Causes of Vaginitis
List of causes of Vaginitis
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Vaginitis)
that could possibly cause Vaginitis includes:
More causes:
see full list of causes for Vaginitis
Causes of Vaginitis (Diseases Database):
The follow list shows some of the possible medical causes of Vaginitis
that are listed by the Diseases Database:
Source: Diseases Database
Vaginitis Causes: Risk Factors
The following conditions have been cited in various
sources as potentially causal risk factors
related to Vaginitis:
Vaginitis and Genetics: Book Excerpts
Vaginitis Causes: Book Excerpts
Vaginitis: Related Medical Conditions
To research the causes of Vaginitis, consider researching the causes of these
these diseases that may be similar, or associated with Vaginitis:
Vaginitis: Causes and Types
Causes of Types of Vaginitis: Review the cause informationfor the various types of Vaginitis:
Causes of Broader Categories of Vaginitis: Review the causal information about the various more general categories of medical conditions:
Vaginitis as a complication of other conditions:
Other conditions that might have
Vaginitis as a complication may,
potentially, be an underlying cause of Vaginitis.
Our database lists the following as having
Vaginitis as a complication of that condition:
Vaginitis as a symptom:
Conditions listing Vaginitis
as a symptom may also be potential underlying causes of Vaginitis.
Our database lists the following as having
Vaginitis as a symptom of that condition:
Medications or substances causing Vaginitis:
The following drugs, medications, substances or toxins are some of the possible
causes of Vaginitis as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
See full list of 123
medications causing Vaginitis
Related information on causes of Vaginitis:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Vaginitis may be found in:
Causes of Vaginitis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Vaginitis.
Vaginal Discharge:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Physiologic
–Many women will have a consistent, slightly clear, non-odor-producing discharge, either midcycle or premenstrually, particularly if they are on oral contraceptives
–A change in odor, consistency, or color of discharge may signify that evaluation is necessary
–Increased discharge is associated with pregnancy
- Sexually transmitted disease
–Trichomonas vaginalis: “Strawberry cervix” with punctate erythema, flagellated oval organisms on wet mount
–Gonorrhea/Chlamydia may be associated with pelvic pain/dysmenorrhea and dyspareunia
- Bacterial vaginosis
–Various organisms and changes in normal flora with a characteristic fishy odor
–Not considered an STD
–Increases the risk of preterm delivery in
pregnant women
- Alteration of normal vaginal flora and/or inflammatory response
–Candida albicans overgrowth is more common with recent antibiotic use, poorly controlled diabetes, and/or pregnancy; presents with intensely pruritic, inflamed, and erythematous introitus
–Doderlein's cytolysis (caused by an
overgrowth of lactobacilli)
-
Atrophic vaginitis
–Common in postmenopausal women, especially those not on HRT
–Poor coital lubrication, dyspareunia
–Dysuria due to atrophic urethral tissue
-
Foreign body vaginitis (e.g., retained tampon)
-
Noninfectious irritant/allergic contact vaginitis (e.g., soaps, feminine pads, perfumes)
-
Cervicitis (usually due to gonorrhea or Chlamydia)
-
Cervical dysplasia, cancer, or polyps
-
Vaginal or vulvar trauma or cancer
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Vaginal Discharge:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Physiologic leukorrhea
–In newborns for 2–3 weeks, due to maternal estrogen effect, and in pubertal girls
–Discharge typically clear to white, sticky, and
nonirritating
–Newborns may have withdrawal bleeding
- Infections
–Bacterial vaginosis: Previously known as nonspecific vaginitis; polymicrobial in etiology (coliforms, streptococci, Gardnerella); discharge may be gray and malodorous (fishy smell) but generally nonirritating
–Candida: Discharge may be cheesy and white with erythematous, pruritic, irritated vulva; typical discharge is rarely seen in prepubertal children; discharge typically has no odor
–Trichomonas: Discharge may be frothy, malodorous, creamy, green, bloody, or pruritic (or asymptomatic)
–Chlamydia: Commonly asymptomatic or a nonspecific discharge
–Gonorrhea: Infection is commonly asymptomatic or has a gray-white, thick, purulent discharge
–Group A β-hemolytic streptococci:
Discharge may be bloody
–Shigella: Discharge may be bloody
-
Irritation/hygiene
–Due to bubble baths and other chemical irritants, tight clothing, obesity, poor wiping
-
Foreign body
–Commonly includes toilet paper, forgotten tampon
–Discharge is often bloody and malodorous
-
Anatomic
–Ectopic urethra
–Rectovaginal fistula
–Urethral prolapse
-
Urinary tract infection
-
Masturbation
-
Sarcoma botyroides
-
Oral contraceptives (estrogen effect)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Abnormal Vaginal Bleeding:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Dysfunctional uterine bleeding (DUB)
–Physiologic anovulation is normal for up to 2
years after menarche
–Androgen excess
–Functional ovarian hyperandrogenism, or
polycystic ovary syndrome, is common in
adolescence
–Estrogen excess
–Hyperprolactinemia
–Hypothyroidism
–Early premature ovarian failure
-
Luteal phase defects
-
Pregnancy disorders
–Spontaneous abortion (threatened, missed,
incomplete)
–Molar pregnancy
–Ectopic pregnancy
-
True vaginal bleeding
–Trauma (including sexual abuse)
–Vaginal sarcoma (sarcoma botyroides)
–Foreign body (more common in the younger
child)
-
Menorrhagia
–Idiopathic: Most common cause of menorrhagia in adolescents
–Coagulopathy/bleeding disorder (e.g., thrombocytopenia, von Willebrand disease, factor IX deficiency)
–Uterine polyp or neoplasm
-
Hematuria mistaken for vaginal bleeding
–Urethral prolapse
–Urinary tract infection
-
Excoriations due to pruritus
-
Vulvovaginitis
–Trichomonas
–Chlamydia
–Gonorrhea
–Pinworms (rare)
-
Cervical lesions
–Cervical polyp
–Hemangioma
–Cervical friability
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Metrorrhagia:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Cervicitis
Cervicitis is a nonspecific infection that may cause spontaneous bleeding, spotting, or posttraumatic bleeding. Assessment reveals red, granular, irregular lesions on the external cervix. Purulent vaginal discharge (with or without odor), lower abdominal pain, and a fever may occur.
