Cyclical

Female Reproductive System & Breast


Step 1: View Clinicals

A 30 year old woman presents with a thick whitish vaginal discharge for 3 months, in association with vulvovaginal itching. She also experiences pain during intercourse.


The symptoms tended to increase in severity around two weeks prior to menstruation. Her menstrual cycles are regular, being around 28 days in length.


Her medical and gynecological histories are unremarkable, while she is not on any drugs. She is in a monogamous relationship.


Step 2: Order Relevant Investigations

1. Wet Mount Microscopy

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Microscopy reveals the presence of a large number of intermediate epithelial cells, copious amounts of lactobacilli of varying lengths, and cytoplasmic debris (including bare and naked nuclei). No leukocytes are seen.

2. Vaginal pH

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The vaginal pH is 3.8

3. Whiff Test

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The whiff test is negative.

4. Pap Smear

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The pap smear is within normal limits.

Step 3: Select Appropriate Management

1. Topical Antimycotics

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2. Screen Partner

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3. NaHCO3 Douching

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4. Stop using Tampons

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