CCFP priority topic 103 of 105
Vaginitis on the CCFP exam
5 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 5 key features for Vaginitis. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 5
Not just yeast
When itch or discharge keeps returning, think past yeast: ask, then look.
CFPC skill Clinical reasoningPhase Hypothesis generation, physicalSources Society of Obstetricians and Gynaecologists of Canada
On the exam
A woman of 66 with a year of vulvar itch and three failed yeast courses. Expect a short menu (pick several from a list).
Pick the history and exam that widen it.
Common mistakes
Another azole, or a stronger one, because a swab grew Candida. Light growth is often harmless, and three failed courses mean the label is wrong.
Approach
- Treat repeated failure as a sign the diagnosis is wrong. Stop and widen the list.
- Ask where it itches, and about discharge, odour, bleeding and pain with sex. Ask about gas or stool from the vagina.
- Ask what touches the skin: creams, soaps, pads, wipes and washes.
- Examine the whole vulva and the skin around the anus, not just the vagina.
- Thin, white, crinkled skin in a figure-of-eight around the vulva and anus, with flattened inner lips, points to lichen sclerosus.
- Lichen sclerosus raises the risk of vulvar cancer. It needs early treatment and long-term follow-up.
| Cause | What you see | Clue in the story |
|---|---|---|
| Lichen sclerosus | Thin, white, crinkled skin around vulva and anus; inner lips flattened | Months of itch, often after menopause; yeast courses failed |
| Contact dermatitis | Red, weeping or scaly skin where a product touched | A new cream, soap, pad or wash |
| Thick skin from scratching (lichen simplex chronicus) | Thick, leathery, darker skin | Itch that leads to scratching, which leads to more itch |
| Thinning after menopause | Pale, thin, dry vaginal walls; vulvar skin not white | Dryness and pain with sex |
| Bowel-to-vagina fistula | Stool or foul discharge in the vagina | Gas or stool from the vagina; past bowel surgery, radiation or diverticulitis |
Key feature 2 of 5
Normal discharge
After a clean history, exam and tests, tell the patient the discharge is normal.
CFPC skill Clinical reasoningPhase Diagnosis
On the exam
A young woman is back a fourth time with discharge. Her exam and swabs are normal. Expect one best answer.
Pick what to tell her.
Common mistakes
Another swab, or a yeast course just in case. Both tell her something is wrong and bring her back. So does saying only that nothing was found.
Approach
- Check for warning signs first: odour, itch, burning, bleeding, pelvic pain, a new partner, or a change in the discharge.
- Look at the discharge and the cervix. Swab for infection as the story suggests, including sexual infections.
- With a normal exam and negative tests, say it plainly: this is normal discharge.
- Explain that the amount changes over the cycle, in pregnancy and on the pill.
- Advise against douching and scented washes.
- Tell her what should bring her back: odour, itch, a change in colour, pain or bleeding.
Key feature 3 of 5
Yeast or BV on a report
Yeast or bacterial vaginosis on a Pap or screening swab: check for symptoms before treating.
CFPC skill Clinical reasoning, selectivityPhase History, treatmentSources Society of Obstetricians and Gynaecologists of Canada
On the exam
A Pap report shows yeast. She has no itch, discharge, burning or odour. Expect one best answer.
Pick the management.
Common mistakes
One fluconazole dose to be safe, a cream, boric acid or weekly suppression. Candida lives harmlessly in many women. With no symptoms, there is nothing to treat.
Approach
- Ask about itch, burning, discharge and odour. A report alone is not a diagnosis.
- The SOGC (Society of Obstetricians and Gynaecologists of Canada) treatment advice is written for symptomatic yeast and bacterial vaginosis. With no symptoms, there is usually nothing to treat.
- Symptomatic yeast: an azole antifungal (such as fluconazole or clotrimazole), by mouth or in the vagina, works about equally well.
- Symptomatic bacterial vaginosis: metronidazole 500 mg by mouth twice a day for 7 days. Metronidazole gel or clindamycin are options.
- Recurrent yeast means 4 or more episodes a year. Weekly fluconazole for up to 6 months after the first course helps.
