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The Vulva During Childhood

  • Adriadna Caussade
Chapter

Abstract

Girls’ vulva and vagina are particularly susceptible to various clinical conditions because of their anatomy, their lack of estrogen exposure, and frequent contact with irritants. In this chapter we will analyze the girl’s anatomy and how it differs from that of the adult, the most suitable testing and examination methods in that age group, and the hygiene measures recommended to preserve vulvovaginal health. The girls’ vulva may be affected by a wide range of conditions, including congenital defects, infections, dermatosis, dermatitis, and coalescence of the labia minora. This chapter will also focus on vulvovaginitis and the most common related infections, including the clinical and therapeutic controversies on HPV, the varying degrees of dermatitis and lichen sclerosus, with all the diagnostic challenges they pose, and recommended treatments. Finally, we will focus on the coalescence of labia minora and its monitoring.

References

  1. 1.
    Kurman RJ. Blaustein’s. Pathology of the female genital tract. 5th ed. New York: Springer; 2002.Google Scholar
  2. 2.
    Sanfillipo J, Muram D, Lee P, Dewhurst JC. Pediatric and adolescent gynecology. Philadelphia: WB Saunders; 2001. p. 187–9.Google Scholar
  3. 3.
    Yung-Weng W, Ying-Ju C. A preliminary study of bottom care effects on premature infants’ heart rate and oxygen saturation. J Nurs Res. 2004;12(2):161–8.CrossRefGoogle Scholar
  4. 4.
    Barclay L. Guidelines issued for gynecologic examination for adolescents in the pediatric office setting. Medscape medical news; 2010.Google Scholar
  5. 5.
    Caussade A. La patología vulvar en las niñas. Vulva y vagina. Diagnóstico y tratamiento. Montevideo: Bibliomédica ediciones; 2015. p. 319–39.Google Scholar
  6. 6.
    Singleton AF. Vaginal discharge in children and adolescents. Evolution and management: a review. Clin Pediatr. 1980;19:799–804.CrossRefGoogle Scholar
  7. 7.
    Smith SD, Fischer GD. Childhood onset vulval lichen sclerosus does not resolve at puberty: a prospective case series. Pediatr Dermatol. 2009;26:725–9.CrossRefGoogle Scholar
  8. 8.
    Krapf JM. Vulvovaginitis. Emedicine. Updated: Jan 19, 2018. https://emedicine.medscape.com/article/2188931-overview. Last accessed: 15 October 2018.
  9. 9.
    Fischer GO. Vulval disease in pre-pubertal girls. Australas J Dermatol. 2001;42:225–36.CrossRefGoogle Scholar
  10. 10.
    Fischer G, Rogers M. Vulvar diseases in children: a clinical audit of 130 cases. Pediatr Dermatol. 2000;17:1–6.CrossRefGoogle Scholar
  11. 11.
    Fischer G, Rogers M. Paediatric vulvovaginitis. In: Proceedings of the 3rd symposium on diseases of the vulva and vagina. Melbourne: Melbourne University; 1997. p. 26–9.Google Scholar
  12. 12.
    Caussade A. Condilomatosis vulvar en la niña. Vulva y vagina. Diagnóstico y tratamiento. Montevideo: Bibliomédica ediciones; 2015. p. 341–46.Google Scholar
  13. 13.
    Antonsson A, Karanfilovska S, Lindqvist PG, Hansson BG. General acquisition of human papillomavirus infections of skin occurs in early infancy. J Clin Microbiol. 2003;41:2509–14.CrossRefGoogle Scholar
  14. 14.
    Syrjanen S. Current concepts on human papillomavirus infections in children. APMIS. 2010;118:494–509.CrossRefGoogle Scholar
  15. 15.
    Medeiros LR, Ethur AB, Hilgert JB, Zanini RR, Berwanger O. Bozzetti MCl, et al. vertical transmission of the human papillomavirus: a systematic quantitative review. Cad Saude Publica. 2005;21:1006–15.CrossRefGoogle Scholar
  16. 16.
