Introduction Description: Cervical polyps are benign fleshy tumors that arise from the cells of the endocervical canal (most common) or the ectocervix. Prevalence: 4% of gynecologic patients, most common benign growth of the cervix. Predominant Age: 40s–50s (multiparous women). Ectocervical polyps predominate in postmenopausal women. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Considered to arise because of inflammation and the focal hyperplasia and proliferation that…

Introduction Description: Cervical eversion is a turning outward of the endocervical canal so that it is visible and appears as a red, inflamed mass at the cervical opening. Prevalence: Common, especially in adolescents, pregnant patients, and those using combination oral contraceptives. Predominant Age: Reproductive age. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Chronic cervicitis, estrogen exposure (oral contraceptives, pregnancy). In parous women, the external cervix…

Introduction Description: Cervical erosion is the loss of the epithelial surface on the vaginal portion of the cervix, resulting in the exposure of the underlying cervical stroma. Cervical eversion (exposing the dark-red columnar epithelium of the endocervix, ectropion) is often mistaken for or incorrectly labeled as cervical erosion. Prevalence: Uncommon. Ectropion is common in adolescents, pregnant patients, and those using combination oral contraceptives. Predominant Age: Reproductive…

Introduction Description: Almost all cancers of the cervix are carcinomas—85%–90% are squamous carcinoma and 10%–15% are adenocarcinoma. Prevalence: 13,800 cases and 4290 deaths annually (2020 data). Lifetime risk: 1 Predominant Age: 40s–60s; median age is 52 years. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Strongly linked to certain serotypes of human papillomavirus (HPV; 99.7% of all cancers have oncogenic HPV DNA detectable) and is associated…

Introduction Description: Carcinoma in situ of the cervix is characterized by morphologic alteration of the cervical epithelium in which the full thickness of the epithelium is replaced with dysplastic cells (cervical intraepithelial neoplasia [CIN] 3). This change is generally associated either spatially or temporally with invasive carcinoma. Patients with low-grade CIN (CIN 1) are unlikely to develop cervical malignancy, whereas those with high-grade lesions (CIN 2–3)…

Introduction Description: Low-grade squamous intraepithelial lesions (LSILs) encompass changes associated with human papillomavirus (HPV), mild dysplasia, and cervical intraepithelial neoplasia (CIN) 1. High-grade squamous intraepithelial lesions (HSILs) include CIN 2 and 3 and carcinoma in situ (CIS). Patients with low-grade CIN are unlikely to develop cervical malignancy, whereas those with high-grade lesions are at high risk of progression to malignancy. Prevalence: Less than 1% of Pap…

Introduction Description: One of the most perplexing aspects of management under the Bethesda reporting system is how to interpret smears reported as showing atypical squamous or glandular cells (ASCUS, ASCH, or AGC). The atypical squamous cell (ASC) diagnosis has been developed to describe squamous cell changes that are more severe than reactive changes but not as marked as those found in squamous intraepithelial lesions (SIL, high…

Introduction Description: Trichomonas vaginitis is a vaginal infection caused by an anaerobic flagellate protozoan, Trichomonas vaginalis. Prevalence: Approximately 3.7 million cases per year in the United States (2.1% of women); accounts for 25% of “vaginal infections.” The most common nonviral sexually transmitted infection (STI). Predominant Age: 15–50 years (may occur at any age). One study found a peak rate at ages 47–53 years. Genetics: No genetic…

Introduction Description: Monilial vaginitis is a vaginal infection caused by ubiquitous fungi found in the air or as common inhabitants of the vagina, rectum, and mouth. Prevalence: 25%–40% of “vaginal infections”; 30%–50% of women experience one or more lifetime occurrences; Candida species may be found in the lower genital tract in 10%–25% of healthy, reproductive-aged women. Predominant Age: 15–50 years (rare outside this range except for…

Introduction Description: Bacterial vaginitis is a vaginal infection that is caused by an overgrowth of normal or pathogenic bacteria, resulting in a rise in pH (>4.5), irritation, inflammation, and clinical symptoms. Bacterial vaginosis is a change in the vaginal ecology caused by an overgrowth of anaerobic bacteria, often with an absence of clinical symptoms. It should be noted that bacterial vaginosis does not engender an inflammatory…

Introduction Description: Atrophic vaginitis is characterized by the degeneration (atrophy) of vaginal tissues caused by the loss of ovarian steroids. It is part of the broader issue of genitourinary syndrome of menopause. Prevalence: Occurs to some extent in 100% of postmenopausal women who do not undergo estrogen therapy. Predominant Age: 50 years and older (or after surgical menopause). Genetics: No genetic pattern. Etiology and Pathogenesis Causes:…

Introduction Description: Vaginal prolapse is the loss of the normal support mechanism, resulting in descent of the vaginal wall down the vaginal canal. In the extreme, this may result in the vagina becoming everted beyond the vulva to a position outside the body. Vaginal prolapse is generally found only after hysterectomy and is a special form of enterocele. Prevalence: Depends on the severity of the original…

Introduction Description: Nonobstetric lacerations of the vaginal wall or introitus are most often the result of sexual trauma (80%; consensual or otherwise); sports and straddle injuries make up most of the rest. Prevalence: Uncommon, but specific prevalence is unknown. Predominant Age: Reproductive age (most common in females younger than 25 years). Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Intercourse (80%), saddle or sports injury (bicycling,…

Introduction Description: Vaginal dryness is characterized by the loss of normal vaginal moisture resulting in irritation, itching, or pain with intercourse. This loss may result from alterations in vaginal physiology caused by an infection or the loss of estrogen stimulation (atrophic change). This may also occur situationally because of inadequate or inappropriate sexual stimulation, sexual phobia, or pain. Prevalence: Common in menopausal women not undergoing estrogen…

Introduction Description: Cystic masses in the vaginal wall are uncommon and may arise from either congenital (Gartner duct cysts) or acquired (epithelial inclusion cysts) processes. Prevalence: 1/200 women. Predominant Age: Generally from adolescence to middle reproductive years. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Congenital (Gartner duct cyst or remnant, generally found in the anterior lateral vaginal wall), structural (urethral diverticulum, loss of vaginal wall…

Introduction Description: A transverse vaginal septum is a partial or complete obstruction of the vagina and is generally found at the junction of the upper third and lower two-thirds of the vaginal canal. The septum is generally less than 1 cm in thickness and may or may not have a small opening to the upper genital tract (the location and thickness are highly variable). Prevalence: 1/30,000–80,000…

Introduction Description: Sarcoma botryoides is a rare form of sarcoma (embryonal rhabdomyosarcoma) that is generally found in the vagina of young girls. These tumors may rarely arise from the cervix. Although the cervical form of the sarcoma is histologically similar to the vaginal form, the prognosis for the cervical form is better. Prevalence: Rare. Predominant Age: Generally younger than 8 years and two-thirds younger than 2…

Introduction Description: Failure of the normal support mechanisms between the rectum and vagina results in rectocele—herniation of the posterior vaginal wall and underlying rectum into the vaginal canal and eventually to and through the introitus. Also called posterior compartment prolapse. Prevalence: 10%–15% of women; 30%–40% after menopause. Predominant Age: Late reproductive to postmenopausal. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Loss of normal tissue integrity…

Introduction Description: A fistula is an abnormal communication between two cavities or organs. In gynecology, this usually refers to a communication between the gastrointestinal or urinary tract and the genital tract. Connections directly to the skin are not discussed here. Prevalence: Gastrointestinal fistulae are uncommon; urinary tract fistulae are estimated to occur in 1/200 abdominal hysterectomies. Predominant Age: Reproductive age and older. Genetics: No genetic pattern.…

Introduction Description: Enterocele is the loss of support for the apex of the vagina through either a rupture or attenuation of the pubovesicocervical fascia, manifested by the descent or prolapse of the vaginal wall and underlying peritoneum, most commonly after abdominal or vaginal hysterectomy. An enterocele may occur when the uterus is present, and tissue damage or weakness allows herniation behind the cervix and between the…