Diagnostic Tests for Vaginitis
Vaginitis: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Vaginitis
includes:
- Vaginal fluid tests
- Vaginal swab
Vaginitis Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Vaginitis:
- Home STD Testing
- Menopause: Related Home Testing:
- Vaginal Health: Home Testing:
- Sexuality & Libido: Home Testing:
- Liver Health & Hepatitis: Home Testing
- Breast Cancer: Related Home Tests:
Vaginitis Diagnosis: Book Excerpts
Tests and diagnosis discussion for Vaginitis:
The cause of vaginitis cannot be adequately determined solely on
the basis of symptoms or a physical examination. Laboratory tests allowing
microscopic evaluation of vaginal fluid are required for a correct
diagnosis. (Source: excerpt from Vaginal Infections & Vaginitis: NWHIC)
Diagnostic Tests for Vaginitis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Vaginitis.
METRORRHAGIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, sedimentation rate, urinalysis, pregnancy test, chemistry panel, ANA test, coagulation profile, thyroid profile, and flat plate of the abdomen. A Pap smear and vaginal smear and culture should also be done.
If these are negative, referral to a gynecologist should be made before undertaking expensive diagnostic tests such as ultrasound or CT scans of the abdomen and pelvis. Alternatively, a trial of cyclical estrogen and progesterone hormones may be done if dysfunctional bleeding is suspected before referral is made. A gynecologist may be able to resolve the diagnostic dilemma with a good pelvic examination or, if that is unsuccessful, may perform laparoscopy or culdocentesis. A dilation and curettage or office endometrial biopsy are among the additional procedures at the gynecologist's disposal. An endocrinologist may be of help in deciding whether pituitary or ovarian dysfunction is responsible. An FSH of greater than 40 ml suggests ovarian failure. The endocrinologist may note hirsutism and order a free testosterone and 17-hydroxy progesterone to rule out adrenal or ovarian neoplasm.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
PRURITUS, VULVAE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
If there is a discharge, microscopic examination of a potassium hydroxide preparation and saline preparation is necessary. A smear and culture of the discharge should be done for bacteria and fungi. Scrapings of the burrows for scabies may be useful. Skin biopsy may help diagnose the cause of a rash. Lesions should be biopsied also. If senile vaginitis is suspected, serum FSH and estradiol and a Pap smear may help determine if there is estrogen deficiency. A gynecologist should be consulted in all difficult diagnostic problems.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
VAGINAL DISCHARGE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The most important test is microscopic examination of a saline and potassium hydroxide preparation. This will diagnose most cases of trichomoniasis and candidiasis.
Gardnerella
vaginalis
can be diagnosed if clue cells are found, and the pH of the discharge will be greater than 4.7. If this is unrevealing, a Gram stain for gonorrhea and cultures for trichomoniasis, candidiasis, chlamydia,
Gardnerella vaginalis
, and gonorrhea may be done. A Pap smear should be done to rule out malignancy. Polyps or inflamed areas of the cervix should be biopsied. Colposcopy may help further differentiate a cervical lesion. A dilation and curettage may be necessary to diagnose endometrial carcinoma and hydatidiform mole. Occasionally, pelvic ultrasound and CT scans are necessary. However, before ordering these expensive diagnostic tests, a gynecologist should be consulted. Patients with documented evidence of gonorrhea should have a VDRL test and HIV testing.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
VULVAL OR VAGINAL MASS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Referral to a gynecologist or urologist can obviate an expensive diagnostic workup in most cases. The primary care physician may wish to treat acute bartholinitis or vulvitis, however. A culture and sensitivity is the only procedure required in those cases.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
VULVAL OR VAGINAL ULCERATIONS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The workup includes a CBC, sedimentation rate, urinalysis, and VDRL test. A smear and culture of material from the ulceration should be done. A dark field examination may also be necessary. The Frei test may diagnose lymphogranuloma venereum, but a serologic test for this disorder may also be ordered. Biopsy may be ultimately necessary. It is wise to enlist the help of a urologist or gynecologist in difficult cases.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Metrorrhagia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin your evaluation by obtaining a thorough menstrual history. Ask the patient when she began menstruating and about the duration of menstrual periods, the interval between them, and the average number of tampons or pads she uses. When does metrorrhagia usually occur in relation to her period? Does she experience other signs or symptoms? Find out the date of her last menses, and ask about other recent changes in her normal menstrual pattern. Get details of previous gynecologic problems. If applicable, obtain a contraceptive and obstetric history. Record the dates of her last Papanicolaou smear and pelvic examination. Ask the patient when she last had sex and whether or not it was protected. Next, ask about her general health and any recent changes. Is she under emotional stress? If possible, obtain a pregnancy history of the patient’s mother. Was the patient exposed in utero to diethylstilbestrol? (This drug has been linked to vaginal adenosis.)
