What should you suspect?
A young woman comes in for a routine wellness examination. You notice that her vaginal walls have deep rugae and are slightly bluish in color. She also has a thicker white discharge.
A) Hypoxia
B) Varicosities
C) Pregnancy
D) Sexually transmitted infection
C) Pregnancy
You should suspect early pregnancy with a bluish discoloration of the vaginal walls and thicker discharge (Chadwick's sign). You may also notice a softening at the isthmus of the uterus on bimanual examination (Hegar's sign). New hypoxia in an otherwise asymptomatic patient would be unusual. While any unusual discharge should make one consider an STI, this is less likely.
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