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 may contribute to an increased risk of yeast infections due to hormonal changes.
- Other Likely Diagnoses
- Bacterial Vaginosis (BV): BV is a common cause of vaginal discharge and irritation, which could align with the patient's initial symptoms.
- Trichomoniasis: This sexually transmitted infection (STI) can cause vaginal itching, irritation, and abnormal discharge, making it a possible diagnosis given the patient's history of unprotected sex.
- Cervical Polyp or Lesion: The patient's report of passing a chunk of skin-like material could be indicative of a cervical polyp or lesion, which may cause irregular menstrual bleeding or spotting.
- Do Not Miss Diagnoses
- Cervical Cancer: Although less likely, cervical cancer must be considered, especially given the patient's report of passing abnormal tissue. It is crucial to rule out this potentially life-threatening condition.
- Ectopic Pregnancy: Despite the patient being on the Depo injection, pregnancy should not be entirely ruled out, and an ectopic pregnancy could present with abnormal vaginal bleeding or tissue passage.
- Pelvic Inflammatory Disease (PID): PID is a serious condition that can result from untreated STIs, and its symptoms can include pelvic pain, abnormal vaginal discharge, and irregular menstrual bleeding.
- Rare Diagnoses
- Vaginal Tumor or Cancer: Although rare, vaginal tumors or cancer could cause abnormal vaginal bleeding, discharge, or tissue passage.
- Foreign Body or Retained Tampon: The patient's report of passing a chunk of skin-like material could, in rare cases, be indicative of a foreign body or retained tampon, which would require immediate medical attention.