Perform a pelvic examination if indicated, and obtain blood and urine samples for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Vaginal discharge:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Also, ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Next, ask if she has had vaginal discharge before or has ever been treated for a vaginal infection. What treatment did she receive? Did she complete the course of medication? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Vulvar lesions:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient when she first noticed a vulvar lesion, and find out about associated features, such as swelling, pain, tenderness, itching, or discharge. Does she have lesions elsewhere on her body? Ask about signs and symptoms of systemic illness, such as malaise, fever, or rash on other body areas. Is the patient sexually active? Could she have been exposed to sexually transmitted disease?
Also, examine the lesion, do a pelvic examination, and obtain cultures. (See Recognizing common vulvar lesions.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Vaginal bleeding, postmenopausal:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Determine the patient’s age and her age at menopause. Ask when she first noticed the abnormal bleeding. Then obtain a thorough obstetric and gynecologic history. When did she begin menstruating? Were her periods regular? If not, ask her to describe any menstrual irregularities. How old was she when she first had intercourse? How many sexual partners has she had? Has she had any children? Has she had fertility problems? If possible, obtain an obstetric and gynecologic history of the patient’s mother, and ask about a family history of gynecologic cancer. Determine if the patient has any associated symptoms and if she’s taking estrogen.
Observe the external genitalia, noting the character of any vaginal discharge and the appearance of the labia, vaginal rugae, and clitoris. Carefully palpate the patient’s breasts and lymph nodes for nodules or enlargement. The patient will require pelvic and rectal examinations.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Metrorrhagia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin your evaluation by obtaining a thorough menstrual history. Ask the patient when she began menstruating and about the duration of menstrual periods, the interval between them, and the average number of tampons or pads she uses. When does metrorrhagia usually occur in relation to her period? Does she experience other signs or symptoms? Find out the date of her last menses, and ask about any other recent changes in her normal menstrual pattern. Get details of any previous gynecologic problems. If applicable, obtain a contraceptive and obstetric history. Record the dates of her last Papanicolaou smear and pelvic examination. Ask the patient when she last had sex and whether or not it was protected. Next, ask about her general health and any recent changes. Is she under emotional stress? If possible, obtain a pregnancy history of the patient’s mother. Was the patient exposed in utero to diethylstilbestrol? (This drug has been linked to vaginal adenosis.)
Perform a pelvic examination if indicated, and obtain blood and urine samples for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal discharge:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Also, ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Next, ask if she has had a vaginal discharge before or has ever been treated for a vaginal infection. What treatment did she receive? Did she complete the course of medication? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge, page 792.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vulvar lesions:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when she first noticed a vulvar lesion, and find out about associated features, such as swelling, pain, tenderness, itching, or discharge. Does she have lesions elsewhere on her body? Ask about signs and symptoms of systemic illness, such as malaise, fever, or a rash on other body areas. Is the patient sexually active? Could she have been exposed to a sexually transmitted disease?
