Chapter 49. Vaginitis

A 21-year-old woman is upset to report vaginal discharge. The discharge has been present for the past 10 days. She has never had this before and appears to be very anxious.

• What additional questions would you ask to learn more about her discharge?
• Why do you think that she is anxious, and how will you explore that with her?
• What associated symptoms might she have?
• What will you need to know about her sexual history?

Vulvovaginal symptoms are among the most common reasons that patients consult a primary care physician. It is difficult to assess the actual prevalence of vulvovaginitis because many patients treat their own symptoms with over-the-counter medications and never seek medical advice.

Although not usually life threatening, recurrent or chronic vulvovaginal complaints often involve significant discomfort, sexual dysfunction, and emotional distress. Most patients will ultimately prove to have a benign cause of vaginitis, but vaginal symptoms may indicate more serious upper genital tract disease requiring urgent evaluation and treatment. Clinicians should not rely on history alone and should confirm the suspected diagnosis with pelvic examination and microscopy.