Vaginal prurities

Vaginal Itching and Discharge

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Vaginal or Vulvar Itching

• 95% of women with vulvar itching have yeast.

• Giving an anti-fungal agent (Monistat, Lotrimin, etc.) will cure most of this itching.

• Treatment failures need further evaluation.


Yeast (AKA Monilia, Thrush, Candida)• Itching is hallmark symptom

• Red, swollen, tender vulva

• Wet Mount confirms


Yeast Treatment

• Topical anti-fungal agents work well

• Monistat• Gyne Lotrimin• Mycelex G

• Oral agents also work well

• Diflucan 150 PO once


Chronic Yeast

Predisposing Factors:

• Heat• Moisture• Diet• Diabetes• Antibiotics

Solution: PRN Anti-fungal Agents


Tinea Cruris (Jock Itch)

• Raised, reddened intertrigenous lesion

• Dx: visual, but may obtain KOH scrapings

• Rx: (BID x 2-3 weeks) -Monistat -Lotrimin -Diflucan -Nizoral


Contact Dermatitis

• Perfumes

• Deodorants

• Toilet Paper

• Soap

• RX: -Stop exposure

• -Burrow's Solution

• -Topical Steroids


Crabs (Pubic Lice)

Transmitted by:

• Sexual contact• Infected bedding• Sharing towels• Close living quarters


Crabs (Pubic Lice) Treatment

Nix cream

Kwell Shampoo


HPV (Condyloma)

• Clinical warts

• Flat warts

• Soak vulva in vinegar,Exam under 7x power,Red-free light filter

• Cryo, TCA, Laser, Cautery, Podo, etc.


Vulvar Dystrophy - Hypertrophic

• Skin too thick

• Sx: Itching

• Dx: Biopsy

• Rx: Steroid Cream


Vulvar Dystrophy - Lichen Sclerosis

• Skin too thin

• Sx: Itching

• Dx: Biopsy

• Rx: Testosterone Cream or Clobetasol


VIN (Vulvar Intraepithelial Neoplasia)

• Itching• Doesn’t respond to

anti-fungal agents• May have a white

skin discoloration• Need biopsy for

diagnosis


VIN (Vulvar Intraepithelial Neoplasia)


Paget's Disease• Slow-growing malignancy

• Exzematoid lesion -dry, crusty skin -moist, weepy -contact bleeding

• Looks like yeast, but isn’t cured with anti-fungal Rx

• Confirm by Bx, treat with local excision


Vaginal Discharge

• Does it Itch?• Does it smell bad?• What does it look like?• Wet mount, cultures


Bacterial Vaginosis

• Smells bad• “Whiff Test” (KOH)• AKA Gardnerella, BV,

Hemophilus Vag.• Anaerobic bacteria• Rx: Flagyl• Rx: Clindamycin• Rx: Amox


Bacterial Vaginosis• Rx: Flagyl• Rx: Clindamycin• Rx: Amox


Trichomonas

• Bubbly, frothy discharge• Rx: Flagyl

250 TID x 7 days500 BID x 5 days2 gm PO stat


Wet Mount


Cultures

• If GC, Chlamydia, Strep suspected• If pelvic pain present• Treatment failures


Documents

Vaginal prurities