Also, examine the lesion, do a pelvic examination, and obtain cultures. (See Recognizing common vulvar lesions, page 814.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal bleeding, postmenopausal:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Determine the patient’s age and her age at menopause. Ask when she first noticed the abnormal bleeding. Then obtain a thorough obstetric and gynecologic history. When did she begin menstruating? Were her periods regular? If not, ask her to describe any menstrual irregularities. How old was she when she first had intercourse? How many sexual partners has she had? Has she had any children? Has she had fertility problems? If possible, obtain an obstetric and gynecologic history of the patient’s mother, and ask about a family history of gynecologic cancer. Determine if the patient has any associated symptoms and if she’s taking estrogen.
Observe the external genitalia, noting the character of any vaginal discharge and the appearance of the labia, vaginal rugae, and clitoris. Carefully palpate the patient’s breasts and lymph nodes for nodules or enlargement. The patient will require pelvic and rectal examinations.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal Discharge:
Physical examination (4)
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A general physical examination should be performed if systemic illness is suspected. Record vital signs, including temperature, blood pressure, and pulse.
In most cases, a genital examination with the patient in the lithotomy position is adequate.
The external genitalia is carefully inspected for evidence of trauma, blisters, lymph nodes excoriations, swelling, erythema, ulcerations, tenderness or pain.
The amount, color, texture, odor, and location of the discharge should be noted. A complete pelvic examination should be performed with particular attention given to the cervix for evidence of friability or inflammation and a cervical motion test which may indicate pelvic inflammatory disease.
Testing (5)
A. Vaginal fluid pH. Immersing pH paper in the vaginal discharge or the lateral wall of the vagina will give the vaginal pH.
A pH greater than 4.5 indicates BV or T. vaginalis.
B. Saline wet mount. Obtain a drop of vaginal discharge from the posterior fornix; place it on a slide with a drop of saline and apply a cover slip.
1. Clue cells, which are bacteria-coated, stippled epithelial cells, are characteristic of BV.
2. Trichomonads, which are mobile, oval flagellated parasites, confirm the presence of trichomoniasis.
C. Potassium hydroxide (KOH) preparation. Place a second drop of vaginal secretions on a slide containing a drop of KOH; “a positive whiff test” indicates the presence of BV. Threadlike hyphae and budding yeast observed microscopically are characteristic of a candidal infection.
D. Cultures for gonorrhea and chlamydia are not routinely indicated, but should be taken with a history of a new sexual partner, prurulent cervical discharge, or cervical motion tenderness.
Diagnostic assessment
BV causes 40% to 50% of vaginitis, followed by candidiasis (20% to 25%) and trichomoniasis (15% to 20%). Together, these infections account for more than 90% of vaginitis diagnoses.
When evaluating a woman with a vaginal complaint, be sure to hear her true concern. Evaluate and treat appropriately those with acute symptoms (e.g., pain or swelling) and be careful to understand the effect of pretreatment with OTC preparations in the presumptive diagnosis. It is wise to be mindful of the possibility of sexually transmitted diseases with any vaginal complaint and to test appropriately for these diseases. If a vaginitis, presumably infectious, does not respond to initial therapy, consider other causes including trauma, herpes, menopause, contact dermatitis, toxic shock syndrome, steroid-responsive inflammatory vaginitis, and collagen-vascular or other systemic disease.
References
1. Lash DJ, Garcia TA. Diagnosis and treatment of vaginitis. The Female Patient 1998;23:25–41.
2. Carr PL, Majeroni BA, Robinson JC, Talarico LD. Vaginitis: solid diagnosis means effective treatment. Patient Care 1999;33(2):86–106.
3. Miller KE. Sexually transmitted diseases. Prim Care 1997;24(1):179–193.
4. Chan PD, Winkle CR, eds. Gynecology and obstetrics’ 1999–2000 edition. Laguna Hills, CA: Current Clinical Strategies Publishers, 1999:73–79.
5. Sabel JD. Vaginitis. N Engl J Med 1997;337:1896–1903.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Vaginal Discharge:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Symptoms of vaginitis include vaginal discharge, pruritis, irritation, soreness, odor, and less commonly bleeding, dysuria, or pain with intercourse. It is important to distinguish burning on urination due to cystitis, which is internal and accompanied by irritative signs (urinary frequency), from dysuria due to vaginitis, which feels external as the urine passes over an inflamed vulva. Similarly, it is important to distinguish vaginitis, characterized by discharge and pruritus, from cervicitis, with discharge and pelvic pain.
