Thursday, April 21, 2016


A 55 year old woman presents with complaints of pain with sex. She's noticed vaginal dryness, burning, and irritation as well as yellow discharge. In addition, she has dysuria and increased urinary frequency. On exam, you note scarce pubic hair, diminished elasticity and turgor of the skin, and fusion of the labia minora. Vaginal pH is 6.

Challenge: What's your diagnosis?


Al Bundy said...

Low estrogen r/o menopause.

RaH said...

this is a guess: She presents with symptoms for UTI and Kolpiits/Vaginitis. Discharge, pruritus, pH and dys/polyuria all speak for an infectious cause which might have affected both systems. fusions of the labia can be due to a lack of estrogene and to much testosterone or by inflammation. in this case the infection as well as the itching (with mechanical irritation) can give us a cause for the fusion of the labiae.
the pH at 6 could speak for a gardenella vaginalis infection

differential diagnoses are : Chlamydia and gonorrhea (both of those do not create a vaginitis but a cervicitis)

metronizadol for gardenella
ceftriaxon for gonorrhoa
doxycylcin for chlamydia

Craig Chen said...

yes - lack of estrogen - leading to atrophic vaginitis - doesn't necessarily have to be an infection

This is atrophic vaginitis, resulting from decreased estrogen after menopause.

Source: UpToDate.