Search tips
Search criteria 


Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 1993 June; 43(371): 239–244.
PMCID: PMC1372421

Vaginal symptoms of unknown aetiology: a study in Dutch general practice.


Vaginal symptoms are frequently presented by women to general practitioners. In many cases, the aetiology of these symptoms remains unknown. This study focused on the factors associated with microbiologically unexplained vaginal symptoms, the course of symptoms and signs in these cases, and factors modifying this course. In a group of 610 women presenting to their general practitioner with vaginal symptoms (itching, irritation, abnormal but non-bloody discharge) the distribution of diagnoses was studied and factors associated with symptoms of unknown aetiology were identified using logistic regression analysis. During a three month follow up, the course of symptoms and signs was studied in 139 women with unexplained vaginal symptoms, using survival analysis methods. It was found that 25% of all the women had symptoms of unknown aetiology. A larger number of these women, compared with women with other diagnoses, were Caucasian, married, more highly educated, used oral contraceptives and reported psychological distress. During the follow-up period, a specific infection was diagnosed in less than 20% of the women with unexplained vaginal symptoms. Over half of the women (54%) recovered within three months. Short duration of symptoms before presentation was associated with a higher probability of recovery. From the study, it was found that many women visiting the general practitioner for vaginal symptoms had no demonstrable microbial disorder. Often these symptoms were transient and disappeared without intervention. Persistent symptoms may call for further examination where somatic, as well as psychosocial, factors should be taken into account.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Sobel JD. Vaginal infections in adult women. Med Clin North Am. 1990 Nov;74(6):1573–1602. [PubMed]
  • McCue JD. Evaluation and management of vaginitis. An update for primary care practitioners. Arch Intern Med. 1989 Mar;149(3):565–568. [PubMed]
  • Bro F. Patients with vaginal discharge in general practice. Acta Obstet Gynecol Scand. 1989;68(1):41–43. [PubMed]
  • Eschenbach DA, Hillier SL. Advances in diagnostic testing for vaginitis and cervicitis. J Reprod Med. 1989 Aug;34(8 Suppl):555–565. [PubMed]
  • Bro F. Vaginal microbial flora in women with and without vaginal discharge registered in general practice. Dan Med Bull. 1989 Oct;36(5):483–485. [PubMed]
  • Reed BD, Huck W, Zazove P. Differentiation of Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis infections of the vagina. J Fam Pract. 1989 Jun;28(6):673–680. [PubMed]
  • Smail J. Identifying vaginitis in general practice. Nurs Times. 1987 Jul 22;83(29):44–45. [PubMed]
  • Berg AO, Heidrich FE, Fihn SD, Bergman JJ, Wood RW, Stamm WE, Holmes KK. Establishing the cause of genitourinary symptoms in women in a family practice. Comparison of clinical examination and comprehensive microbiology. JAMA. 1984 Feb 3;251(5):620–625. [PubMed]
  • Schmidt H, Hansen JG, Korsager B. Microbiology of vaginal discharge in general practice. Scand J Prim Health Care. 1986 May;4(2):75–80. [PubMed]
  • Stewart DE, Whelan CI, Fong IW, Tessler KM. Psychosocial aspects of chronic, clinically unconfirmed vulvovaginitis. Obstet Gynecol. 1990 Nov;76(5 Pt 1):852–856. [PubMed]
  • McGuire LS, Guzinski GM, Holmes KK. Psychosexual functioning in symptomatic and asymptomatic women with and without signs of vaginitis. Am J Obstet Gynecol. 1980 Jul 1;137(5):600–603. [PubMed]
  • Dodson MG, Friedrich EG., Jr Psychosomatic vulvovaginitis. Obstet Gynecol. 1978 Jan;51(1 Suppl):23s–25s. [PubMed]
  • Woodward J. The diagnosis and treatment of psychosomatic vulvovaginitis. Practitioner. 1981 Nov;225(1361):1673–1677. [PubMed]
  • Mumford DB, Devereux TA, Maddy PJ, Johnston JV. Factors leading to the reporting of 'functional' somatic symptoms by general practice attenders. Br J Gen Pract. 1991 Nov;41(352):454–458. [PMC free article] [PubMed]
  • Quan M. Diagnosis and management of infectious vaginitis. J Am Board Fam Pract. 1990 Jul-Sep;3(3):195–205. [PubMed]
  • Witkin SS, Jeremias J, Ledger WJ. Recurrent vaginitis as a result of sexual transmission of IgE antibodies. Am J Obstet Gynecol. 1988 Jul;159(1):32–36. [PubMed]
