Diagnosis	Symptoms	Findings	Treatment/comments
Recurrent vulvovaginal candidiasis	Itching Irritation Burning Dyspareunia Abnormal discharge	Erythema of vulva and/or vagina Swelling of labia minora Vaginal thrush Normal pH Hyphae/blastospores on microscopy Positive fungal culture	Treatment depends on species of infecting organism; see text for full discussion.
Irritant dermatitis	Irritation Burning	Erythema of vulva and/or vestibule Normal pH Negative microscopy Negative fungal culture	Removal of potential irritants Topical corticosteroid ointment
Vulvar vestibulitis	Often minor irritation or burning in day-to-day activities Acquired dyspareunia with intromission Pain with other contact with introitus (e.g., tampon insertion)	Areas of focal vestibular erythema Tenderness with palpation of erythematous areas Normal pH Normal microscopy Negative fungal cultural	Removal of potential irritants Topical 4% lidocaine prior to coitus Low-potency topical corticosteroid ointment Low-dose tricyclic antidepressant therapy Pelvic floor biofeedback therapy Low oxalate diet with calcium citrate pills Vestibulectomy with vaginal advancement
Bacterial vaginosis	Chronic gray discharge Fishy odor Mild irritation or itching	Gray or yellow discharge ≥pH 4.5 Positive amine test Epithelial cells with more than 20% clue cells	Oral metronidazole (Flagyl), 500 mg twice daily for seven days Topical metronidazole gel 0.75%, at bedtime for five days Topical clindamycin 2% vaginal cream (Cleocin Vaginal) at bedtime for three days No clear consensus on management of patient with recurrent infection; treating partner not shown to be effective.
Physiologic discharge	Chronic white discharge, unchanged with past therapies Mild acid odor	Flocculent or thick white discharge Normal pH Normal microscopy Negative fungal culture	None