Dysfunctional uterine bleeding
Abnormal uterine bleeding not caused by pregnancy or major gynecologic disorders usually occurs as metrorrhagia, although menorrhagia is possible. Bleeding may be profuse or scant, intermittent or constant.
Endometrial polyps
In most patients, endometrial polyps cause abnormal bleeding, usually intermenstrual or postmenopausal; however, some patients do remain asymptomatic.
Endometriosis
Metrorrhagia (usually premenstrual) may be the only indication of endometriosis or it may accompany cyclical pelvic discomfort, infertility, and dyspareunia. A tender, fixed adnexal mass may be palpable on bimanual examination.
Endometritis
Endometritis causes metrorrhagia, purulent vaginal discharge, and enlargement of the uterus. It also produces a fever, lower abdominal pain, and abdominal muscle spasm.
Gynecologic cancer
Metrorrhagia is commonly an early sign of cervical or uterine cancer. Later, the patient may experience weight loss, pelvic pain, fatigue and, possibly, an abdominal mass.
Uterine leiomyomas
Besides metrorrhagia, uterine leiomyomas may cause increasing abdominal girth and heaviness in the abdomen, constipation, and urinary frequency or urgency. The patient may report pain if the uterus attempts to expel the tumor through contractions and if the tumors twist or necrose after circulatory occlusion or infection, but the patient with leiomyomas is usually asymptomatic.
Vaginal adenosis
Vaginal adenosis commonly produces metrorrhagia. Palpation reveals roughening or nodules in affected vaginal areas.
Other causes
Drugs
Anticoagulants and oral, injectable, or implanted contraceptives may cause metrorrhagia.
Herb Alert
Herbal remedies, such as ginseng, can cause postmenopausal bleeding.
Surgery and procedures
Cervical conization and cauterization may cause metrorrhagia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Vaginal discharge:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Atrophic vaginitis
With atrophic vaginitis, a thin, scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial vaginosis
Bacterial vaginosis (formerly called Gardnerella vaginalis and Haemophilus vaginalis) results from an ecozogic disturbance of the vaginal flora. Causing a thin, foul-smelling, green or gray-white discharge, it adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other signs of vaginal irritation may occur but are usually minimal.
Candidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine, red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chancroid
Chancroid — a rare but highly contagious sexually transmitted disease — produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and fever to 102.2° F (39° C) are common.
Chlamydial infection
Chlamydial infection causes a yellow, mucopurulent, odorless, or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially following menses. Many women remain asymptomatic.
Endometritis
A scant, serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, lower back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts
Genital warts are mosaic, papular vulvar lesions that can cause a profuse, mucopurulent vaginal discharge, which may be foul-smelling if the warts are infected. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a yellow or green, foul-smelling discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul-smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital)
A copious mucoid discharge results from herpes simplex, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis
Trichomoniasis can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; a red, inflamed vagina with tiny petechiae; dysuria and urinary frequency; and dyspareunia, postcoital spotting, menorrhagia, or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies
Contraceptive creams and jellies can increase vaginal secretions.
Drugs
Drugs that contain estrogen, including hormonal contraceptives, can cause increased mucoid vaginal discharge. Antibiotics, such as tetracycline, may increase the risk of a candidal vaginal infection and discharge.
Radiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Vulvar lesions:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Basal cell carcinoma
Most common in postmenopausal women, this nodular tumor has a central ulcer and a raised, poorly rolled border. Typically asymptomatic, the tumor may occasionally cause pruritus, bleeding, discharge, and a burning sensation.
Benign cysts
Epidermal inclusion cysts, the most common vulvar cysts, appear primarily on the labia majora and are usually round and asymptomatic. Occasionally, they become erythematous and tender.
Bartholin’s duct cysts are usually unilateral, tense, nontender, and palpable; they appear on the posterior labia minora and may cause minor discomfort during intercourse or, when large, difficulty with intercourse or even walking. Bartholin’s abscess, infection of a Bartholin’s duct cyst, causes gradual pain and tenderness and possibly vulvar swelling, redness, and deformity.
Benign vulvar tumors
Cystic or solid benign vulvar tumors are usually asymptomatic.
Chancroid
Chancroid, a rare, sexually transmitted disease, causes painful vulvar lesions. Headache, malaise, and fever to 102.2° F (39° C) may occur, with enlarged, tender inguinal lymph nodes.
Genital warts
Genital warts, a sexually transmitted disease, produces painless warts on the vulva, vagina, and cervix. Warts start as tiny red or pink swellings that grow and become pedunculated. Multiple swellings with a cauliflower appearance are common. Other findings include pruritus, erythema, and a profuse, mucopurulent vaginal discharge. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
Vulvar lesions, which usually are confined to Bartholin’s glands, may develop along with pruritus, a burning sensation, pain, and a green-yellow vaginal discharge, but most patients are asymptomatic. Other findings include dysuria and urinary incontinence; vaginal redness, swelling, bleeding, and engorgement; and severe pelvic and lower abdominal pain.
Granuloma inguinale
Initially, a single painless macule or papule appears on the vulva, ulcerating into a raised, beefy-red lesion with a granulated, friable border. Other painless and possibly foul-smelling lesions may occur on the labia, vagina, or cervix. These become infected and painful, and regional lymph nodes enlarge and may become tender. Systemic effects include fever, weight loss, and malaise.
Herpes simplex (genital)
With herpes simplex, fluid-filled vesicles appear on the cervix and, possibly, on the vulva, labia, perianal skin, vagina, or mouth. The vesicles, initially painless, may rupture and develop into extensive, shallow, painful ulcers, with redness, marked edema, and tender inguinal lymph nodes. Other findings include fever, malaise, and dysuria.
Lymphogranuloma venereum
Patients with lymphogranuloma venereum, a bacterial infection commonly present with a single, painless papule or ulcer on the posterior vulva that heals in a few days. Painful, swollen lymph nodes, usually unilateral, develop 2 to 6 weeks later. Other findings include fever, chills, headache, anorexia, myalgias, arthralgias, weight loss, and perineal edema.
