4: Peds Vulvovaginitis

Question 1

How does vulvovaginitis present in children?

Answer 1

• Dysuria
• Vulvovaginal pain and/or pruritis
• Local erythema
• Discharge

Question 2

What should be included in a hx for vulvovaginitis?

Answer 2

• Symptom analysis including dysuria, hematuria, abd pain, flank pain, fever, n/v.
• Ask specifics about any nocturnal enuresis. New or chronic?
• Ask specifics about discharge (how much, what color, odor).
• Ask about history of atopy/eczema.
• Ask if any concern over inappropriate physical contact.

Question 3

Should you perform an internal GU exam when suspicious for vulvovaginitis?

Answer 3

No.

• Perform oropharyngeal exam (strep or sexual abuse)
• Full abd exam (including CVA tenderness)
• External GU
• Q-tip for vaginal secretions for wet mount

Question 4

What diagnostic testing should be performed?

Answer 4

• UA, culture
• Possibly tape testing (pinworms)
• Wet mount/KOH
• If need to do STI screening be careful as it might have legal ramifications

Question 5

Treatment for nonspecific vulvovaginitis?

Answer 5

• Avoid all irritants (including soap) for approximately 2 days
• Wash well with warm water
• May use a low potency steroid and antifungal combo but not longer than 1 week