is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME. Obstetrics and Gynecology – Vaginal Discharge / Vulvar Pruritus Whiteboard Animation Transcript with Kate Pulman, MD Vulvar pruritus and vaginal discharge are two common gynecologic symptoms that may present simultaneously or independently. Most etiologies will fall into the following 3 categories: 1. Infectious: such as bacterial vaginosis, trichomoniasis, and candidiasis. 2. Neoplastic diseases: such as vulvar cancer, and it’s precursor vulvar dysplasia. 3. Dermatologic conditions: such as lichen sclerosus, contact dermatitis, or eczema. After completing a thorough history, the following steps of your physical exam will help lead you to your diagnosis: Step 1: Visual inspection of the vulva Look for single or multifocal lesions that may be raised or discolored. These may represent VIN, or a vulvar carcinoma, that you would not want to miss. Diffuse erythema may lead you to diagnose vulvar candidiasis or contact dermatitis. Diffuse symmetric whitening of the vulva is associated with lichen sclerosus. In this condition, you may see a loss of vulvar architecture, narrowing of the introitus, and fissuring may occur. You must biopsy any suspicious lesion for diagnosis. Step 2: Speculum examination of the vagina and cervix Evaluate the discharge for colour, odor, and consistency. Copious thin grayish discharge suggests bacterial vaginosis. Frothy yellow-green discharge or a “strawberry” cervix suggests trichomoniasis. Chunky white discharge suggests candidiasis. Step 3: Bimanual pelvic examination Cervical motion tenderness, uterine, or adnexal tenderness in association with vaginal discharge may be a sign of pelvic inflammatory disease. Step 4: Special tests Vaginal and cervical swabs can be done for culture. Wet mount microscopy may allow you to detect hyphae to indicate candidiasis, trichomonads, or clue cells in bacterial vaginosis. The KOH whiff test: bacterial vaginosis can be diagnosed by a “fishy” odor.