Squamous cell carcinoma
Invasive carcinoma occurs primarily in postmenopausal women and may produce vulvar pruritus, pain, and a vulvar lump. As the tumor enlarges, it may encroach on the vagina, anus, and urethra, causing bleeding, discharge, or dysuria. Carcinoma in situ is most common in premenopausal women, producing a vulvar lesion that may be white or red, raised, well defined, moist, crusted, and isolated.
Squamous cell hyperplasia
Formerly known as hyperplastic dystrophy, these vulvar lesions may be well delineated or poorly defined; localized or extensive; and red, brown, white, or both red and white. However, intense pruritus, possibly with vulvar pain, intense burning, and dyspareunia, is the cardinal symptom. With lichen sclerosis, a type of vulvar dystrophy, vulvar skin has a parchmentlike appearance. Fissures may develop between the clitoris and urethra or other vulvar areas.
Syphilis
Chancres, the primary vulvar lesions of syphilis, may appear on the vulva, vagina, or cervix 10 to 90 days after initial contact. Usually painless, they start as papules that then erode, with indurated, raised edges and clear bases. Condylomata lata, highly contagious secondary vulvar lesions, are raised, gray, flat topped, and commonly ulcerated. Other findings include a maculopapular, pustular, or nodular rash; headache; malaise; anorexia; weight loss; fever; nausea; vomiting; generalized lymphadenopathy; and a sore throat.
Viral disease (systemic)
Varicella, measles, and other systemic viral diseases may produce vulvar lesions.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Vaginal bleeding, postmenopausal:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Atrophic vaginitis
When bloody staining occurs, it usually follows coitus or douching. Characteristic white, watery vaginal discharge may be accompanied by pruritus, dyspareunia, and a burning sensation in the vagina and labia. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Cervical cancer
Early invasive cervical cancer causes vaginal spotting or heavier bleeding, usually after coitus or douching but occasionally spontaneously. Related findings include persistent, pink-tinged, and foul-smelling vaginal discharge and postcoital pain. As the cancer spreads, back and sciatic pain, leg swelling, anorexia, weight loss, hematuria, dysuria, rectal bleeding, and weakness may occur.
Cervical or endometrial polyps
Cervical or endometrial polyps are small, pedunculated growths that may cause spotting (possibly as a mucopurulent, pink discharge) after coitus, douching, or straining to defecate. Many endometrial polyps are asymptomatic, however.
Endometrial hyperplasia or cancer
Bleeding occurs early, can be brownish and scant or bright red and profuse, and usually follows coitus or douching. Bleeding later becomes heavier and more frequent, leading to clotting and anemia. Bleeding may be accompanied by pelvic, rectal, lower back, and leg pain. The uterus may be enlarged.
Ovarian tumors (feminizing)
Estrogen-producing ovarian tumors can stimulate endometrial shedding and cause heavy bleeding unassociated with coitus or douching. A palpable pelvic mass, increased cervical mucus, breast enlargement, and spider angiomas may be present.
Vaginal cancer
Characteristic spotting or bleeding may be preceded by a thin, watery vaginal discharge. Bleeding may be spontaneous but usually follows coitus or douching. A firm, ulcerated vaginal lesion may be present; dyspareunia, urinary frequency, bladder and pelvic pain, rectal bleeding, and vulvar lesions may develop later.
Other causes
Drugs
Unopposed estrogen replacement therapy is a common cause of abnormal vaginal bleeding. This can usually be reduced by adding progesterone (in women who haven’t had a hysterectomy) and by adjusting the patient’s estrogen dosage.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Vulvovaginitis:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Common causes include:
❑ infection with Trichomonas vaginalis, a protozoan flagellate usually transmitted through sexual intercourse
❑ infection with Candida albicans, a fungus that requires glucose for growth. Incidence rises during the menstrual cycle’s secretory phase (Such infection occurs twice as often in pregnant females as in nonpregnant females. It also commonly affects users of hormonal contraceptives, patients who are diabetic, and patients receiving systemic therapy with broad-spectrum antibiotics [incidence may reach 75%.])
❑ infection with Gardnerella vaginalis, a gram-negative bacillus
❑ parasitic infection (Phthirus pubis [crab louse])
❑ trauma (skin breakdown may lead to secondary infection)
❑ poor personal hygiene
❑ chemical irritations, or allergic reactions to hygiene sprays, douches, detergents, clothing, or toilet paper
❑ vulval atrophy in menopausal women due to decreasing estrogen levels
❑ retention of a foreign body, such as a tampon or diaphragm.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Vaginal cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The exact cause of vaginal cancer remains unknown. This cancer generally occurs in women in their early to mid-50s, but some of the rarer types occur in younger women, and rhabdomyosarcoma appears in children. (Clear cell adenocarcinoma has an increased incidence in young women whose mothers took diethylstilbestrol).
Vaginal cancer varies in severity according to its location and effect on lymphatic drainage. (The vagina is a thin-walled structure with a rich lymphatic drainage.) Vaginal cancer is similar to cervical cancer in that it may progress from an intraepithelial tumor to an invasive cancer. However, it spreads more slowly than cervical cancer.
A lesion in the upper third of the vagina (the most common site) usually metastasizes to the groin nodes; a lesion in the lower third (the second most common site) usually metastasizes to the hypogastric and iliac nodes; but a lesion in the middle third metastasizes erratically. A posterior lesion displaces and distends the vaginal posterior wall before spreading to deep layers. By contrast, an anterior lesion spreads more rapidly into other structures and deep layers because, unlike the posterior wall, the anterior vaginal wall isn't flexible.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Metrorrhagia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Cervicitis
This nonspecific infection may cause spontaneous bleeding, spotting, or posttraumatic bleeding. Assessment reveals red, granular, irregular lesions on the external cervix. Purulent vaginal discharge (with or without odor), lower abdominal pain, and fever may occur.
Dysfunctional uterine bleeding
Abnormal uterine bleeding not caused by pregnancy or major gynecologic disorders usually occurs as metrorrhagia, although menorrhagia is possible. Bleeding may be profuse or scant, intermittent or constant.
Endometrial polyps
In most patients, this disorder causes abnormal bleeding, usually intermenstrual or postmenopausal; however, some patients do remain asymptomatic.
