Abdominal Examination for Vaginal Itching and Burning
An abdominal exam is indicated when a patient with vaginal itching and burning also presents with lower abdominal pain, but is not routinely necessary for isolated vaginal symptoms without abdominal complaints. 1
When Abdominal Examination IS Required
A complete pelvic examination including abdominal assessment is always indicated in cases of lower abdominal pain to identify potential sources such as pelvic inflammatory disease, ovarian mass or torsion, ectopic pregnancy, or normal pregnancy. 1
The American Academy of Pediatrics specifically states that when lower abdominal pain accompanies vaginal symptoms, the examination must be performed to identify the source of pain, which may be caused by serious gynecologic conditions requiring urgent intervention. 1
When Abdominal Examination is NOT Routinely Necessary
For isolated vaginal itching and burning without abdominal pain, the diagnostic approach focuses on:
External inspection of the vulva and perineum to assess for erythema, discharge characteristics, lesions, or architectural changes 1, 2
Vaginal examination (speculum or vaginal swab) to obtain specimens for diagnosis of common causes including vulvovaginal candidiasis, bacterial vaginosis, or trichomoniasis 1, 3
pH testing and microscopy of vaginal discharge to differentiate between infectious causes 3, 4
The most common causes of vaginal itching and burning are vulvovaginal candidiasis (20-25% of cases), bacterial vaginosis (40-50%), and trichomoniasis (15-20%), none of which require abdominal examination for diagnosis. 3, 4
Clinical Algorithm
Perform abdominal examination if:
- Lower abdominal pain is present 1
- Gastrointestinal symptoms accompany vaginal complaints (abdominal bloating, difficulty eating, early satiety) 5
- Signs of systemic illness (fever, hemodynamic instability) suggest pelvic inflammatory disease or abscess 5
Abdominal examination not required if:
- Symptoms are limited to vaginal itching, burning, or discharge without abdominal pain 1, 3
- Physical findings are consistent with uncomplicated vulvovaginal candidiasis or other localized vaginitis 1, 3
Important Caveats
In postmenopausal women with chronic vulvar itching and burning, consider lichen sclerosus or lichen planus, which require careful vulvar inspection but not necessarily abdominal examination unless pain is present. 2
Any woman with gynaecologic complaints including vaginal discharge or vulvar symptoms should undergo appropriate components of pelvic examination, but this refers to visual inspection and speculum/bimanual examination rather than abdominal palpation unless pain is a feature. 5