On examination, the vulva appears normal in bacterial vaginosis, while erythema, edema or fissures suggest candidiasis, trichomonas or dermatitis. An erythematous, friable cervix with a mucopurulent discharge is consistent with cervicitis rather than vaginitis. This must be distinguished from ectropion (normal endocervical glandular tissue visible on the exocervix), which is not friable.
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Source: Field Guide to Bedside Diagnosis, 2007
Vaginal Bleeding:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Passage of clots or inability to control bleeding with tampons is consistent with heavy flow (menorrhagia). Bleeding between normal cyclic menses is metrorrhagia. Remember to establish that bleeding is uterine and not from the rectum or urethra.
In adolescents, anovulation is the cause in 90% of cases of metrorrhagia, although pregnancy should be considered. An underlying bleeding diathesis is found in about 20% of adolescents with menorrhagia. In adult premenopausal women, pregnancy and malignancy are the most important considerations, although leiomyomas (fibroids) are the most common. In perimenopausal women, anovulatory cycles and progesterone deficiency with long periods of unopposed estrogen lead to endometrial hyperplasia and polyps. Bleeding in postmenopausal women should be thoroughly evaluated for endometrial cancer, which will be found in 10% of cases.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Vaginal discharge:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge, page 680.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement. Palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vulvar lesions:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Examine the lesion, perform a pelvic examination, and obtain cultures. (See Recognizing common vulvar lesions.) Examine the rest of the skin for rashes and lesions.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal bleeding, postmenopausal:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Observe the external genitalia, noting the character of any vaginal discharge and the appearance of the labia, vaginal rugae, and clitoris. Carefully palpate the patient’s breasts and lymph nodes for nodules or enlargement. The patient will require pelvic and rectal examinations.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal Discharge:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Nonspecificvulvovaginitis is most common cause of vaginal discharge in prepubertal girls.If discharge fails to improve with good perineal hygiene or if itis purulent, specific bacterial infection, sexually transmittedinfection, or foreign body should be suspected. Wet mounts (salineand KOH), Gram stain, and vaginal cultures should be performed.Exam under anesthesia may be necessary for suspected foreign body.In pubertal girls who are not sexuallyactive, most common causes of vaginal discharge are physiologicleukorrhea, bacterial vaginosis, and C. albicans. Wet preparations(saline and KOH) and Gram stain should be performed. Bacterial andfungal cultures also should be considered.In girls who are sexually active, thesame diagnoses described for pubertal nonsexually active femalesare possible, but sexually transmitted infections also are likely.In addition to wet preparations and Gram stain, cultures for C.trachomatis, N. gonorrhoeae, and other aerobic and anaerobic bacteria shouldbe performed. In some centers nucleic acid amplification technologyis available for detection of C. trachomatis and N. gonorrhoeaefrom endocervical and urine specimens. Laparoscopy may provide definitivediagnosis in suspected pelvic inflammatory disease with negativecervical cultures.If sexual abuse is suspected at anyage, vaginal, rectal, and throat cultures for N. gonorrhoeae andvaginal and rectal cultures for C. trachomatis should be performed,even in an asymptomatic child. HIV testing should be considered.So should pregnancy prophylaxis, which depends on whether menarche hasbeen reached and on nature of abuse.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Vaginal Bleeding:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Before Menarche
Trauma,vulvovaginitis, and foreign body are most common causes of abnormalvaginal bleeding before menarche.Complete history and physical examshould be performed, including exam of external genitalia and vaginalintroitus. Exam under anesthesia is necessary with significant trauma,foreign body that cannot be removed, or suspected genital tumor.Approach to precocious puberty andvulvovaginitis is described in Chap.48, Precocious Puberty, and Chap. 71,Vaginal Discharge,respectively. After Menarche