Endometriosis
Metrorrhagia (usually premenstrual) may be the only indication of this disorder, or it may accompany cyclical pelvic discomfort, infertility, and dyspareunia. A tender, fixed adnexal mass may be palpable on bimanual examination.
Endometritis
This disorder causes metrorrhagia, purulent vaginal discharge, and enlargement of the uterus. It also produces fever, lower abdominal pain, and abdominal muscle spasm.
Gynecologic cancer
Metrorrhagia is commonly an early sign of cervical or uterine cancer. Later, the patient may experience weight loss, pelvic pain, fatigue and, possibly, an abdominal mass.
Syphilis
Primary- or secondary-stage syphilis may cause metrorrhagia and postcoital bleeding. In primary syphilis, one or more usually painless chancres erupt on the genitalia and possibly other areas. In secondary syphilis, generalized lymphadenopathy may appear, along with a rash on the arms, trunk, palms, soles, face, and scalp.
Uterine leiomyomas
Besides metrorrhagia, these tumors may cause increasing abdominal girth and heaviness in the abdomen, constipation, and urinary frequency or urgency. The patient may report pain if the uterus attempts to expel the tumor through contractions and if the tumors twist or necrose after circulatory occlusion or infection, but many women with leiomyomas are asymptomatic.
Vaginal adenosis
This disorder commonly produces metrorrhagia. Palpation reveals roughening or nodules in affected vaginal areas.
Other causes
Drugs
Anticoagulants and oral, injectable, or implanted contraceptives may cause metrorrhagia.
Herb Alert
Herbal remedies, such as ginseng, can cause postmenopausal bleeding.
Surgery and procedures
Cervical conization and cauterization may cause metrorrhagia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal discharge:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Atrophic vaginitis
In this disorder, a scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial Vaginosis
This infection, caused by Gardnerella vaginalis (formerly called Haemophilus vaginalis), results from an ecozogic disturbance of the vaginal flora. It produces a thin, foul-smelling, green or gray-white discharge that adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other mild signs of vaginal irritation may also occur.
Candidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chancroid
This rare but highly contagious sexually transmitted disease produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and a fever as high as 102.2° F (39° C) are common.
Chlamydial infection
This infection causes a yellow, mucopurulent, odorless or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially after menses. Many women, however, remain asymptomatic.
Endometritis
A scant serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, low back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts
These mosaic, papular vulvar lesions can cause a profuse mucopurulent vaginal discharge, which may be foul smelling if the warts are infected. Patients commonly complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a foul-smelling yellow or green discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital)
A copious mucoid discharge results from this disorder, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis
This infection can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; an inflamed, erythematous vagina with tiny petechiae; dysuria and urinary frequency; dyspareunia; postcoital spotting; and menorrhagia or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies
These products can increase vaginal secretions.
Drugs
Drugs that contain estrogen, including hormonal contraceptives, can cause a mucoid vaginal discharge. Antibiotics such as tetracycline may increase the risk of a candidal vaginal infection and associated discharge.
Radiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vulvar lesions:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Basal cell carcinoma
Most common in postmenopausal women, this nodular tumor has a central ulcer and a raised, poorly rolled border. Although it typically produces no symptoms, basal cell carcinoma occasionally causes pruritus, bleeding, discharge, and a burning sensation.
Benign cysts
Epidermal inclusion cysts, the most common vulvar cysts, appear primarily on the labia majora. They’re usually round and cause no symptoms; occasionally, they become erythematous and tender.
Bartholin’s duct cysts are usually unilateral, tense, nontender, and palpable; they appear on the posterior labia minora and may cause minor discomfort during intercourse or, when large, difficulty with intercourse or even walking. Bartholin’s abscess, an infected Bartholin’s duct cyst, causes gradual pain and tenderness and possibly vulvar swelling, redness, and deformity.
Benign vulvar tumors
Cystic or solid benign vulvar tumors usually produce no symptoms.
Chancroid
This rare sexually transmitted disease causes painful vulvar lesions. Other findings may include headache, malaise, fever up to 102.2° F (39° C), and enlarged, tender inguinal lymph nodes.
Dermatoses (systemic)
Psoriasis, seborrheic dermatitis, and other skin conditions may produce vulvar lesions that resemble the causative lesions found in other body areas.
Genital warts
This sexually transmitted condition is characterized by painless warts on the vulva, vagina, and cervix. The warts start as tiny red or pink swellings that grow and become pedunculated. Multiple swellings with a cauliflower-like appearance are common. Other findings include pruritus, erythema, burning or paresthesia in the vaginal introitus, and a profuse mucopurulent vaginal discharge.
Gonorrhea
Although most women with gonorrhea are asymptomatic, some develop vulvar lesions, which are usually confined to Bartholin’s glands and may be accompanied by pruritus, a burning sensation, pain, and a green-yellow vaginal discharge. Other findings include dysuria and urinary incontinence; vaginal redness, swelling, bleeding, and engorgement; and severe pelvic and lower abdominal pain.
Granuloma inguinale
This rare, chronic venereal infection begins with a single painless macule or papule on the vulva that ulcerates into a raised, beefy-red lesion with a granulated, friable border. Later, other painless and possibly foul-smelling lesions may erupt on the labia, vagina, or cervix. Eventually, they become infected and painful and may be accompanied by enlarged and tender regional lymph nodes, fever, weight loss, and malaise.
Herpes simplex (genital)
In this disorder, fluid-filled vesicles appear on the cervix and, possibly, on the vulva, labia, perianal skin, vagina, or mouth. The vesicles, initially painless, may rupture and develop into extensive shallow, painful ulcers, with redness, marked edema, and tender inguinal lymph nodes. Other findings include fever, malaise, and dysuria.
Herpes zoster
This viral infection may produce vulvar lesions, although other areas are more commonly affected. Small, red nodular lesions erupt on painful erythematous areas. The lesions quickly evolve into vesicles or pustules, which dry and form scabs about 10 days later. Other findings include fever, malaise, paresthesia or hyperesthesia, and pain.
Lymphogranuloma venereum
Most patients with this bacterial infection initially exhibit a single painless papule or ulcer on the posterior vulva that heals in a few days. Painful, swollen lymph nodes, usually unilateral, develop 2 to 6 weeks later. Other findings include fever, chills, headache, anorexia, myalgia, arthralgia, weight loss, and perineal edema.
