Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Vaginal discharge, chronic, treatment-resistant, vulvovaginitis, investigations, treatment

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, manaeament and treatment options

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Pregnancy, sexually transmitted infections, infection, effects, newborn, mother

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Aetiology, pathogenesis, clinical presentations, diagnosis, differential diagnosis, management and treatment options

Non-infectious benign vaginal conditions are a small fraction of genital conditions causing pruritus, irritation, dyspareunia, vaginal discharge, malodour and burning. In an attempt to differentiate between the various aetiologies – infectious (Candidiasis, Trichomonas, group A Streptococcus, bacterial vaginosis), hormone-related (vaginal atrophy), immune mediated (desquamative inflammatory vaginitis, erosive lichen planus), miscellaneous (contact dermatitis, trauma) – one needs to understand the delicate equilibrium between vaginal epithelium, microbiota and reproductive hormones, and learn to use the wet mount (microscopy) and pH as basic tools for conducting a thorough evaluation of vaginal secretions. Differentiating between a normal to an abnormal discharge is crucial and is a basic clinical skill needed in primary gynaecological clinics. A flow chart combining pH and wet mount will be presented in order to diagnose causation of vaginal discomfort. Two non-infectious benign vaginal conditions will be presented in detail; vaginal atrophy (genitourinary syndrome of the menopause) and desquamative inflammatory vaginitis.

Children and adolescents presenting with common and rare gynaecological conditions are described in this chapter. Communication needs to be sensitive and appropriate for age and development to retrieve as much information as possible.

Puberty heralds the development of secondary sexual characteristics, gonadal maturation, and start of reproductive capacity. Pubertal disorders can be divided into precocious and delayed puberty. Menarche is an important marker of puberty and menstruation should be seen as a vital sign. Oligomenorrhoea is pathological over time and most girls with oligomenorrhoea develop polycystic ovary syndrome (PCOS).

Sex development in the human is the result of a complex interaction involving production and response to sex hormones which is regulated by genetic and environmental factors. Disorders of sex development occur when an individual’s sex development takes a different path.