Abstract
Pediatric and adolescent patients may present to the emergency room with vulvovaginal bleeding, pruritus, or lesions. This chapter presents a broad differential diagnosis for vulvovaginal complaints in this population, subdivided by conditions presenting with bleeding, vesicles, ulcers or masses, and infectious versus noninfectious etiologies. Diagnostic approaches are provided for specific presenting complaints, as well as management methods for a range of conditions, including but not limited to vaginal foreign bodies, vulvovaginitis, lichen sclerosis, infections (bacterial, protozoan, fungal, and viral), Lipschutz ulcers, labial adhesions and urethral prolapse.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Emans SJ. Chapter 4. Vulvovaginal problems in the prepubertal child. In: Emans SJ, Laufer MR, editors. Pediatric and adolescent gynecology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
Jones JG, Worthington T. Genital and anal injuries requiring surgical repair in females less than 21 years of age. J Pediatr Adolesc Gynecol. 2008;21:207–11.
Iqbal CW, Jrebi NY, Zielinski MD, Benavente-Chenhalls LA, Cullinane DC, Zietlow SP, et al. Patterns of accidental genital trauma in young girls and indications for operative management. J Pediatr Surg. 2010;45:930–3.
Klaassen Z, Go PH, Mansour EH, Marano MA, Petrone SJ, Houng AP, et al. Pediatric genital burns: a 15-year retrospective analysis of outcomes at a level 1 burn center. J Pediatr Surg. 2011;46:1532–8.
Bercaw-Pratt JL, Boardman LA, Simms-Cendan JS, North American Society for Pediatric and Adolescent Gynecology. Clinical recommendation: pediatric lichen sclerosus. J Pediatr Adolesc Gynecol. 2014;27:111–6.
Simpson RC, Murphy R. Paediatric vulvar disease. Best Pract Res Clin Obstet Gynaecol. 2014;28:1028–41.
Rome ES. Vulvovaginitis and other common vulvar disorders in children. Endocr Dev. 2012;22:72–83.
Mok-Lin EY, Laufer MR. Management of vulvar hematomas: use of a word catheter. J Pediatr Adolesc Gynecol. 2009;22:e156–8.
McCann J, Miyamoto S, Boyle C, Rogers K. Healing of nonhymenal genital injuries in prepubertal and adolescent girls: a descriptive study. Pediatrics. 2007;120:1000–11.
Stricker T, Navratil F, Sennhauser FH. Vaginal foreign bodies. J Paediatr Child Health. 2004;40:205–7.
Huppert J, Griffeth S, Breech L, Hillard P. Vaginal burn injury due to alkaline batteries. J Pediatr Adolesc Gynecol. 2009;22:e133–6.
Sahn EE, Bluestein EL, Oliva S. Familial lichen sclerosus et atrophicus in childhood. Pediatr Dermatol. 1994;11:160–3.
Smith YR, Quint EH. Clobetasol propionate in the treatment of premenarchal vulvar lichen sclerosus. Obstet Gynecol. 2001;98:588.
Chi CC, Kirtschig G, Baldo M, Brackenbury F, Lewis F, Wojnarowska F. Topical interventions for genital lichen sclerosus. Cochrane Database Syst Rev. 2011;CD008240.
Fischer GO. Vulvar disease in pre-pubertal girls. Australas J Dermatol. 2001;42:225–36.
Lysell J, Tessma M, Nikamo P, Wahlgren CF, Ståhle M. Clinical characterisation at onset of childhood psoriasis – a cross sectional study in sweden. Acta Derm Venereol. 2015;95:457–61.
Gudjonsson JE, Elder JT. Chapter 18. Psoriasis. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=392&Sectionid=41138713. Accessed 25 May 2015.
Samarasekera E, Sawyer L, Parnham J, Smith CH, Guideline Development Group. Assessment and management of psoriasis: summary of NICE guidance. BMJ. 2012;345:e6712.
Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, et al. Chapter 4. Benign disorders of the lower reproductive tract. In: Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, Calver LE, editors. Williams gynecology. 2nd ed. New York: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=399&Sectionid=41722292. Accessed 25 May 2015.
Committee on Infectious Diseases, American Academy of Pediatrics. Larry K. Pickering, MD, FAAP, ed. 2012. Red Book®: 2012 Report of the Committee on Infectious Diseases – 29th Ed. Printed in the United States of America. American Academy of Pediatrics. ISBN-10: 1-58110-703-X, ISBN-13: 978-1-58110-703-6. ISSN: 1080–0131. STAT!Ref Online Electronic Medical Library. http://online.statref.com.ezp-prod1.hul.harvard.edu/Document.aspx?fxId=76&docId=167. Accessed 21 June 2015.
