A 4-year-old patient and her mom present for evaluation of vaginal discharge. The mom states that the child has had an intermittent clear, white vaginal discharge for a year that stains her underwear. The mom also notes that at times she has a "red, irritated-looking vagina.” She states that the symptoms come and go and when they are present the patient's vulva is "red and itchy." The patient states that she does scratch it. She denies any vaginal pain. The mom denies a vaginal odor. The mom states that the patient just got over "an episode." The patient was seen by her primary care physician and he thought she may have a yeast infection. He prescribed an antifungal cream to the vulvovaginal area 3 months ago. This treatment slightly improved the symptoms, but only temporarily. Their doctor referred the patient to gynecology for further evaluation. The mom denies vaginal bleeding or any signs of breast development.