Malignant melanoma
This type of skin cancer may cause irregular, pigmented vulvar or clitoral lesions that enlarge rapidly and may ulcerate and bleed.
Molluscum contagiosum
This viral infection produces raised, umbilicated, pearly or flesh-colored vulvar papules that are 1 to 2 mm in diameter and have a white core. Pruritic lesions may also appear on the face, eyelids, breasts, and inner thighs.
Pediculosis pubis
This parasitic infection produces erythematous vulvar papules with pruritus and skin irritation. Adult pubic lice and nits are visible on pubic hair with magnification.
Squamous cell carcinoma
Invasive carcinoma occurs primarily in postmenopausal women and may produce a painful, pruritic vulvar tumor. As the tumor enlarges, it may encroach on the vagina, anus, and urethra, causing bleeding, discharge, or dysuria. Carcinoma in situ is most common in premenopausal women and produces a vulvar lesion that may be white or red, raised, well defined, moist, crusted, and isolated.
Squamous cell hyperplasia
Formerly known as hyperplastic dystrophy, this disorder produces vulvar lesions that may be well delineated or poorly defined; localized or extensive; and red, brown, white, or red and white. However, its cardinal symptom is intense pruritus, possibly with vulvar pain, intense burning, and dyspareunia. In lichen sclerosis, a type of vulvar dystrophy, vulvar skin has a parchmentlike appearance. Fissures may develop between the clitoris and urethra or other vulvar areas.
Syphilis
In this sexually transmitted disease, chancres may appear on the vulva, vagina, or cervix 10 to 90 days after initial contact. They usually start as painless papules and then erode to form indurated ulcers with raised edges and clear bases. Condylomata lata develop after these ulcers clear up. These highly contagious secondary vulvar lesions are raised, gray, flat topped, and commonly ulcerated. Other findings include a maculopapular, pustular, or nodular rash; headache; malaise; anorexia; weight loss; fever; nausea and vomiting; generalized lymphadenopathy; and sore throat.
Viral diseases (systemic)
Varicella, measles, and other systemic viral diseases may produce vulvar lesions.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal bleeding, postmenopausal:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Atrophic vaginitis
When bloody staining occurs in this disorder, it usually follows coitus or douching. The characteristic watery white vaginal discharge may be accompanied by pruritus, dyspareunia, and a burning sensation in the vagina and labia. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Cervical cancer
Early invasive cervical cancer causes vaginal spotting or heavier bleeding, usually after coitus or douching but occasionally spontaneously. Related findings include a persistent, pink-tinged, and foul-smelling vaginal discharge and postcoital pain. As the cancer spreads, back and sciatic pain, leg swelling, anorexia, weight loss, hematuria, dysuria, rectal bleeding, and weakness may occur.
Cervical or endometrial polyps
These small, pedunculated growths may cause spotting (possibly as a mucopurulent pink discharge) after coitus, douching, or straining at defecation. However, many endometrial polyps produce no symptoms.
Endometrial hyperplasia or cancer
Bleeding occurs early in these disorders; it can be brownish and scant or bright red and profuse, and usually follows coitus or douching. Bleeding later becomes heavier and more frequent, leading to clotting and anemia. It may be accompanied by pelvic, rectal, low back, and leg pain and an enlarged uterus.
Ovarian tumors (feminizing)
Estrogen-producing ovarian tumors can stimulate endometrial shedding and cause heavy bleeding that isn’t associated with coitus or douching. A palpable pelvic mass, increased cervical mucus, breast enlargement, and spider angiomas may be present.
Vaginal cancer
Characteristic spotting or bleeding may be preceded by a thin, watery vaginal discharge. Bleeding may be spontaneous but usually follows coitus or douching. A firm, ulcerated vaginal lesion may be present; dyspareunia, urinary frequency, bladder and pelvic pain, rectal bleeding, and vulvar lesions may develop later.
Other causes
Drugs
Unopposed estrogen replacement therapy is a common cause of abnormal vaginal bleeding. This can usually be reduced by adding progesterone (in women who haven’t had a hysterectomy) and by adjusting the patient’s estrogen dosage.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal Discharge:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Physiologic discharge
❑ Candida vulvovaginitis
❑ Bacterial vaginosis
❑ Trichomonas vaginitis
❑ Atrophic vaginitis
❑ Irritant dermatitis
❑ Gonorrheal cervicitis
❑ Chlamydial cervicitis
❑ Herpes simplex
❑ Cervical cancer
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Vaginal Bleeding:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Ovulatory bleeding
❑ Anovulatory bleeding
❑ Uterine leiomyoma
❑ Dysfunctional bleeding
❑ Threatened abortion
❑ Cervical erosion or polyp
❑ Perimenopause
❑ Retained products of gestation
❑ Ectopic pregnancy
❑ Oral contraceptives
❑ Hyperandrogenism
❑ Cervical cancer
❑ Endometrial cancer
❑ Anticoagulation therapy
❑ Thrombocytopenia
❑ Hypothalamic-pituitary-gonadal immaturity
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Source: Field Guide to Bedside Diagnosis, 2007
Vulvovaginitis:
Causes
(Handbook of Diseases)
Common causes of vaginitis (with or without consequent vulvitis) include:
❑ infection with Trichomonas vaginalis, a protozoan flagellate, usually transmitted through sexual intercourse
❑ infection with Candida albicans (Monilia), a fungus that requires glucose for growth (Incidence rises during the secretory phase of the menstrual cycle. Such infection occurs twice as often in pregnant females as in nonpregnant females. It also commonly affects users of hormonal contraceptives, diabetics, and patients receiving systemic therapy with broad-spectrum antibiotics [incidence may reach 75%].)
❑ infection with Gardnerella vaginitis, a gram-negative bacillus
❑ venereal infection with Neisseria gonorrhoeae (gonorrhea), a gram-negative diplococcus
❑ viral infection with venereal warts (condylomata acuminata) or herpes-virus Type II, usually transmitted by sexual intercourse
❑ vaginal mucosa atrophy in meno-pausal women due to decreasing levels of estrogen, which predisposes to bacterial invasion.