  • Hammill HA. Unusual causes of vaginitis (excluding trichomonas, bacterial vaginosis, and Candida albicans). Obstet Gynecol Clin North Am. 1989 Jun;16(2):337–345. [PubMed]
  • Schaaf VM, Perez-Stable EJ, Borchardt K. The limited value of symptoms and signs in the diagnosis of vaginal infections. Arch Intern Med. 1990 Sep;150(9):1929–1933. [PubMed]
  • Hill LV, Embil JA. Vaginitis: current microbiologic and clinical concepts. CMAJ. 1986 Feb 15;134(4):321–331. [PMC free article] [PubMed]
  • Lossick JG. Sexually transmitted vaginitis. Semin Adolesc Med. 1986 Jun;2(2):131–142. [PubMed]
  • Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1168–1176. [PubMed]
  • Faro S. Bacterial vaginitis. Clin Obstet Gynecol. 1991 Sep;34(3):582–586. [PubMed]
  • Møller BR, Sparre Jørgensen A, From E, Stenderup A. Chlamydia, mycoplasmas, ureaplasmas, and yeasts in the lower genital tract of females. Comparison between a group attending a venereal disease clinic and a control group. Acta Obstet Gynecol Scand. 1985;64(2):145–149. [PubMed]
  • Kovacs GT, Westcott M, Rusden J, Asche V, King H, Haynes SE, Moore EK, Hall BE. Microbiological profile of the cervix in 1,000 sexually active women. Aust N Z J Obstet Gynaecol. 1988 Aug;28(3):216–220. [PubMed]
  • De Punzio C, Masoni S, Conaldi PG, Fioretti P. Typical and atypical lesions of herpes genitalis. Eur J Gynaecol Oncol. 1990;11(3):195–201. [PubMed]
  • Deitch KV, Smith JE. Symptoms of chronic vaginal infection and microscopic condyloma in women. J Obstet Gynecol Neonatal Nurs. 1990 Mar-Apr;19(2):133–138. [PubMed]
  • Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979 Feb;9(1):139–145. [PubMed]
  • Verhaak PF, Wennink HJ, Tijhuis MA. The importance of the GHQ in general practice. Fam Pract. 1990 Dec;7(4):319–324. [PubMed]
  • Wallston BS, Wallston KA, Kaplan GD, Maides SA. Development and validation of the health locus of control (HLC) scale. J Consult Clin Psychol. 1976 Aug;44(4):580–585. [PubMed]
  • Strickland BR. Internal-external expectancies and health-related behaviors. J Consult Clin Psychol. 1978 Dec;46(6):1192–1211. [PubMed]
  • Boyle ES, Harrison BE. Factor structure of the Health Locus of Control Scale. J Clin Psychol. 1981 Oct;37(4):819–824. [PubMed]
  • Thomason JL, Gelbart SM, Anderson RJ, Walt AK, Osypowski PJ, Broekhuizen FF. Statistical evaluation of diagnostic criteria for bacterial vaginosis. Am J Obstet Gynecol. 1990 Jan;162(1):155–160. [PubMed]
  • Hanna NF, Taylor-Robinson D, Kalodiki-Karamanoli M, Harris JR, McFadyen IR. The relation between vaginal pH and the microbiological status in vaginitis. Br J Obstet Gynaecol. 1985 Dec;92(12):1267–1271. [PubMed]
  • Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan;74(1):14–22. [PubMed]
  • Spiegel CA. Bacterial vaginosis. Clin Microbiol Rev. 1991 Oct;4(4):485–502. [PMC free article] [PubMed]
  • Weaver CH, Mengel MB. Bacterial vaginosis. J Fam Pract. 1988 Aug;27(2):207–215. [PubMed]
  • Ceddia T, Cappa F, Cialfi R, Gioia G, Cassone A. Prevalence of non-specific vaginitis and correlation with isolation of Gardnerella vaginalis in Italian outpatients. Eur J Epidemiol. 1989 Dec;5(4):529–531. [PubMed]
  • Faro S, Phillips LE. Non-specific vaginitis or vaginitis of undetermined aetiology. Int J Tissue React. 1987;9(2):173–177. [PubMed]
  • Krohn MA, Hillier SL, Eschenbach DA. Comparison of methods for diagnosing bacterial vaginosis among pregnant women. J Clin Microbiol. 1989 Jun;27(6):1266–1271. [PMC free article] [PubMed]
  • Hallén A, Påhlson C, Forsum U. Bacterial vaginosis in women attending STD clinic: diagnostic criteria and prevalence of Mobiluncus spp. Genitourin Med. 1987 Dec;63(6):386–389. [PMC free article] [PubMed]
  • Stamm WE. Diagnosis of Chlamydia trachomatis genitourinary infections. Ann Intern Med. 1988 May;108(5):710–717. [PubMed]
  • Taylor-Robinson D, McCormack WM. The genital mycoplasmas (second of two parts). N Engl J Med. 1980 May 8;302(19):1063–1067. [PubMed]
  • Hatch KD. Vulvovaginal human papillomavirus infections: clinical implications and management. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1183–1188. [PubMed]
  • Marinoff SC, Turner ML. Vulvar vestibulitis syndrome: an overview. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1228–1233. [PubMed]
  • Mayou R. Medically unexplained physical symptoms. BMJ. 1991 Sep 7;303(6802):534–535. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners