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Endometriosis: Clinical Manifestation and Differential Diagnosis
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Assessment of the external genitalia does not particularly have any pathognomonic features of endometriosis except in the rare case reports of endometriosis at the perineum or the episiotomy scar. However, referred pain from pelvic endometriosis to the labia has been reported in the literature and thus, endometriosis should be considered in the differential diagnosis of perineal and vaginal pain (53). Abnormally heightened sensitivity to pain is another factor that should be considered during clinical examination (29). Visual assessment of the vaginal wall, particularly the posterior fornix, may reveal the presence of endometriosis, a pathognomonic finding. One should exclude congenital vaginal cysts which are less tender. Examination of the cervix may show the presence of rare cases of endometrioma of the cervix, but it will also be part of the diagnostic workup to eliminate other abnormalities or coexisting pathology, like pelvic inflammatory disease. The same is valid for noting any abnormal vaginal discharge.
Urogenital prolapse
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Sushma Srikrishna, Dudley Robinson
Women are generally examined in the left lateral position using a Simms’ speculum, although digital examination when standing allows more accurate assessment of the degree of urogenital prolapse and, in particular, vaginal vault support. An abdominal examination should also be performed to exclude the presence of an abdominal or pelvic tumour that may be responsible for the vaginal findings. Differential diagnosis includes: vaginal cysts;pendunculated fibroid polyp;urethral diverticulum;chronic uterine inversion.
Vaginal Swellings
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
There are few other structures that present as localised swellings within the vagina (vaginal cysts and abscesses). Cysts in the vaginal wall may occur in the remnants of Gartner’s ducts (embryological ducts that form during fetal development); they can result from trauma at birth or occur in the Bartholin’s gland. They may be incidental findings during pregnancy or when taking a cervical smear. They may cause discomfort during intercourse or tampon insertion, and may be found on self-examination.
Aggressive angiomyxoma of the female urethra
Published in Baylor University Medical Center Proceedings, 2022
Mohamed Elsaqa, Mahmoud Elsabbagh, Hend A. Sharafeldin, Nahed M. Baddour
AAM usually poses a diagnostic dilemma, and it is often misdiagnosed at presentation. AAM usually appears as a painless, slowly growing mass with a wide scope of presentations based on the site.6 For the evaluation of AAM, ultrasound and magnetic resonance imaging can be utilized, and both show characteristic imaging features. Imaging can be used for evaluation of deep tumor extension and planning of radical surgery.7 The differential diagnosis of AAM in the periurethral area includes lipoma, urethral diverticulum, vaginal cyst, Gartner’s cyst, Bartholin cyst, pelvic organ prolapse, hernia of the canal of Nuck, and vulvar abscesses.6
A peri-urethral mass – what are the possible diagnoses?
Published in Journal of Obstetrics and Gynaecology, 2018
A 67-year-old lady presented to a general gynaecology clinic in March 2015 after noticing a vaginal lump over a few months. The patient had no pain or bleeding. Her only gynaecological symptom of note was stress incontinence. All smears had been up-to-date and normal. Her medical history included hypothyroidism and hypertension, and the patient had undergone an ovarian cystectomy in the 1970s. On examination, a 2 cm fluctuant area was noted in the lower part of the vagina, 2 cm from the urethral meatus. The differential diagnosis at this point included a vaginal cyst or urethrocele, and after a discussion with a consultant urogynaecologist, a MRI was advised.