Vaginal discharge—causes, diagnosis, and treatment
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7451.1306 (Published 27 May 2004) Cite this as: BMJ 2004;328:1306
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Sir,
In the most recent article in the ABC of Sexually Transmitted
Diseases series, it would have been helpful to include another important
cause of persistent vaginal discharge, namely erosive lichen planus.
Erosive lichen planus, especially the vulvo-vagino-gingival syndrome,
can affect the vagina and may present with a sero-sanguinous discharge. It
is frequently overlooked but is an important diagnosis to make as there
can be long term consequences for the patient if untreated, due to the
development of vaginal scarring and ultimately, complete vaginal stenosis.
It can also involve the vulva, cervix, skin and oral mucosa and diagnostic
pointers may be present at these sites.
Erosive lichen planus can be a therapeutic challenge but many
patients are helped by intra-vaginal topical steroids and the
hydrocortisone acetate foam preparations used in the treatment of
inflammatory bowel disease are useful.
Referral of these patients to a specialist Vulval Clinic is
beneficial as a multi-disciplinary approach may be needed in management.
Competing interests:
None declared
Competing interests: No competing interests
Vaginal discharge is one of the most common presentations in general
practice and as such requires a solid evidence base for management. Why is
it then that the article by Mitchell is unreferenced? While I applaud
efforts to present this topic in a meaningful way, much research has been
undertaken on this topic and original research including results of
systematic reviews should be cited correctly so that GPs and others
wanting to pursue areas of interest can do so.
Competing interests:
None declared
Competing interests: No competing interests
Another cause of chronic vaginitis
There is another cause of chronic vaginitis in women: contact
dermatitis. I have found in women who are atopic, or have signs of
contact dermatitis on their fingers, that they may be having an allergic
reaction to the soaps they are using to bathe with or wash their underwear
with. I recommend that they change to a completely hypoallergenic soap
both in the shower, and in the washing machine.
They also should not use fabric softeners. A significant minority of the
women who do respond to this treatment.
Competing interests:
None declared
Competing interests: No competing interests