Prepubertal Vulval Disorders Flashcards
What is the definition of vulvovaginitis?
Inflammation of the vulva and vagina with associated discharge
What is the commonest gynaecological problem in young girls?
Vulvovaginitis
What are the organisms that can cause vulvovaginitis?
Group A haemolytic streptococcus
Haemophilus influenzae
Less common
Threadworms
Candida rare in prepuberty, but may be isolated in diabetes, after a recent course of antibiotics or if still wearing nappies
Why are prepubertal girls prone to vulvovaginitis?
Thin vaginal mucosa Alkaline pH Absence of vulval fat pads Absence of pubic hair Close proximity of vagina to anus Poor hygiene
What is the definition of labial adhesions?
Adhesions between the labia minora
What is the incidence of labial adhesions in prepubertal girls
1-3%
Never present at birth
Peak incidence is between the first and second year of life
What is the pathophysiology of labial adhesions?
Exact cause unknown
Combination of low oestrogen levels and local inflammation
What are the risk factors for labial adhesions?
Nappy dermatitis
Poor hygiene
What is the management of vulvovaginitis?
Antibiotics if pathogen isolated
General advice on hygiene
Avoidance of irritants - bubble baths, harsh soaps
Loose cotton underwear preferable to tight synthetic underwear
Careful evaluation for sexual abuse
What is the management of labial adhesions?
Local oestrogen cream application (daily for 6 weeks)
For severe cases refractory to oestrogen treatment, the labia can be separated surgically under LA or GA
Surgical separation
Oestrogen cream should be used post-operativelyto prevent recurrence
What symptoms are seen with severe labial fusion?
Urinary symptoms
As urine accumulates behind the fused labia
Post-micturition dribble
Dysuria
Recurrent UTIs
Urinary retention
What are risk factors for prepubertal lichen sclerosus?
Autoimmune disorders
Infections
Local trauma
