Differential Diagnosis for White Vaginal Discharge with Slight Odor, Painful Intercourse, and Abdominal Swelling

• Single Most Likely Diagnosis
  • Bacterial Vaginosis (BV): This condition is characterized by an imbalance in the vaginal microbiome, leading to symptoms such as white or gray vaginal discharge with a fishy odor, although the odor can sometimes be slight. Painful intercourse (dyspareunia) and abdominal swelling can also occur, especially if the infection spreads or if there are complications. BV is a common condition and matches the described symptoms closely.
• Other Likely Diagnoses
  • Yeast Infection (Candidiasis): Typically presents with a thick, white, cottage cheese-like vaginal discharge and can cause itching, burning, and painful intercourse. While the discharge description might not perfectly match, the presence of painful intercourse and potential abdominal discomfort due to intense itching or secondary infection makes it a consideration.
  • Trichomoniasis: A sexually transmitted infection that can cause a frothy, greenish-yellow or grayish discharge with a strong odor, but in some cases, the discharge might appear white. It can also lead to painful intercourse and abdominal swelling due to pelvic inflammatory disease (PID) as a complication.
  • Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause abdominal pain, painful intercourse, and abnormal vaginal discharge. While PID itself might not directly cause a white discharge, the underlying infections leading to PID (like gonorrhea or chlamydia) can present with various types of discharge.
• Do Not Miss Diagnoses
  • Ovarian Cancer: Although rare and less likely to present with vaginal discharge as a primary symptom, ovarian cancer can cause abdominal swelling and painful intercourse due to the tumor's size and potential spread. It's crucial to consider in the differential due to its severity and the importance of early detection.
  • Ectopic Pregnancy: Can cause abdominal pain and swelling, and while not typically associated with vaginal discharge, any pregnancy-related condition needs to be ruled out due to the potential for severe complications.
  • Appendicitis: Although primarily causing abdominal pain, appendicitis can sometimes present with vague symptoms that might include painful intercourse if the appendix is located near the reproductive organs. It's less likely related to vaginal discharge but is a critical condition to diagnose promptly.
• Rare Diagnoses
  • Lymphogranuloma Venereum (LGV): A sexually transmitted infection that can cause abdominal swelling, painful intercourse, and potentially abnormal discharge, though it's more commonly associated with lymphadenopathy.
  • Genital Tuberculosis: A rare condition in many parts of the world but can cause a variety of symptoms including abnormal vaginal discharge, abdominal pain, and infertility. It's more likely to be considered in endemic areas or in individuals with risk factors for tuberculosis.