What is the treatment for a female patient of reproductive age with vaginitis caused by a reaction to a sanitary pad?

Treatment for Contact Vaginitis from Sanitary Pad Reaction

The primary treatment for vaginitis caused by a sanitary pad reaction is immediate removal of the irritant (discontinue the offending pad), followed by symptomatic management with gentle hygiene practices and consideration of topical corticosteroids for vulvar inflammation if present.

Immediate Management

Remove the Causative Agent

• Discontinue use of the current sanitary pad immediately and switch to hypoallergenic, unscented alternatives or 100% cotton pads 1
• Avoid all potential irritants including scented products, synthetic materials, and prolonged moisture exposure 1
• This is a contact/irritant vaginitis, which is a noninfectious cause accounting for 5-10% of vaginitis cases 2

Rule Out Infectious Causes

Before attributing symptoms solely to pad reaction, confirm the absence of infectious vaginitis:

• Perform vaginal pH testing: Normal pH (≤4.5) supports noninfectious etiology; elevated pH (>4.5) suggests bacterial vaginosis or trichomoniasis 1, 2
• Conduct wet mount microscopy with both saline and 10% KOH preparations to exclude clue cells, trichomonads, yeast, or pseudohyphae 1, 3
• Perform whiff test: Negative result supports noninfectious cause 1, 4
• The presence of external vulvar inflammation with minimal discharge and absence of vaginal pathogens confirms mechanical or chemical irritation 5

Symptomatic Treatment

For Vulvar Irritation and Inflammation

• Apply low-potency topical corticosteroids (e.g., hydrocortisone 1% cream) to inflamed external vulvar areas if significant inflammation is present 2
• Topical agents for contact vaginitis cause minimal systemic side effects, though local burning may occur initially 5

Hygiene and Preventive Measures

• Recommend cotton underwear and avoidance of tight synthetic materials to reduce moisture and friction 1
• Advise gentle cleansing with water only—no soaps, douches, or scented products 1
• Counsel against douching, as it disrupts normal lactobacilli flora and can precipitate bacterial vaginosis 1
• Ensure proper pad changing frequency during menstruation, as prolonged use increases risk of bacterial overgrowth 6

Important Clinical Pitfalls

Do Not Treat Asymptomatic Colonization

• Approximately 10-20% of asymptomatic women harbor Candida species; identifying yeast without symptoms does not warrant antifungal treatment 5, 1
• Unnecessary treatment may disrupt normal vaginal flora and worsen symptoms 1

Avoid Misdiagnosis as Candidiasis

• Contact vaginitis presents with external vulvar inflammation and minimal discharge, whereas candidal vaginitis typically presents with thick white discharge, pruritus, and pseudohyphae on microscopy 5, 2
• Oil-based antifungal creams may further irritate already inflamed tissue in contact dermatitis 5

Monitor for Secondary Infection

• Poor menstrual hygiene practices, including use of irritating pads, are associated with increased risk of bacterial vaginosis 6
• Instruct patient to return if symptoms persist beyond 1-2 weeks or if new symptoms develop (malodorous discharge, increased volume) 5, 1

Patient Education

Pad Selection Guidance

• Switch to 100% cotton, unscented sanitary pads or consider menstrual cups made from medical-grade silicone 1
• Women using cloth absorbents have higher rates of bacterial vaginosis compared to sanitary pad users, but only if hygiene is inadequate 6

Expected Timeline

• Symptoms should improve within 3-7 days after removing the irritant and implementing proper hygiene 1
• Physiologic discharge (clear to white, non-malodorous) is normal and requires no treatment 1

When to Seek Further Care

• Return for evaluation if symptoms persist after 2 weeks of conservative management, as this may indicate an undiagnosed infectious cause 5, 1
• New onset of fever, pelvic pain, or purulent discharge requires immediate reassessment for upper tract infection or cervicitis 7