Case history
Case history #1
A 25-year-old white woman presents to the office with malodorous vaginal discharge and pruritus for the last 15 days. She reports the smell is worse after intercourse and the discharge is white. She is in a stable monogamous relationship and has never been pregnant. She denies any significant medical or gynecological history. She reports this is the first time she has had these symptoms and is worried about STIs. Physical examination shows a white discharge in the posterior vaginal fornix, but there is no vaginal erythema or bleeding.
Case history #2
A 46-year-old black woman presents to the office with complaints of white vaginal discharge, dyspareunia, pruritus, and vulvar burning, especially when she urinates. She reports the vaginal discharge looks like cottage cheese and has no odor. She has a 10-year history of diabetes mellitus type 2, which is treated with metformin; she denies any other medical history. She has not had similar symptoms in the past. On physical examination, the vaginal walls are covered by white plaques with the appearance of cottage cheese. Upon detaching them from the base, an erythematous area is left. Hyphae and budding yeast are noted on the wet mount. There is also an erythematous area in the upper third of the vulva, near the urethra. There is no other abnormal finding on the physical exam.
Other presentations
Women with atrophic vaginitis present postmenopause with symptoms of dryness, dyspareunia, vaginal spotting, and, less commonly, dysuria. Atrophic vaginitis may occur in nonmenopausal women with a history of chemotherapy, radiation therapy, or oophorectomy.
Irritant or allergic vaginitis presents with similar symptoms of vulvodynia, dyspareunia, or pruritus, with or without a history of atopy. Women may report douching, and/or a recent change in soaps, contraceptive devices, tampons, and medications.[1]
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