, stenosis and atresia amoebiasis

12. Diagnostic tools KOH prep: pseudohyphae of candida Whiff test : fishy odour in bv pH : > 4.5 nitrazine paper Clue cells with fuzzy border  bv Hanging drop test : motile trichomonous org CULTURE Chocolate agar  gonococci Sabouraud’s medium  candida Special enriched medium  trichomonous Vaginal smears  lateral vaginal smears : cytohormonal assessment vaginal pool or vault smears: pfv –endometrial and ovarian cancer.

13. bacterial vaginosis –metronidazole 500 mg orally BD for 7 days , clindamycin cream vaginally. Candida vaginitis – vaf –butaconazole ,clotrimazole & miconazole oaf-fluconazole SD 150mg dose Trichomonas vaginitis – metronidazole Gardnerella vaginosis – metronidazole , tetracycline /doxycycline, sulphafurazole management

14. Thank you