A 23 year old woman presents with vulvular itching and vaginal discharge. She in not currently sexually active, and does not use contraceptives. She works in an office, drinks 3 alcoholic beverages a week and recently took up long-distance running. Physical examination reveals reddened vulva without surface ulcerations, the absence of lice or nits, normal appearing vaginal secretions and an unremarkable vaginal cavity. There is no adnexal tenderness. Which important item is missing from this patient’s history?A. Age of menarcheB. Family history of endometrial cancerC. Prior deliveriesD. Use of local irritants
D.
D. Use of local irritants.
The patient’s symptoms of vulvular itching and vaginal discharge can be indicative of various conditions, including a vaginal infection or allergic reaction to local irritants. However, the absence of surface ulcerations, lice or nits, adnexal tenderness, and normal appearing vaginal secretions, makes it difficult to determine the specific etiology of the patient’s symptoms. Therefore, it is important to consider potential local irritants, including products such as soaps, lotions, and detergents, that the patient may have recently started using or come into contact with. Obtaining a thorough history that includes any change in routine or use of new products will be helpful in establishing a diagnosis and developing an appropriate treatment plan for the patient.