Full Answer Section

• • Exposure to potential irritants (soaps, bubble baths).
  • Any possibility of sexual abuse.
  • Recent illnesses, or antibiotic use.
• Key Points in Physical Examination:
  • General appearance and signs of systemic illness.
  • Careful external genital examination:
    • Visual inspection of the vulva, perineum, and perianal area for erythema, edema, excoriation, or lesions.
    • Assessment of the hymen for integrity.
    • Note the location and characteristics of the discharge.
  • Abdominal examination.
  • Perianal examination (to rule out pinworms or fecal contamination).
  • If there is a high suspicion of a foreign body, or sexual abuse, a more in depth exam may be needed.

16-Year-Old with Yellow Vaginal Discharge:

• Approach Differences:
  • A 16-year-old is sexually active, so the differential diagnosis expands significantly. ¹  
    1. Sexual Function in 16- to 21-Year-Olds in Britain – PMC

    

    pmc.ncbi.nlm.nih.gov

  • The history must include a detailed sexual history:
    • Number of sexual partners.
    • Type of sexual activity (vaginal, oral, anal).
    • Use of condoms.
    • Menstrual history.
    • Any history of sexually transmitted infections (STIs).
  • A pelvic examination is essential:
    • Speculum examination to visualize the cervix and vaginal walls.
    • Collection of samples for STI testing (chlamydia, gonorrhea, trichomoniasis).
    • Bimanual examination to assess the uterus and ovaries.
  • The possibility of pregnancy must be considered.
  • Discussion of safe sex practices, and contraception.

Similarities and Differences:

• Similarities:
  • Both require a thorough history and physical examination.
  • Both require assessment of the character and location of the discharge.
  • Both require consideration of potential irritants and hygiene practices.
  • Both require that the medical professional maintains a sensitive and supportive approach.
• Differences:
  • The differential diagnosis is significantly different due to sexual activity in the 16-year-old.
  • The 16-year-old requires a pelvic examination and STI testing.
  • The 6-year-old requires a high index of suspicion for foreign body insertion or sexual abuse.
  • The 16 year old needs education about safe sexual practices.
  • The 6 year old needs to have the possibility of sexual abuse addressed, and reported as needed.
• Key Takeaway: The presence of sexual activity drastically changes the approach to vaginal discharge.