    Rintala MA, Grenman SE, Puranen MH, Isolauri E, Ekblad U, Kero PO, et al. Transmission of high-risk human papillomavirus (HPV) between parents and infant: a prospective study of HPV in families in Finland. J Clin Microbiol. 2005;43:376–81.CrossRefGoogle Scholar
  17. 17.
    Syrjanen S. HPV infections in children. Invited review. Papillomavirus Rep. 2003;14:93–110.CrossRefGoogle Scholar
  18. 18.
    Atherton DJ. The aetiology and management of irritant diaper dermatitis. J Eur Acad Dermatol Venereol. 2001;15(Suppl. 1):1–4.CrossRefGoogle Scholar
  19. 19.
    Powell JJ, Wojnarowska F. Childhood vulvar lichen sclerosus: an increasingly common problem. J Am Acad Dermatol. 2001;44:803–6.CrossRefGoogle Scholar
  20. 20.
    Berth-Jones J, Graham-Brown RAC, Burns DA. Lichen sclerosus et atrophicus: a review of 15 cases in young girls. Clin Exp Dermatol. 1991;16:14–7.CrossRefGoogle Scholar
  21. 21.
    Meyrick Thomas RH, Ridley CM, McGibbon DH, Black MM. Anogenital lichen sclerosus in women. J R Soc Med. 1996;89:694–8.CrossRefGoogle Scholar
  22. 22.
    Funaro D. Lichen sclerosus: a review and practical approach. Dermatol Ther. 2004;17:28–37.CrossRefGoogle Scholar
  23. 23.
    Poindexter G, Morrell D. Anogenital pruritus: lichen sclerosus in children. Pediatr Ann. 2007;36:785–91.CrossRefGoogle Scholar
  24. 24.
    Maronn ML, Esterly NB. Constipation as a feature of anogenital lichen sclerosus in children. Pediatrics. 2005;115:230–2.CrossRefGoogle Scholar
  25. 25.
    Priestley BL, Bleehen SS. Lichen sclerosus et atrophicus in children misdiagnosed as sexual abuse. Br Med J. 1987;295:211.CrossRefGoogle Scholar
  26. 26.
    Goodfield MJD, Jones SK, Veale DJ. The connective tissue diseases. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s textbook of dermatology. 7th ed. Massachusetts: Blacwell Publishing Company; 2004. p. 56.119–25.Google Scholar
  27. 27.
    Heymann WR. Lichen sclerosus. J Am Acad Dermatol. 2007;56:683–4.CrossRefGoogle Scholar
  28. 28.
    Serrano G, Millan F, Fortea JM, Grau M, Aliaga A. Topical progesterone as a treatment of choice in genital lichen sclerosus et atrophicus in children. Pediatr Dermatol. 1993;10:201.CrossRefGoogle Scholar
  29. 29.
    Torok E, Orley J, Goracz G, Daroczy J. Lichen sclerosus et atrophicus in children: clinical and pathological analysis of 33 cases. Mod Probl Paediatr. 1975;17:262–71.PubMedGoogle Scholar
  30. 30.
    Bradford J, Fischer G. Long-term management of vulval lichen sclerosus in adult women. Aust N Z J Obstet Gynecol. 2010;50(2):148–52.CrossRefGoogle Scholar
  31. 31.
    Matsumoto Y, Yamamoto T, Isobe T, Kusunoki T, Tsuboi R. Successful treatment of vulvar lichen sclerosus in a child with low-concentration topical tacrolimus ointment. J Dermatol. 2007;34:114–6.CrossRefGoogle Scholar
  32. 32.
    Assmann T, Becker-Wegerich P, Grewe M, Megahed M, Ruzicka T. Tacrolimus ointment for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol. 2003;48:935–7.CrossRefGoogle Scholar
  33. 33.
    Leung AK, Robson WL, Tay-Uyboco J. The incidence of labial fusion in children. J Paediatr Child Health. 1993;29:235–6.CrossRefGoogle Scholar
  34. 34.
    Gaudens DA, Moh-Ello N, Fiogbe M, et al. Labial fusion in the paediatric surgery department of Yopougon University hospital (cote d’Ivoire): 108 cases. Sante. 2008;18(1):35–8.PubMedGoogle Scholar
  35. 35.
    Capraro VJ, Greenberg H. Adhesions of the labia minora. Obstet Gynecol. 1972;39:65–9.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Adriadna Caussade
    • 1
  1. 1.Clínica de Tracto Genital InferiorMontevideoUruguay

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