Common causes of vulvitis include:
❑ parasitic infection (Phthirus pubis [crab louse])
❑ trauma (skin breakdown may lead to secondary infection)
❑ poor personal hygiene
❑ chemical irritations, or allergic reactions to hygiene sprays, douches, detergents, clothing, or toilet paper
❑ vulval atrophy in menopausal women due to decreasing estrogen levels
❑ retention of a foreign body, such as a tampon or diaphragm.
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Source: Handbook of Diseases, 2003
Vaginal discharge:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Atrophic vaginitis
With atrophic vaginitis, a thin, scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial vaginosis
Bacterial vaginosis results in a thin, foul-smelling, green or gray-white discharge that adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other signs of vaginal irritation may occur but are usually minimal.
Candidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine, red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chlamydial infection
A chlamydial infection causes a yellow, mucopurulent, odorless, or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially following menses. Many women remain asymptomatic.
Endometritis
A scant, serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, lower back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts
Genital warts are mosaic, papular vulvar lesions that can cause a profuse, mucopurulent vaginal discharge, which may be foul-smelling if the warts are infected. Patients with genital warts frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a yellow or green, foul-smelling discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul-smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital)
A copious mucoid discharge results from genital herpes, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis
Trichomoniasis can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; a red, inflamed vagina with tiny petechiae; dysuria and urinary frequency; and dyspareunia, postcoital spotting, menorrhagia, or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies
These products can increase vaginal secretions.
Drugs
Drugs that contain estrogen, including hormonal contraceptives, can cause increased mucoid vaginal discharge. Antibiotics, such as tetracycline, may increase the risk of a candidal vaginal infection and discharge.
Radiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vulvar lesions:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Basal cell carcinoma
Most common in postmenopausal women, basal cell carcinoma is a nodular tumor that has a central ulcer and a raised, poorly rolled border. Although it typically doesn’t produce symptoms, the tumor may occasionally cause pruritus, bleeding, discharge, and a burning sensation.
Benign cysts
Epidermal inclusion cysts, the most common benign vulvar cysts, appear primarily on the labia majora, are usually round, and typically produce no symptoms. Occasionally, they become erythematous and tender.
Bartholin’s duct cysts are usually unilateral, tense, nontender, and palpable; they appear on the posterior labia minora and may cause minor discomfort during intercourse or, when large, difficulty with intercourse or even walking. Bartholin’s abscess, infection of a Bartholin’s duct cyst, causes gradual pain and tenderness and possibly vulvar swelling, redness, and deformity.
Genital warts
Genital warts is an STD that produces painless warts on the vulva, vagina, and cervix. Genital warts start as tiny red or pink swellings that grow and become pedunculated. Multiple swellings with a cauliflower appearance are common. Other findings include pruritus, erythema, and a profuse, mucopurulent vaginal discharge. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
With gonorrhea, vulvar lesions, which usually are confined to Bartholin’s glands, may develop along with pruritus, a burning sensation, pain, and a green-yellow vaginal discharge, but most patients with gonorrhea are asymptomatic. Other findings include dysuria and urinary incontinence; vaginal redness, swelling, bleeding, and engorgement; and severe pelvic and lower abdominal pain.
Herpes simplex (genital)
With genital herpes simplex, fluid-filled vesicles appear on the cervix and, possibly, on the vulva, labia, perianal skin, vagina, or mouth. The vesicles, initially painless, may rupture and develop into extensive, shallow, painful ulcers, with redness, marked edema, and tender inguinal lymph nodes. Other findings include fever, malaise, and dysuria.
Molluscum contagiosum
Molluscum contagiosum is a viral infection that produces raised vulvar papules that are 1 to 2 mm in diameter and pearly or flesh colored with umbilicated centers, and that have a white core. Pruritic lesions may also appear on the face, eyelids, breasts, and inner thighs.
Pediculosis pubis
Infection with pediculosis pubis produces erythematous vulvar papules with pruritus and skin irritation. Adult pubic lice and nits are visible on pubic hair with magnification.
Squamous cell carcinoma
Invasive carcinoma occurs primarily in postmenopausal women and may produce vulvar pruritus, pain, and a vulvar lump. As the tumor enlarges, it may encroach on the vagina, anus, and urethra, causing bleeding, discharge, or dysuria. Carcinoma in situ is most common in premenopausal women, producing a vulvar lesion that may be white or red, raised, well defined, moist, crusted, and isolated.
Squamous cell hyperplasia
Squamous cell hyperplasia are vulvar lesions that may be well delineated or poorly defined; localized or extensive; and red, brown, white, or both red and white. However, intense pruritus, possibly with vulvar pain, intense burning, and dyspareunia, is the cardinal symptom of squamous cell hyperplasia. With lichen sclerosis, a type of vulvar dystrophy, vulvar skin has a parchmentlike appearance. Fissures may develop between the clitoris and urethra or other vulvar areas.
Syphilis
Chancres, the primary vulvar lesions of syphilis, may appear on the vulva, vagina, or cervix 10 to 90 days after initial contact. Usually painless, they start as papules that then erode, with indurated, raised edges and clear bases. Condylomata lata, highly contagious secondary vulvar lesions, are raised, gray, flat-topped, and commonly ulcerated. Other findings include a maculopapular, pustular, or nodular rash; headache; malaise; anorexia; weight loss; fever; nausea; vomiting; generalized lymphadenopathy; and a sore throat.
Viral disease (systemic)
Varicella, measles, and other systemic viral diseases may produce vulvar lesions. The characteristics of the lesions depend on the particular viral infection.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal bleeding, postmenopausal:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Atrophic vaginitis
When bloody staining occurs in atrophic vaginitis, it usually follows coitus or douching. Characteristic white, watery vaginal discharge may be accompanied by pruritus, dyspareunia, and a burning sensation in the vagina and labia. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Cervical cancer
Early invasive cervical cancer causes vaginal spotting or heavier bleeding, usually after coitus or douching but occasionally spontaneously. Related findings include persistent, pink-tinged, and foul-smelling vaginal discharge and postcoital pain. As the cancer spreads, back and sciatic pain, leg swelling, anorexia, weight loss, hematuria, dysuria, rectal bleeding, and weakness may occur.
