Differential Diagnosis
- Single most likely diagnosis
- Vaginal Yeast Infection (Candidiasis): The patient's symptoms of pain, dryness, and burning during vaginal and oral sex, followed by burning while urinating, are consistent with a vaginal yeast infection. The fact that she hasn't had intercourse in 4 months and then experienced symptoms after resuming sexual activity suggests a possible disruption of the vaginal flora, leading to an overgrowth of Candida.
- Other Likely diagnoses
- Bacterial Vaginosis (BV): BV can cause similar symptoms, including burning during urination and discomfort during sex. However, BV is often associated with a fishy odor, which is not mentioned in the scenario.
- Vaginal Atrophy: Although less likely in a 27-year-old, vaginal atrophy can cause dryness, pain, and burning during sex. However, this condition is more common in postmenopausal women.
- Urinary Tract Infection (UTI): The patient's symptom of burning while urinating could suggest a UTI. However, UTIs are often accompanied by other symptoms such as frequent urination, urgency, and abdominal pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sexually Transmitted Infections (STIs): Although the patient hasn't had intercourse in 4 months, it's essential to consider STIs, such as gonorrhea, chlamydia, or herpes, which can cause similar symptoms. Missing an STI diagnosis can have severe consequences, including infertility and long-term health problems.
- Pelvic Inflammatory Disease (PID): PID is a serious condition that can cause pelvic pain, burning during urination, and discomfort during sex. Although less likely in this scenario, PID can have severe consequences if left untreated, including infertility and chronic pelvic pain.
- Rare diagnoses
- Lichen Sclerosus: A rare condition that can cause vaginal dryness, pain, and burning. However, it's often associated with other symptoms such as white patches on the skin and is less likely in this scenario.
- Vulvar Vestibulitis: A rare condition that can cause burning pain in the vulvar area, especially during sex. However, it's often associated with other symptoms such as redness and swelling, which are not mentioned in the scenario.