Vaginal symptoms in palliative care

In patients with palliative care needs, vaginal pain, itch, discomfort, dryness and discharge may be caused by:

• atrophic changes—for treatment recommendations, see the Sexual and Reproductive Health guidelines
• dermatitis—for treatment recommendations, see the Dermatology guidelines
• infection, most commonly candidal infection—see the Antibiotic guidelines for treatment recommendations for candidal vulvovaginitis and bacterial vaginosis
• local tumour invasion with secretions, fistula formation or bleeding—treatment of a cancer-associated wound includes use of appropriate dressings (eg activated charcoal pads), systemic drug therapy (eg metronidazole, tranexamic acid) and other interventions (eg radiotherapy) to manage pain, discharge, odour and bleeding. For advice on management, see Cutaneous malignant wounds in palliative care. Assistance from a stomal therapist or wound care nurse may be needed
• premature ovarian insufficiency or early menopause secondary to cancer therapy—for treatment recommendations, see the Sexual and Reproductive Health guidelines.

Vaginal symptoms in patients with palliative care needs may also contribute to sexual difficulties. See the Sexual and Reproductive Health guidelines for advice on screening for sexual difficulties, low libido, sexual pain and orgasm difficulties.