Vaginal discharge
O&G
Introduction
Author: Idayat Olawale
Taking a patient history for vaginal discharge requires a sensitive, respectful, and nonjudgmental approach. Begin by creating a comfortable environment, ensuring privacy and explaining the purpose of your questions. Start with open-ended questions about the discharge, such as its duration, color, consistency, odor, and whether it is associated with itching, pain, or bleeding. Ask about sexual history, including recent partners, contraceptive use, and any history of sexually transmitted infections. It is also important to explore menstrual history, recent antibiotic use, and any new hygiene products that might be relevant. Always use inclusive language and be attentive to the patient’s comfort throughout the conversation.
WIPER
Wash hands:
Introduction: Introduce yourself by your full name and your role
Patient details: Gather the patient’s full name and DOB
Explain/Establish: Explain what you are going to do and Establish consent
ExPose: Expose & Position the patient if necessary.
Presenting Complaint
Main Symptom: Vaginal discharge
History of presenting complaint:
Onset - when did it first start?
Colour - smell, consistency, colour, blood?
Amount - how much discharge? Does this vary?
Associated features - pain, fever, itchiness, foul odour, dysuria, abdominal pain, dyspareunia?
Menstrual History
Regularity
Clots? How often is the patient changing pads
Contraceptive use? Condoms, pills or none
Sexual History
Last sexual contact
age of sexual partner
regular/irregular sexual partner
Mode of sexual intercourse (vaginal/oral-genital/anal)
Male or female sexual partner
Do they have any symptoms?
Systems review:
Sexual activity, STI screening, gravida and parity
Any chance of pregnancy?
Last cervical smear
Past Medical History
Wash hands:
Introduction: Introduce yourself by your full name and your role
Patient details: Gather the patient’s full name and DOB
Explain/Establish: Explain what you are going to do and Establish consent
ExPose: Expose & Position the patient if necessary.
Medications
OTC, herbal or prescribed medications, specify recent use of abx
Ask about allergies
Family History
Any conditions that run in the family?
Social History
Smoke, alcohol, drink, occupation, hobbies
Differential Diagnosis
Separate differentials into most likely, less likely and can’t miss. Each section will differ based on results from the history and examination
Differentials include: STI, spotting, normal vaginal discharge
Management
Remember: Bedside --> Laboratory --> Imaging
Bedside examination includes:
Bimanual +/- speculum examination
Laboratory investigations include bloods such as:
STI screen - high vaginal swab for bacterial vaginosis, candida, trichomonas and gonorrhoea (culture).
Use the opportunity to encourage compliance with smear testing.
Management plan
Tailor the management based on diagnoses
Can treat empirically if severe symptoms
Discuss with all relevant persons ie: the patient and colleagues