- Probiotics have limited evidence for bacterial vaginosis.
| Finding | Symptoms | What to do |
|---|---|---|
| Yeast | None | Usually no treatment |
| Yeast | Itch, burning, thick white discharge | An azole, by mouth or in the vagina |
| Bacterial vaginosis | None | Usually no treatment |
| Bacterial vaginosis | Fishy odour, thin grey discharge | Metronidazole 500 mg twice a day for 7 days |
| Yeast, 4 or more episodes a year | Present each time | Treat, then weekly fluconazole for up to 6 months |
Key feature 4 of 5
Discharge in a child
In a girl with discharge, look for sexual infection and an object in the vagina.
CFPC skill Clinical reasoning, selectivityPhase Hypothesis generation, diagnosis
On the exam
A 6-year-old girl has weeks of smelly, sometimes bloody discharge. Expect a short menu (pick several from a list).
Pick the causes to rule out and the tests.
Common mistakes
An antifungal cream for yeast. Yeast is uncommon in a child out of diapers. Missing an object, or an infection from abuse, is the real harm.
Approach
- Irritation from soap, bubble bath and wiping is common in young girls. Still rule out two causes.
- An object in the vagina, such as toilet paper, gives a foul, sometimes bloody discharge that keeps coming back.
- Take a careful history. Talk with the child alone if her age allows.
- Examine gently, with the legs in a frog position. Never use a speculum on a young child.
- Test for sexual infections. One found in a young child is a reason to suspect abuse.
- Report suspected abuse to child protection. That duty comes before confidentiality.
Key feature 5 of 5
Yeast in a child
Yeast in a young child needs a reason: check for diabetes or weak immunity.
CFPC skill Clinical reasoningPhase Hypothesis generation, diagnosis
On the exam
A 7-year-old girl has her third bout of vulvar yeast. Expect a short menu (pick several from a list).
Pick the history and tests that find the cause.
Common mistakes
A longer antifungal course and no more questions. Yeast in a child out of diapers has a reason, and new diabetes can be missed.
Approach
- Confirm it is yeast. Irritation is often called yeast in children.
- Ask about thirst, passing a lot of urine, weight loss and tiredness. Check her blood sugar.
- Ask about recent antibiotics, steroids, and diapers or pull-ups at night.
- Think of weak immunity: frequent or severe infections, poor growth, or mouth thrush that will not clear.
- Treat the yeast, and treat the cause you find.
Flashcards
Answer it first, then check.
KF 1Three yeast courses failed for vulvar itch. What is your next step?
Examine the vulva and the skin around the anus. Repeated failure means the yeast label is likely wrong.
KF 1White, crinkled skin around the vulva and anus, with flat inner lips. What is it?
Lichen sclerosus. It raises the risk of vulvar cancer, so it needs treatment and long-term follow-up. Source: Society of Obstetricians and Gynaecologists of Canada
KF 2Fourth visit for discharge. Normal exam, negative swabs. What do you tell her?
That it is normal discharge, why it happens, and which changes should bring her back.
KF 3A Pap report shows yeast, and she has no symptoms. Do you treat?
No. Yeast often lives harmlessly in the vagina. Treat symptoms, not a report.
KF 3When is yeast called recurrent, and what prevents more episodes?
Four or more episodes a year. After the first course, weekly fluconazole for up to 6 months. Source: Society of Obstetricians and Gynaecologists of Canada
KF 3Symptomatic bacterial vaginosis in a woman who is not pregnant. First choice?
Metronidazole 500 mg by mouth twice a day for 7 days. Source: Society of Obstetricians and Gynaecologists of Canada
KF 4A 5-year-old has foul, bloody discharge. Which two causes must you rule out?
An object in the vagina, and a sexual infection that points to abuse.
KF 5A 7-year-old has vulvar yeast again. What do you check first?
Her blood sugar, for diabetes. Then ask about weak immunity and recent antibiotics.
FAQ
Which Canadian guideline covers vaginitis?
The SOGC 2015 vulvovaginitis guideline covers yeast, bacterial vaginosis and trichomonas. It does not cover skin disease such as lichen sclerosus, or discharge in children. Those come from other sources.
Do I need a swab every time?
No. The history and exam lead. Swab when the story is unclear, symptoms keep coming back, or a sexual infection is possible. Yeast or bacterial vaginosis on a swab, with no symptoms, usually needs no treatment. A sexual infection on a swab is always treated.
Is lichen sclerosus only a disease of older women?
No. It is most common after menopause, but girls before puberty get it too. In a child, it can be mistaken for yeast or for signs of abuse.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- SOGC guidelines and JOGCSociety of Obstetricians and Gynaecologists of Canada