Cervical or endometrial polyps
Cervical or endometrial polyps are small, pedunculated growths that may cause spotting (possibly as a mucopurulent, pink discharge) after coitus, douching, or straining at stool. Many endometrial polyps produce no symptoms, however.
Endometrial hyperplasia or cancer
With endometrial hyperplasia or cancer, bleeding occurs early, can be brownish and scant or bright red and profuse, and usually follows coitus or douching. Bleeding later becomes heavier and more frequent, leading to clotting and anemia. Bleeding may be accompanied by pelvic, rectal, lower back, and leg pain. The uterus may be enlarged.
Ovarian tumor (feminizing)
Estrogen-producing ovarian tumors can stimulate endometrial shedding and cause heavy bleeding unassociated with coitus or douching. A palpable pelvic mass, increased cervical mucus, breast enlargement, and spider angiomas may be present.
Vaginal cancer
With vaginal cancer, characteristic spotting or bleeding may be preceded by a thin, watery vaginal discharge. Bleeding may be spontaneous but usually follows coitus or douching. A firm, ulcerated vaginal lesion may be present; dyspareunia, urinary frequency, bladder and pelvic pain, rectal bleeding, and vulvar lesions may develop later.
Other causes
Drugs
Unopposed estrogen replacement therapy is a common cause of abnormal vaginal bleeding. This can usually be reduced by adding progesterone (in women who haven’t had a hysterectomy) and by adjusting the patient’s estrogen dosage.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal Discharge:
Principal Causes of Vaginal Discharge
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Prepubertalonset
- Physiologicleukorrhea
- Vulvovaginitis
- Nonspecificcauses
- Specific infections
- Foreign body
- Pubertal and postpubertal onset
- Physiologicleukorrhea
- Vulvovaginitis
- Nonspecificcauses
- Specific infections
- Bacterialvaginosis
- Candida species
- Trichomonas vaginalis
- Herpes simplex virus
- Cervicitis
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Pelvic inflammatory disease
- Foreign body
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Vaginal Bleeding:
Principal Causes of Vaginal Bleeding
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Beforenormal menarche
- Trauma
- Vulvovaginitis
- Foreign body
- Urethral prolapse
- Condyloma acuminata
- Exogenous hormone preparations
- Precocious puberty
- Premature menarche
- Hypothyroidism
- Genital tract tumors
- After menarche
- Trauma
- Vulvovaginitis
- Foreign body
- Pelvic inflammatory disease
- Cervicitis
- Cervical polyps
- Anovulatory cycles
- Ovulation
- Endometriosis
- Genital tract tumors
- Bleeding disorders
- Endocrine disorders
- Systemic diseases
- Drugs
- Complications of pregnancy
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Metrorrhagia:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Cervicitis.Cervicitis may cause spontaneous bleeding, spotting, or posttraumatic bleeding. Assessment reveals red, granular, irregular lesions on the external cervix. Purulent vaginal discharge (with or without odor), lower abdominal pain, and fever may occur.
Dysfunctional uterine bleeding. Abnormal uterine bleeding not caused by pregnancy or major gynecologic disorders usually occurs as metrorrhagia, although menorrhagia is possible. Bleeding may be profuse or scant, intermittent or constant.
Endometrial polyps.In most patients, endometrial polyps cause abnormal bleeding, usually intermenstrual or postmenopausal; however, some patients do remain asymptomatic.
Endometriosis.Metrorrhagia (usually premenstrual) may be the only indication of endometriosis or it may accompany cyclical pelvic discomfort, infertility, and dyspareunia. A tender, fixed adnexal mass may be palpable on bimanual examination.
Endometritis.Endometritis causes metrorrhagia, purulent vaginal discharge, and enlargement of the uterus. It also produces fever, lower abdominal pain, and abdominal muscle spasm.
Gynecologic cancer.Metrorrhagia is commonly an early sign of cervical or uterine cancer. Later, the patient may experience weight loss, pelvic pain, fatigue and, possibly, an abdominal mass.
Uterine leiomyomas.Besides metrorrhagia, uterine leiomyomas may cause increasing abdominal girth and heaviness in the abdomen, constipation, and urinary frequency or urgency. The patient may report pain if the uterus attempts to expel the tumor through contractions and if the tumors twist or necrose after circulatory occlusion or infection, but the patient with leiomyomas is usually asymptomatic.
Vaginal adenosis.Vaginal adenosis commonly produces metrorrhagia. Palpation reveals roughening or nodules in affected vaginal areas.
Other causes
Drugs.Anticoagulants and oral, injectable, or implanted contraceptives may cause metrorrhagia.
Surgery and procedures.Cervical conization and cauterization may cause metrorrhagia.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Vaginal discharge:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Atrophic vaginitis.With atrophic vaginitis, a thin, scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial vaginosis.Bacterial vaginosis causes a thin, foul-smelling, green or gray-white discharge, it adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other signs of vaginal irritation may occur but are usually minimal.
Candidiasis.Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine, red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chancroid.Chancroid produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and fever to 102.2° F (39° C) are common.
Chlamydial infection.Chlamydial infection causes a yellow, mucopurulent, odorless, or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially following menses. Many women remain asymptomatic.
Endometritis.A scant, serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, lower back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts.Genital warts are mosaic, papular vulvar lesions that can cause a profuse, mucopurulent vaginal discharge, which may be foul-smelling if the warts are infected. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea.Although 80% of women with gonorrhea are asymptomatic, others have a yellow or green, foul-smelling discharge that can be expressed from Bartholin's or Skene's ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer.Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul-smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital).A copious mucoid discharge results from genital herpes simplex, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis.Trichomoniasis can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; a red, inflamed vagina with tiny petechiae; dysuria and urinary frequency; and dyspareunia, postcoital spotting, menorrhagia, or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies.Contraceptive creams and jellies increase vaginal secretions.
Drugs.Drugs that contain estrogen, including hormonal contraceptives, can cause increased mucoid vaginal discharge. Antibiotics, such as tetracycline, may increase the risk of a candidal vaginal infection and discharge.
Radiation therapy.Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Vulvar lesions:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Basal cell carcinoma.This nodular tumor has a central ulcer and a raised, poorly rolled border. Typically producing no symptoms, the tumor may occasionally cause pruritus, bleeding, discharge, and a burning sensation.