2015 STD Treatment Guidelines. Centers for Disease Control and Prevention website. http://www.cbc.gov/std/tg2015/default.htm. Updated October 21, 2015. Accessed February 12, 2016.
Straumanis JP, Bocchini Jr JA. Group A beta-hemolytic streptococcal vulvovaginitis in prepubertal girls: a case report and review of the past twenty years. Pediatr Infect Dis J. 1990;9:845–850.
Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, et al. Chapter 14. Pediatric gynecology. In: Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, Calver LE, editors. Williams gynecology. 2nd ed. New York: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=399&Sectionid=41722302. Accessed 24 May 2015.
Murphy TV, Nelson JD. Shigella vaginitis: report in 38 patients and review of literature. Pediatrics. 1979;63:511–6.
Jasper JM, Ward MA. Shigella vulvovaginitis in a prepubertal child. Pediatr Emerg Care. 2006;22:585–6.
Khan WA, Seas C, Dhar U, Salam MA, Bennish ML. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. A double-blind, randomized, controlled trial. Ann Intern Med. 1997;126:697–703.
Farrell MK, Billmire ME, Shamroy JA, Hammond JG. Prepubertal gonorrhea: a multidisciplinary approach. Pediatrics. 1981;67:151–3.
Ingram DL, Everett VD, Lyna PR, White ST, Rockwell LA. Epidemiology of adult sexually transmitted disease agents in children being evaluated for sexual abuse. Pediatr Infect Dis J. 1992;11:945–50.
Muzny CA, Schwebke JR. The clinical spectrum of Trichomonas vaginalis infection and challenges to management. Sex Transm Infect. 2013;89:423–5.
Xu F, Lee FK, Morrow RA, Sternberg MR, Luther KE, Dubin G, et al. Seroprevalence of herpes simplex virus type 1 in children in the United States. J Pediatr. 2007;151:374–7.
Bradley H, Markowitz LE, Gibson T, McQuillan GM. Seroprevalence of herpes simplex virus types 1 and 2–United States, 1999–2010. J Infect Dis. 2014;209:325–33.
Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L. Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years–United States, 1988 to 2010. Sex Transm Dis. 2013;40:860–4.
Reading R, Rannan-Eliya Y. Evidence for sexual transmission of genital herpes in children. Arch Dis Child. 2007;92:608–13.
Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF. The epidemiology of molluscum contagiosum in children. J Am Acad Dermatol. 2006;54:47–54.
Chen X, Anstey AV, Bugert JJ. Molluscum contagiosum virus infection. Lancet Infect Dis. 2013;13(10):877–88.
Herman BE, Corneli HM. A practical approach to warts in the emergency department. Pediatr Emerg Care. 2008;24:246–51.
Allen AL, Siegfried EC. The natural history of condyloma in children. J Am Acad Dermatol. 1998;39:951–5.
Jansen KU, Shaw AR. Human papillomavirus vaccines and prevention of cervical cancer. Annu Rev Med. 2004;55:319–31.
Kellogg N, American Academy of Pediatrics Committee on Child Abuse and Neglect. The evaluation of sexual abuse in children. Pediatrics. 2005;116:506–12.
Moresi JM, Herbert CR, Cohen BA. Treatment of anogenital warts in children with topical 0.05% podofilox gel and 5% imiquimod cream. Pediatr Dermatol. 2001;18:448–50.
Huppert JS, Gerber MA, Deitch HR, Mortensen JE, Staat MA, Adams Hillard PJ. Vulvar ulcers in young females: a manifestation of aphthosis. J Pediatr Adolesc Gynecol. 2006;19:195–204.
Farhi D, Wendling J, Molinari E, Raynal J, Carcelain G, Morand P, et al. Non-sexually related acute genital ulcers in 13 pubertal girls: a clinical and microbiological study. Arch Dermatol. 2009;145:38–45.
Sehgal VN, Pandhi D, Khurana A. Nonspecific genital ulcers. Clin Dermatol. 2014;32:259–74.
Rosman IS, Berk DR, Bayliss SJ, White AJ, Merritt DF. Acute genital ulcers in nonsexually active young girls: case series, review of the literature, and evaluation and management recommendations. Pediatr Dermatol. 2012;29:147–53.
Huppert JS. Lipschutz ulcers: evaluation and management of acute genital ulcers in women. Dermatol Ther. 2010;23:533–40.
