Differential Diagnosis for Vaginal Itching and Irritation
The patient presents with a history of vaginal itching, irritation, and a recent episode of passing a chunk of skin-like material, which warrants a thorough differential diagnosis. The following categories outline potential causes:
- Single Most Likely Diagnosis
- Yeast Infection (Candidiasis): Given the patient's symptoms of vaginal itching and irritation, which have since resolved, a yeast infection is a plausible explanation. The use of the Depo injection for contraception can alter the vaginal flora, increasing the risk of yeast infections.
- Other Likely Diagnoses
- Bacterial Vaginosis (BV): BV is a common cause of vaginal discharge and irritation, which could be related to the patient's symptoms. However, the resolution of symptoms and the passage of a skin-like material make it less likely.
- Trichomoniasis: This sexually transmitted infection (STI) can cause vaginal itching, irritation, and abnormal discharge. The patient's history of unprotected sex increases the risk of STIs.
- Cervical Polyp or Fibroid: The passage of a chunk of skin-like material could be related to a cervical polyp or fibroid, especially if it was accompanied by menstrual bleeding.
- Do Not Miss Diagnoses
- Ectopic Pregnancy: Although the patient is on the Depo injection, which is an effective form of contraception, it is essential to rule out ectopic pregnancy, especially given the patient's history of unprotected sex and current menstrual bleeding.
- Cervical Cancer: Abnormal vaginal bleeding or the passage of unusual material can be a symptom of cervical cancer. While rare in young women, it is crucial to consider this possibility, especially if the patient has a history of unprotected sex or is not up-to-date on cervical cancer screening.
- Rare Diagnoses
- Vaginal Tumor: A rare possibility is a vaginal tumor, which could cause abnormal vaginal bleeding or the passage of unusual material.
- Foreign Body: The patient may have inadvertently inserted a foreign body into the vagina, which could cause irritation and the passage of unusual material.
- Endometriosis: Although less likely, endometriosis could cause abnormal vaginal bleeding, especially if the patient has a history of pelvic pain or heavy menstrual bleeding.