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 fit the patient's initial 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 associated with menstrual bleeding.
- Do Not Miss Diagnoses
- Ectopic Pregnancy: Although the patient is on the Depo injection, which is highly effective, no contraceptive method is 100% effective. The patient's recent unprotected sex and current menstrual bleeding do not rule out an ectopic pregnancy, which is a medical emergency.
- 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 essential to consider this diagnosis, 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 bleeding or the passage of unusual material.
- Foreign Body: The patient might have inadvertently inserted a foreign body into her vagina, which could cause irritation and the passage of unusual material.
- Endometriosis: Although less likely, endometriosis could cause abnormal bleeding, including the passage of tissue-like material, especially if it involves the vagina or cervix.