Usually a simple case of ‘bum-itch’ in kids, symptoms of pinworms in adult women are more complex

Parasitic worms in a human stool, as seen from a microscope | Image by Jarun011/iStock/Getty Images Plus, St. George News

FEATURE — I have discussed pinworm infections once before, but it is such a common issue, and one that is vastly underdiagnosed by women’s health providers, that I think it deserves one more pass.

Pinworms are thought of as an issue of kids in preschool through grade school. They experience severe “bum-itch” at night and get diagnosed with and treated for pinworms by their pediatrician, and usually that’s the end of it.

But pinworms can also affect adults, and women have a unique set of symptoms that often get confused with other common problems.

By far, the most common symptoms are vaginal discharge and burning pain, especially right at the entrance to the vagina. Many times, they have already been seen and treated for yeast or bacterial vaginosis and the symptoms persist.

There can be urethral irritation when emptying the bladder, or symptoms that feel like inflamed internal hemorrhoids. If any of these are present, especially if you have already been evaluated and treated, it’s time to think about the possibility of pinworms.

Read more: 7 things you didn’t want to know – but probably should – about the curious plague of rectal pinworms

Diagnosing pinworms is tricky. I think I missed a lot of cases in my first 10 years of practice because in my training, pinworms were not in the differential diagnosis, and what I saw under the microscope I dismissed as artifacts, such as a strand from a Q-tip, a hair, et cetera.

Pinworms are very tiny, but you have to look for them on a lower magnification than bacterial vaginosis or yeast.

One day, I saw a poor woman who was just miserable. I didn’t see anything on my usual survey under the microscope, but then I saw a pinworm, and it all clicked. Pinworms die immediately upon entering the vagina, but as they break down, they release chemicals that are very irritating. Hence the pain and maybe some discharge, even when the upper vaginal vault looks totally normal.

Diagnosing usually requires using a microscope, and anal swabs are very accurate indicators. Treatment with over-the-counter medication is over 90% effective. These medications are safe and can be purchased at any pharmacy.

The take-home message here is that if you don’t have a healthy dose of suspicion about your symptoms, then you will never get the problem solved. My receptionist can schedule a visit, ask the symptoms and guess that it is a pinworm infestation accurately 90% of the time.


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