Overview of vulvovaginal complaints in the prepubertal child
- Marc R Laufer, MD
Marc R Laufer, MD
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- S Jean Emans, MD
S Jean Emans, MD
- Mary Allen Avery Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss common vulvovaginal disorders in this population. The gynecological history and physical examination and techniques for obtaining cultures in these children are reviewed separately. (See "Gynecologic examination of the newborn and child".)
Vulvovaginal complaints in prepubertal children may be the result of infection, congenital abnormalities, trauma, or dermatologic conditions. Vaginitis may have a nonspecific etiology or may be due to known pathogens. It is the commonest gynecological problem in prepubertal girls . Symptoms include vaginal discharge, erythema, soreness, pruritus, dysuria, and bleeding. Occasionally, urinary tract or bowel symptoms may be interpreted by a child as vulvar or vaginal complaints.
Nonspecific vulvovaginitis is responsible for 25 to 75 percent of vulvovaginitis in prepubertal girls . There are a number of potential factors in children that increase their risk of vulvovaginitis:
●Lack of labial development
●Unestrogenized thin mucosa
Subscribers log in hereLiterature review current through: Dec 2016. | This topic last updated: Fri Dec 02 00:00:00 GMT 2016.References
- Joishy M, Ashtekar CS, Jain A, Gonsalves R. Do we need to treat vulvovaginitis in prepubertal girls? BMJ 2005; 330:186.
- Garden AS. Vulvovaginitis and other common childhood gynaecological conditions. Arch Dis Child Educ Pract Ed 2011; 96:73.
- Stricker T, Navratil F, Sennhauser FH. Vulvovaginitis in prepubertal girls. Arch Dis Child 2003; 88:324.
- Ranđelović G, Mladenović V, Ristić L, et al. Microbiological aspects of vulvovaginitis in prepubertal girls. Eur J Pediatr 2012; 171:1203.
- Yilmaz AE, Celik N, Soylu G, et al. Comparison of clinical and microbiological features of vulvovaginitis in prepubertal and pubertal girls. J Formos Med Assoc 2012; 111:392.
- Sikanić-Dugić N, Pustisek N, Hirsl-Hećej V, Lukić-Grlić A. Microbiological findings in prepubertal girls with vulvovaginitis. Acta Dermatovenerol Croat 2009; 17:267.
- Cuadros J, Mazón A, Martinez R, et al. The aetiology of paediatric inflammatory vulvovaginitis. Eur J Pediatr 2004; 163:105.
- Bartley DL, Morgan L, Rimsza ME. Gardnerella vaginalis in prepubertal girls. Am J Dis Child 1987; 141:1014.
- Ingram DL, White ST, Lyna PR, et al. Gardnerella vaginalis infection and sexual contact in female children. Child Abuse Negl 1992; 16:847.
- Emans SJ, Laufer MR. Pediatric and Adolescent Gynecology, 6th, Lippincott Williams & Wilkins, Philadelphia 2012.
- Trichomoniasis. 2015 Sexually transmitted diseases treatment guidelines. Centers for Disease Control and Prevention available at https://www.cdc.gov/std/tg2015/trichomoniasis.htm (accessed 11/29/2016).
- Allen AL, Siegfried EC. The natural history of condyloma in children. J Am Acad Dermatol 1998; 39:951.
- Spiryda LB, Laufer MR, Soiffer RJ, Antin JA. Graft-versus-host disease of the vulva and/or vagina: diagnosis and treatment. Biol Blood Marrow Transplant 2003; 9:760.
- Striegel AM, Myers JB, Sorensen MD, et al. Vaginal discharge and bleeding in girls younger than 6 years. J Urol 2006; 176:2632.
- Farhi D, Wendling J, Molinari E, et al. Non-sexually related acute genital ulcers in 13 pubertal girls: a clinical and microbiological study. Arch Dermatol 2009; 145:38.
