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?
Low estrogen r/o menopause.
ReplyDeletethis 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.
ReplyDeletethe 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)
treatment
metronizadol for gardenella
ceftriaxon for gonorrhoa
doxycylcin for chlamydia
yes - lack of estrogen - leading to atrophic vaginitis - doesn't necessarily have to be an infection
ReplyDelete-
Aging
This is atrophic vaginitis, resulting from decreased estrogen after menopause.
Source: UpToDate.