Differential diagnosis by dominant vulvovaginal symptom

Dominant symptom	Potential etiologies
Inflammation or irritation	Vulvar dermatitis Desquamative inflammatory vaginitis
Pruritis (itching)	Infectious Candidiasis Trichomoniasis Bacterial vaginosis Non-infectious Vulvar dermatitis Vulvar dermatoses (eg, lichen sclerosus) Cytolytic vaginitis Malignancy
Pain	Acute onset of discharge and pain Pelvic inflammatory disease Group A Streptococcus Candidiasis Serosanguinous discharge and pain Fallopian tube carcinoma Chronic vaginal pain Vulvar pain of unknown etiology (vulvovdynia) Vaginismus Myofascial pelvic pain
Vulvar lesions	Red lesions (eg, atopic dermatitis, lichen simplex chronicus, psoriasis) White lesions (eg, lichen sclerosus, squamous intraepithelial lesions) Black, brown, and/or blue lesions (eg, hyperpigmentation, nevi) Yellow, skin-colored, and/or edamatous lesions (eg, folliculitis, furunculosis) Vesicles, bullae, erosions, and ulcers (eg, HSV, herpes zoster, impetigo)
Persistent genital malodor	Neglected foreign body (eg, retained tampon or condom) Infectious Bacterial vaginosis Trichomoniasis Infectious ulcer Pelvic inflammatory disease Hydradenitis suppurativa Chronic constipation Urinary incontinence Fecal incontinence (accidental bowel leakage) Poor hygiene Malignant ulcer Excessive genital perspiration and local bacterial colonization

Courtesy of Dr. Jack Sobel.

Graphic 141751 Version 2.0