Girls withabnormal vaginal bleeding should have complete history and physicalexam, which includes speculum exam of vagina and cervix and bimanualvaginal exam. Source of bleeding must be determined, whether vulvar,vaginal, cervical, or uterine. If significant vaginal trauma hasoccurred from injury, exam of vagina and cervix may have to be performedunder anesthesia.Diagnostic approach to vulvovaginitisin this age group is discussed in Chap.71, Vaginal Discharge. If uncertainty about pregnancyexists, urine pregnancy test should be performed.If bleeding is from normal-sized uterus,most common cause is from anovulatory cycle, but this is diagnosisof exclusion. Other common causes include ovulation and oral contraceptiveuse. Abnormal vaginal discharge and abdominal pain suggest pelvicinflammatory disease. Heavy cyclic bleeding suggests coagulationdisorder, and certain tests should be performed: CBC with differential,analysis of blood smear, platelet count, prothrombin time, activatedpartial thromboplastin time, and bleeding time. Uterine tumors arerare in adolescent age group.If bleeding is from enlarged uterus,it is likely that there is complication of pregnancy (e.g., spontaneousabortion, ectopic pregnancy, placenta previa, or abruptio placenta).If individual is <20 wks pregnant and has normal BP, eitherectopic pregnancy or spontaneous abortion is likely. In either case, pregnancytest should be performed unless it is a known pregnancy, and obstetricconsultation should be obtained.In girl who is <20 wks pregnantand hypotensive with severe bleeding, ectopic pregnancy is mostlikely cause. If uterine bleeding occurs during third trimesterof pregnancy, placenta previa or abruptio placenta is likely. Externalgenitalia should be inspected and obstetric consultation shouldbe requested. An intravenous line should be placed, CBC drawn, andblood sent for type and cross-match. If patient is hypotensive,fluid resuscitation should be started immediately. >>
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Metrorrhagia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation by obtaining a thorough menstrual history. Ask the patient when she began menstruating, the duration of menses, the interval between them, and the average number of tampons or pads she uses each month. Establish when metrorrhagia occurs in relation to her menses. Does she experience other signs or symptoms? Find out the date of her last menses, and ask about other changes in her normal menstrual pattern. Ask for details of previous gynecologic problems. If applicable, obtain a contraceptive and obstetric history. Record the dates of her last Papanicolaou (Pap) smear and pelvic examination. Ask the patient if she is sexually active. Next, ask about her general health and any recent changes. Is she under emotional stress? If possible, obtain a pregnancy history of the patient's mother. Was the patient exposed in utero to diethylstilbestrol? (This drug has been linked to vaginal adenosis.)
Prepare the patient for a pelvic examination if indicated, and obtain blood samples and a urine specimen for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Vaginal discharge:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Ask if she has had vaginal discharge before or has ever been treated for a vaginal infection or sexually transmitted disease. What treatment did she receive? Did she complete the course of medication and were all sexual contacts treated? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Vulvar lesions:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient when she first noticed a vulvar lesion and find out about associated features, such as swelling, pain, tenderness, itching, or discharge. Does she have lesions elsewhere on her body? Ask about signs and symptoms of systemic illness, such as malaise, fever, or rash on other body areas. Is the patient sexually active? Ask whether she could have been exposed to sexually transmitted disease.
Examine the lesion, do a pelvic examination, and obtain cultures. (See Recognizing common vulvar lesions, page 640.)
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Vaginal bleeding, postmenopausal:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Determine the patient's age and her age at menopause. Ask when she first noticed the abnormal bleeding then obtain a thorough obstetric and gynecologic history. When did she begin menstruating? Were her menses regular? If not, ask her to describe menstrual irregularities. How old was she when she first had intercourse? How many sexual partners has she had? Has she had children? Has she had fertility problems? If possible, obtain an obstetric and gynecologic history of the patient's mother and ask about a family history of gynecologic cancer. Determine whether the patient has associated symptoms and if she's taking estrogen.
Observe the external genitalia, noting the character of vaginal discharge and the appearance of the labia, vaginal rugae, and clitoris. Carefully palpate the patient's breasts and lymph nodes for nodules or enlargement. The patient will require pelvic and rectal examinations.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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