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

Treatment of Vaginitis Due to Sanitary Pad Reaction

The primary treatment for vaginitis caused by sanitary pad reaction is immediate discontinuation of the irritating product combined with symptomatic relief using topical hydrocortisone (applied 3-4 times daily to external areas only), while ruling out concurrent infectious causes through proper diagnostic evaluation. 1, 2, 3

Immediate Management Steps

Eliminate the Irritant

• Discontinue the offending sanitary pad immediately and switch to unscented, hypoallergenic alternatives or 100% cotton products 1, 2
• Avoid all potential chemical irritants including perfumed products, douches, scented soaps, and tight synthetic underwear 1, 2
• The reaction may be due to colophony (rosin) or other adhesive components commonly found in sanitary pads 4

Symptomatic Relief

• Apply hydrocortisone cream (1-2.5%) to external vulvar areas 3-4 times daily for inflammation and itching 3
• Critical caveat: Do NOT use hydrocortisone if vaginal discharge is present until infectious causes are ruled out 3
• Recommend sitz baths with plain warm water to soothe irritated tissues 1, 2

Diagnostic Evaluation Required

You must rule out infectious causes before attributing symptoms solely to contact dermatitis, as mixed infections are common and vulvovaginal candidiasis can occur concurrently with irritant reactions 2, 5

Essential Testing

• Measure vaginal pH: Normal pH (≤4.5) suggests candidiasis or irritant reaction; elevated pH (>4.5) indicates bacterial vaginosis or trichomoniasis 1, 2, 5
• Perform saline wet mount: Look for motile trichomonads, clue cells, or white blood cells 1, 2
• Perform KOH preparation: Visualize yeast/pseudohyphae and conduct whiff test 1, 2
• Visual inspection: Assess for erythema, excoriation, and absence of infectious discharge characteristics 2

Treatment Algorithm Based on Findings

If Tests Are Negative (Pure Irritant Reaction)

• Reassurance that no infection is present 6
• Continue hydrocortisone 3-4 times daily to external areas until symptoms resolve (typically 5-7 days) 3
• Hygiene counseling: wear white cotton underwear, avoid prolonged moisture exposure, wipe front-to-back, use only water for cleansing 2, 6
• No antifungal or antibiotic treatment is indicated 6

If Concurrent Candidiasis Is Identified

Treat with topical azole therapy (more effective than treating irritation alone): 1

• Preferred short-course options: Miconazole 200 mg suppository nightly for 3 days OR Clotrimazole 500 mg tablet single dose OR Fluconazole 150 mg oral single dose 1
• Alternative: Terconazole 0.8% cream 5g intravaginally for 3 days 1
• Continue external hydrocortisone for vulvar irritation while treating the yeast infection 3
• Note: Oil-based creams/suppositories weaken latex condoms 1

If Bacterial Vaginosis or Trichomoniasis Is Found

• Bacterial vaginosis: Oral metronidazole or intravaginal metronidazole/clindamycin 5, 7
• Trichomoniasis: Oral metronidazole or tinidazole with mandatory partner treatment 5, 7

Critical Pitfalls to Avoid

• Never use hydrocortisone intravaginally or when vaginal discharge is present without first ruling out infection 3
• Do not assume all symptoms are from irritation—approximately 50% of women have mixed or concurrent infectious causes 2, 5
• Avoid self-treatment with OTC antifungals unless previously diagnosed with candidiasis—inappropriate use delays proper diagnosis and can worsen outcomes 1
• Laboratory testing fails to identify a cause in a substantial minority of women, but this should be a diagnosis of exclusion 1, 6

Follow-Up Instructions

• Return if symptoms persist beyond 7 days or recur within 2 months 1
• If symptoms resolve with irritant avoidance alone, this confirms contact dermatitis as the primary cause 1, 2
• Consider patch testing for specific allergen identification if reactions recur with different products 4