These case studies demonstrate the Algorithm in action.
The story starts with either symptoms (most commonly) or signs (in which case, another practitioner or the patient herself, has noticed an abnormality). Focus carefully on what the patient says and not on the diagnoses she has been given in the past.
The location of the patient’s reported symptoms is not specifically identified, because when women come in, they usually cannot articulate exactly where they are uncomfortable. The symptoms must be mapped on physical exam. Many symptoms overlap (itching, burning, and pain) and it will be seen that the same condition may manifest in any of them. All itching is not yeast.
Absence of abnormal physical findings does not mean that the patient’s symptoms are “all in her head.” Pain identified by the patient is always “something.” Acute or chronic vulvovaginal conditions, with or without abnormal findings on exam, can have a huge emotional and physical impact on women’s lives.
These case studies represent the most common conditions patients present with but certainly not ALL the possible conditions. Always biopsy or consult about conditions that you do not clearly recognize or conditions that do not improve. In all cases, multiple conditions may be present simultaneously.
The case studies can be used as learning devices, as self-tests, or as tests administered by academic teaching programs. In the latter case, the diagnoses and treatment plans can be blocked for testing purposes.