Differential Diagnosis
The patient presents with vaginal swelling, pain, itchiness, and a history of passing tissue that resembles "meat." These symptoms, combined with pain during sexual intercourse and mild cramping, suggest several possible diagnoses. The differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Necrotic Retained Products of Conception (RPOC): Given the patient's recent menstrual period (LMP 05/08/2025) and last sexual encounter (05/16/2025), along with symptoms of vaginal swelling, pain, and passing tissue, a likely diagnosis could be necrotic RPOC, especially if the patient was pregnant and had a spontaneous abortion or a miscarriage. The passage of tissue could be indicative of the body expelling the products of conception.
Other Likely Diagnoses
- Vaginal Yeast Infection: The symptoms of itchiness and pain could suggest a vaginal yeast infection, which is common and can cause significant discomfort.
- Bacterial Vaginosis (BV): BV can cause vaginal discharge, odor, and sometimes pain, which might align with some of the patient's symptoms.
- Trichomoniasis: This sexually transmitted infection can cause vaginal itching, burning, redness, and swelling, as well as pain during intercourse.
- Endometriosis: Although less likely given the acute onset, endometriosis can cause pelvic pain, cramping, and pain during intercourse, especially if there are endometrial implants on the vagina or vulva.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although the patient reports a recent menstrual period, an ectopic pregnancy must be considered, especially if the patient is of childbearing age and has had sexual intercourse without contraception. Ectopic pregnancy can present with abdominal pain, vaginal bleeding, and can be life-threatening if not promptly diagnosed and treated.
- Ovarian Torsion: This is a surgical emergency that can cause severe pelvic pain and might be associated with vaginal symptoms if there is an ovarian cyst involved. It's less likely but critical not to miss.
- Cervical Cancer: While less common and typically presenting with abnormal vaginal bleeding, advanced cervical cancer could cause a range of symptoms including pain and abnormal vaginal discharge.
Rare Diagnoses
- Vaginal Cancer: This is a rare type of cancer that could present with vaginal bleeding, pain, and abnormal discharge.
- Sarcoma (e.g., Leiomyosarcoma): Extremely rare tumors that could cause a range of symptoms depending on their location and size, including pain and abnormal bleeding.
- Gestational Trophoblastic Disease (GTD): A rare condition that can occur during pregnancy, characterized by abnormal growth of cells inside the uterus, which could potentially cause symptoms similar to those described if there was a molar pregnancy that was miscarried.