Benign cysts.Epidermal inclusion cysts, the most common vulvar cysts, appear primarily on the labia majora and are usually round and produces no symptoms. Occasionally, they become erythematous and tender.
Bartholin's duct cysts are usually unilateral, tense, nontender, and palpable; they appear on the posterior labia minora and may cause minor discomfort during intercourse or, when large, difficulty with intercourse or even walking. Bartholin's abscess, infection of a Bartholin's duct cyst, causes gradual pain and tenderness and possibly vulvar swelling, redness, and deformity.
Benign vulvar tumors.Cystic or solid, benign vulvar tumors usually produce no symptoms.
Chancroid.Chancroid causes painful vulvar lesions. Headache, malaise, and fever to 102.2° F (39° C) may occur, with enlarged, tender inguinal lymph nodes.
Genital warts.Genital warts are painless warts on the vulva, vagina, and cervix. They start as tiny red or pink swellings that grow and become pedunculated. Multiple swellings with a cauliflower appearance are common. Other findings include pruritus, erythema, and a profuse, mucopurulent vaginal discharge. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea.Vulvar lesions, which usually are confined to Bartholin's glands, may develop along with pruritus, a burning sensation, pain, and a green-yellow vaginal discharge, but most patients are asymptomatic. Other findings include dysuria and urinary incontinence; vaginal redness, swelling, bleeding, and engorgement; and severe pelvic and lower abdominal pain.
Granuloma inguinale.With granuloma inguinale, a single painless macule or papule initially appears on the vulva, ulcerating into a raised, beefy-red lesion with a granulated, friable border. Other painless and possibly foul-smelling lesions may occur on the labia, vagina, or cervix. These become infected and painful, and regional lymph nodes enlarge and may become tender. Systemic effects include fever, weight loss, and malaise.
Herpes simplex (genital).With herpes simplex, fluid-filled vesicles appear on the cervix, the vulva, labia, perianal skin, vagina, or mouth. The vesicles, which may initially be painless, may rupture and develop into extensive, shallow, painful ulcers, with redness, marked edema, and tender swollen inguinal lymph nodes. Other findings include fever, malaise, and dysuria. Secondary infections may also occur.
Lymphogranuloma venereum.Lymphogranuloma venereum is a bacterial infection commonly present with a single, painless papule or ulcer on the posterior vulva that heals in a few days. Painful, swollen lymph nodes, usually unilateral, develop 2 to 6 weeks later. Other findings include fever, chills, headache, anorexia, myalgias, arthralgias, weight loss, and perineal edema.
Squamous cell carcinoma.Invasive carcinoma occurs primarily in postmenopausal women and may produce vulvar pruritus, pain, and a vulvar lump. As the tumor enlarges, it may encroach on the vagina, anus, and urethra, causing bleeding, discharge, or dysuria. Carcinoma in situ is most common in premenopausal women, producing a vulvar lesion that may be white or red, raised, well defined, moist, crusted, and isolated.
Squamous cell hyperplasia.Formerly known as hyperplastic dystrophy, these vulvar lesions may be well delineated or poorly defined; localized or extensive; and red, brown, white, or both red and white. However, intense pruritus, possibly with vulvar pain, intense burning, and dyspareunia, is the cardinal symptom. With lichen sclerosis, a type of vulvar dystrophy, vulvar skin has a parchmentlike appearance. Fissures may develop between the clitoris and urethra or other vulvar areas.
Syphilis.Chancres, the primary vulvar lesions of syphilis, may appear on the vulva, vagina, or cervix 10 to 90 days after initial contact. Usually painless, they start as papules that then erode, with indurated, raised edges and clear bases. Condylomata lata, highly contagious secondary vulvar lesions, are raised, gray, flat topped, and commonly ulcerated. Other findings include a maculopapular, pustular, or nodular rash; headache; malaise; anorexia; weight loss; fever; nausea; vomiting; generalized lymphadenopathy; and a sore throat.
Viral disease (systemic).Varicella, measles, and other systemic viral diseases may produce vulvar lesions.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Vaginal bleeding, postmenopausal:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Atrophic vaginitis.When bloody staining occurs with atrophic vaginitis, it usually follows coitus or douching. Characteristic white, watery vaginal discharge may be accompanied by pruritus, dyspareunia, and a burning sensation in the vagina and labia. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Cervical cancer.Early invasive cervical cancer causes vaginal spotting or heavier bleeding, usually after coitus or douching but occasionally spontaneously. Related findings include persistent, pink-tinged, and foul-smelling vaginal discharge and postcoital pain. As the cancer spreads, back and sciatic pain, leg swelling, anorexia, weight loss, hematuria, dysuria, rectal bleeding, and weakness may occur and the drainage may become dark and malodorous.
Cervical or endometrial polyps.Cervical or endometrial polyps are small, pedunculated growths that may cause spotting (possibly as a mucopurulent, pink discharge) after coitus, douching, or straining to defecate. Many endometrial polyps produce no symptoms.
Endometrial hyperplasia or cancer.Bleeding occurs early with endometrial hyperplasia or cancer; it can be brownish and scant or bright red and profuse, and usually follows coitus or douching. Bleeding later becomes heavier and more frequent, leading to clotting and anemia. Bleeding may be accompanied by pelvic, rectal, lower back, and leg pain. The uterus may be enlarged.
Ovarian tumors (feminizing).Ovarian tumors producing estrogen can stimulate endometrial shedding and cause heavy bleeding unassociated with coitus or douching. A palpable pelvic mass, increased cervical mucus, breast enlargement, and spider angiomas may be present.
Vaginal cancer.Characteristic spotting or bleeding with vaginal cancer may be preceded by a thin, watery vaginal discharge. Bleeding may be spontaneous but usually follows coitus or douching. A firm, ulcerated vaginal lesion may be present; dyspareunia, urinary frequency, bladder and pelvic pain, rectal bleeding, and vulvar lesions may develop later.
Other causes
Drugs.Unopposed estrogen replacement therapy is a common cause of abnormal vaginal bleeding. This can usually be reduced by adding progesterone (in women who haven't had a hysterectomy) and by adjusting the patient's estrogen dosage.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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