Leu S, Sun PK, Collyer J, Smidt A, Stika CS, Schlosser B, et al. Clinical spectrum of vulva metastatic Crohn’s disease. Dig Dis Sci. 2009;54:1565–71.
Granada C, Sokkary N, Sangi-Haghpeykar H, Dietrich JE. Labial adhesions and outcomes of office management. J Pediatr Adolesc Gynecol. 2015;28:109–13.
Mroueh J, Muram D. Common problems in pediatric gynecology: new developments. Curr Opin Obstet Gynecol. 1999;11:463–6.
Muram D. Treatment of prepubertal girls with labial adhesions. J Pediatr Adolesc Gynecol. 1999;12:67–70.
Heller DS. Lower genital tract disease in children and adolescents--a review. J Pediatr Adolesc Gynecol. 2005;18:75–83.
Kaplowitz PB, Oberfield SE. Reexamination of the age limit for the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Execute Committees of the Lawson Wilkins Pediatric Endocrine Society. Pediatrics. 1999;104:936–41.
Muir A. Precocious puberty. Pediatr Rev. 2006;27:373–81.
Ejaz S, Lane A, Wilson T. Outcome of isolated premature menarche: a retrospective and follow-up study. Horm Res Paediatr. 2015;84:217–22.
Gray SH, Emans SJ. Abnormal vaginal bleeding in adolescents. Pediatr Rev. 2007;28:175–82.
Deligeoroglou E, Tsimaris P. Menstrual disturbances in puberty. Best Pract Res Clin Obstet Gynaecol. 2010;24:157–71.
Durbin KL, Diaz-Montes T, Loveless MB. Van wyk and grumbach syndrome: an unusual case and review of the literature. J Pediatr Adolesc Gynecol. 2011;24:e93–6.
Gordon CM, Austin DJ, Radovick S, Laufer MR. Primary hypothyroidism presenting as severe vaginal bleeding in a prepubertal girl. J Pediatr Adolesc Gynecol. 1997;10:35–8.
Kondamudi NP, Gupta A, Watkins A, Bertolotti A. Prepubertal girl with vaginal bleeding. J Emerg Med. 2014;46:769–71.
Cezarino BN, Lopes RI, Oliveira LM, Dénes FT, Srougi M. Diagnostic work-up and laparoscopic correction of an ectopic ureter. J Pediatr Urol. 2015;11:285–6.
Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. N Engl J Med. 1999;341:173–81.
Halbert AR, Chan JJ. Anogenital and buttock ulceration in infancy. Australas J Dermatol. 2002;43:1–6.
Morelli JG, Tan OT, Yohn JJ, Weston WL. Treatment of ulcerated hemangiomas in infancy. Arch Pediatr Adolesc Med. 1994;148:1104–5.
Lee J, Sinno H, Tahiri Y, Gilardino MS. Treatment options for cutaneous pyogenic granulomas: a review. J Plast Reconstr Aesthet Surg. 2011;64:1216–20.
Barasoain-Millán A, Rodriguez-Contreras FJ, Guerrero-Fernandez J, Merino MB, Gonzalez-Casado I. Pyogenic granuloma, an unusual presentation of peripubertal vaginal bleeding. Case report and review of the literature. J Pediatr Endocrinol Metab. 2015;28:443–7.
Arora M, Shrivastav RK, Jaiprakash MP. A rare germ-cell tumor site: vaginal endodermal sinus tumor. Pediatr Surg Int. 2002;18:521–3.
Hilgers RD, Malkasian GD Jr, Soule EH. Embryonal rhabdomyosarcoma (botryoid type) of the vagina. A clinicopathologic review. Am J Obstet Gynecol. 1970;107:484–502.
Arndt CA, Donaldson SS, Anderson JR, Andrassy RJ, Laurie F, Link MP et al. What constitutes optimal therapy for patients with rhabdomyosarcoma of the female genital tract? Cancer. 2001;91:2454–68.
Gelmetti C. Chapter 147. Cutaneous Langerhans cell histiocytosis. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=392&Sectionid=41138869. Accessed 23 May 2015.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Brady, P.C. (2016). Vulvovaginitis and Vaginal Bleeding in Pediatric and Adolescent Patients. In: Handbook of Consult and Inpatient Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-27724-0_11
Download citation
DOI: https://doi.org/10.1007/978-3-319-27724-0_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-27722-6
Online ISBN: 978-3-319-27724-0
eBook Packages: MedicineMedicine (R0)