Trichomonal vaginitis is usually sexually acquired and can produce copious malodorous discharge Candida vaginitis can cause a pruritic discharge that is thick, white, and cheesy The vulva may be irritated, and the adolescent may experience dysuria and painful intercourse (dyspareunia) Predisposing factors such as antibiotic or corticosteroid use, chronic illness, or tight-fitting nonabsorbent clothing are often present Candida vaginitis is also common in pregnancy Cervicitis is commonly caused by C trachomatis or N gonorrhoeae , but may also be caused by Mycoplasma genitalium , Ureaplasma urealyticum , and other bacteria that are sexually transmitted but not commonly identified in laboratory tests The adolescent female may present with a yellow, white, or green discharge She may also complain of prolonged menses, intermenstrual bleeding, or pain with intercourse However, the majority of adolescents with chlamydia or gonorrhea may be asymptomatic The untreated or reinfected patient may develop pelvic inflammatory disease, which may leave her at risk for future fertility problems A malodorous, often bloody vaginal discharge in adolescent females may also be the result of a retained foreign body The most commonly found foreign body is a forgotten retained tampon In these cases, one should also monitor for systemic sign and symptoms of toxic shock syndrome Examination It is recommended that a chaperone be present for an adolescent examination Family members and friends should not be used as chaperones As with the prepubertal patient, the supine frog-leg position is the preferred position for examination of the adolescent female Begin with visual inspection of the external genitalia to examine for signs of folliculitis, ulcers, candidal vulvovaginitis, clitoromegaly, excoriation, and discharge or bleeding Speculum examination may be omitted in nonsexually active females who present with signs of physiologic leukorrhea A speculum examination followed by a bimanual examination may be necessary to evaluate sexually active females with vaginal discharge accompanied by foul odor, irregular bleeding, pelvic pain, or dyspareunia The postpubertal patient with candidal vulvovaginitis typically complains of a white, thick, curd-like discharge and intense itching Signs of vulvar inflammation, such as edema, redness, and excoriation are often present T