Case Report

Importance of the physical exam and in-office tests in the evaluation of vulvovaginal irritation

Authors: Ashley Christensen (University of Iowa, Iowa City, Iowa) , Michael Haugsdal (University of Iowa, Iowa City, Iowa) , Noelle C Bowdler (University of Iowa, Iowa City, Iowa)

  • Importance of the physical exam and in-office tests in the evaluation of vulvovaginal irritation

    Case Report

    Importance of the physical exam and in-office tests in the evaluation of vulvovaginal irritation

    Authors: , ,

Abstract

Background: Vulvovaginal irritation is a common gynecologic complaint. A number of factors may lead to a trial of therapy without undertaking a physical exam or diagnostic testing.

Case Report: A 45 year-old woman presented to our colposcopy clinic for evaluation of an abnormal Papanicolaou (Pap) test. She reported a one month history of vulvovaginal irritation, for which Premarin vaginal cream had been empirically prescribed. Examination of the external genitalia showed ulcers and erythema of the labia minora. Speculum exam was deferred because of the patient’s discomfort. Wet mount microscopy from a vaginal swab revealed evidence of Trichomonas vaginalis, bacterial vaginosis (BV), and yeast. A swab of the ulcers was sent for herpes simplex virus (HSV) polymerase chain reaction (PCR); this confirmed HSV-2. Treatment was initiated for each of these conditions, and the patient returned for colposcopy 21 days later.

Conclusion: This case illustrates the importance of the physical exam when evaluating a complaint of vulvovaginal irritation. In many cases, the cause(s) of vulvovaginal irritation can be identified based on physical exam findings and in-office testing with wet mount microscopy, vaginal pH, and the amine “whiff” test. In some cases, additional testing may be required to establish or confirm a diagnosis. Accurate diagnosis is essential not only to initiate appropriate therapy, but also to prevent the transmission of sexually transmitted infections. In some cases, this may decrease the delay in diagnosing vulvar gynecologic malignancies.

Keywords: vulvovaginal irritation, physical exam, vaginosis, vaginitis, sexually transmitted infections

How to Cite:

Christensen, A. & Haugsdal, M. & Bowdler, N. C., (2014) “Importance of the physical exam and in-office tests in the evaluation of vulvovaginal irritation”, Proceedings in Obstetrics and Gynecology 4(2), 1–8. doi: https://doi.org/10.17077/2154-4751.1246

Rights: Copyright © 2014 Ashley Christensen, Michael Haugsdal, and Noelle C. Bowdler

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Published on
30 Oct 2014
Peer Reviewed
License
CC BY 4.0