Differential Diagnosis for Sudden Onset of Vaginal Burning and Pain in a 76-Year-Old

Single Most Likely Diagnosis

• Vaginal Atrophy (Atrophic Vaginitis): This condition is very common in postmenopausal women due to the decrease in estrogen levels, leading to thinning and drying of the vaginal walls, which can cause burning, pain, and discomfort.

Other Likely Diagnoses

• Urinary Tract Infection (UTI): UTIs are common in older adults and can cause dysuria, frequency, and pain, which might be perceived as vaginal burning.
• Vaginal Infections (e.g., Yeast Infections, Bacterial Vaginosis): These infections can cause vaginal itching, burning, and abnormal discharge.
• Prolapse or Other Structural Issues: Weakening of the pelvic floor muscles can lead to prolapse, which might cause discomfort or pain.

Do Not Miss Diagnoses

• Cancer (Vaginal, Cervical, or Endometrial): Although less common, these conditions are critical to diagnose early. Unusual vaginal bleeding, pain, or discharge can be symptoms.
• Herpes Simplex Virus (HSV) or Other Sexually Transmitted Infections (STIs): While less common in this age group, STIs can occur at any age and require prompt treatment.
• Foreign Body: An object left in the vagina can cause severe irritation and infection.

Rare Diagnoses

• Lichen Sclerosus or Lichen Planus: These are rare skin conditions that can affect the vulva and vagina, causing itching, burning, and pain.
• Vulvar Vestibulitis: A condition characterized by chronic pain and burning in the vulvar area, often without an identifiable cause.
• Neurological Conditions (e.g., Neuropathic Pain, Pudendal Neuralgia): These can cause chronic pain in the vaginal or pelvic area without an obvious physical cause.