- Lampert A, Assier-Bonnet H, Chevallier B, et al. Lipschutz's genital ulceration: a manifestation of Epstein-Barr virus primary infection. Br J Dermatol 1996; 135:663.
- Barnes CJ, Alió AB, Cunningham BB, Friedlander SF. Epstein-Barr virus-associated genital ulcers: an under-recognized disorder. Pediatr Dermatol 2007; 24:130.
- Huppert JS, Gerber MA, Deitch HR, et al. Vulvar ulcers in young females: a manifestation of aphthosis. J Pediatr Adolesc Gynecol 2006; 19:195.
- Wetter DA, Bruce AJ, MacLaughlin KL, Rogers RS 3rd. Ulcus vulvae acutum in a 13-year-old girl after influenza A infection. Skinmed 2008; 7:95.
- Piippo S, Lenko H, Vuento R. Vulvar symptoms in paediatric and adolescent patients. Acta Paediatr 2000; 89:431.
- Bacon JL, Romano ME, Quint EH. Clinical Recommendation: Labial Adhesions. J Pediatr Adolesc Gynecol 2015; 28:405.
- Tebruegge M, Misra I, Nerminathan V. Is the topical application of oestrogen cream an effective intervention in girls suffering from labial adhesions? Arch Dis Child 2007; 92:268.
- Schober J, Dulabon L, Martin-Alguacil N, et al. Significance of topical estrogens to labial fusion and vaginal introital integrity. J Pediatr Adolesc Gynecol 2006; 19:337.
- Myers JB, Sorensen CM, Wisner BP, et al. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol 2006; 19:407.
- Eroğlu E, Yip M, Oktar T, et al. How should we treat prepubertal labial adhesions? Retrospective comparison of topical treatments: estrogen only, betamethasone only, and combination estrogen and betamethasone. J Pediatr Adolesc Gynecol 2011; 24:389.
- Ertürk N. Comparison of estrogen and betamethasone in the topical treatment of labial adhesions in prepubertal girls. Turk J Med Sci 2014; 44:1103.
- Mayoglou L, Dulabon L, Martin-Alguacil N, et al. Success of treatment modalities for labial fusion: a retrospective evaluation of topical and surgical treatments. J Pediatr Adolesc Gynecol 2009; 22:247.
- Bacon JL. Prepubertal labial adhesions: evaluation of a referral population. Am J Obstet Gynecol 2002; 187:327.
- Herrmann B, Crawford J. Genital injuries in prepubertal girls from inline skating accidents. Pediatrics 2002; 110:e16.
- Emans SJ, Woods ER, Flagg NT, Freeman A. Genital findings in sexually abused, symptomatic and asymptomatic, girls. Pediatrics 1987; 79:778.
- Berenson A, Heger A, Andrews S. Appearance of the hymen in newborns. Pediatrics 1991; 87:458.
- Berenson AB, Heger AH, Hayes JM, et al. Appearance of the hymen in prepubertal girls. Pediatrics 1992; 89:387.
- McCann J, Voris J, Simon M, Wells R. Perianal findings in prepubertal children selected for nonabuse: a descriptive study. Child Abuse Negl 1989; 13:179.
- Fivozinsky KB, Laufer MR. Vulvar disorders in prepubertal girls. A literature review. J Reprod Med 1998; 43:763.
- NONSPECIFIC VULVOVAGINITIS
- SPECIFIC INFECTIONS
- Respiratory and enteric flora
- Gardnerella vaginalis
- Sexually transmitted diseases
- - Neisseria gonorrhoeae
- - Chlamydia trachomatis
- - Trichomonas vaginalis
- - Condylomata acuminata
- FOREIGN BODY
- POLYPS, SKIN TAGS, OR TUMORS
- SYSTEMIC ILLNESS
- VULVAR ULCERS
- URINARY TRACT PATHOLOGY
- Ectopic ureter
- Urethral prolapse
- CUTANEOUS VULVAR DISEASE
- Lichen sclerosus
- Labial adhesions
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS