Abstract
Study Objective
To compare clinical characteristics, treatment histories, and microbiology of premenarchal
girls who presented to a pediatric gynecology specialty clinic with short-duration
and chronic vulvar symptoms.
Design
Retrospective cohort study.
Setting
Pediatric and adolescent gynecology clinic at a tertiary care children's hospital.
Participants
One hundred eighty-two premenarchal patients ages 2-14 years who presented to a pediatric
gynecology specialty clinic with vulvar complaints and who were evaluated with a yeast
and/or bacterial culture.
Interventions
None.
Main Outcome Measures
Chronic and short-duration vulvar symptoms, microbiology, and diagnosis.
Results
Patients with chronic symptoms were more likely to present with itching (59/102 (57.8%)
vs 34/80 (42.5%); P = .04), redness or rash (53/102 (52.0%) vs 22/80 (27.5%); P = .0009), and discomfort (59/102 (57.8%) vs 30/80 (37.5%); P = .006), compared with patients with short-duration symptoms. Overall, 44.5% of patients
had a history of antifungal treatment, with a greater proportion of patients with
chronic symptoms having received antifungal treatment compared with those with short-duration
symptoms (53/102 (52.0%) vs 28/80 (35.0%); P = .02). Despite a history of antifungal treatment in nearly half of the patients,
Candida albicans was isolated in only 3/144 (2.1%) yeast cultures. Bacterial vulvar cultures were
positive in 75/159 (47.2%), and there was no difference among the symptom duration
groups (38/71 (53.5%) vs 37/88 (42.1%); P = .15).
Conclusion
Vulvovaginitis is a common gynecological diagnosis among premenarchal girls with short-duration
and chronic vulvar symptoms. Regardless of symptom duration, yeast cultures are rarely
positive. Antifungal treatment should be avoided in toilet-trained prepubertal girls.
Key Words
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References
- Pediatric gynecology: assessment strategies and common problems.Semin Reprod Med. 2003; 21: 329
- Vulvovaginitis in prepubertal girls.Arch Dis Child. 2003; 88: 324
- Vulvovaginitis and other common childhood gynaecological conditions.Arch Dis Child Educ Pract Ed. 2011; 96: 73
- Vulvovaginal problems in the prepubertal child.in: Emans S.J. Laufer M.R. DiVasta A.D. Pediatric and Adolescent Gynecology. 7th ed. Lippincott Williams & Wilkins, Philadelphia2019: 175-193
- Pediatric vulvovaginitis.in: Practical Pediatric and Adolescent Gynecology. John Wiley & Sons, Ltd, Chichester, West Sussex2013: 33-37
- Vulvovaginitis.Pediatr Rev. 2006; 27: 116
- Personal hygiene and vulvovaginitis in prepubertal children.J Pediatr Adolesc Gynecol. 2016; 29: 223
- Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract.Arch Dis Child. 1999; 81: 64
- Urogenital symptoms in premenarchal girls: parents’ and girls’ perceptions and associations with irritants.J Pediatr Adolesc Gynecol. 2012; 25: 67
- Childhood vulvovaginitis and vaginal discharge in general practice.Fam Pract. 1996; 13: 369
- Microbiological findings of vulvovaginitis in prepubertal girls.Postgrad Med J. 2014; 90: 8
- Low prevalence of genital candidiasis in children.Eur J Clin Microbiol Infect Dis. 2004; 23: 696
- Chronic pelvic pain in women.Am Fam Physician. 2016; 93: 380
- Vulvovaginitis in the child and adolescent.Pediatr Rev. 1993; 14: 141
- Differential diagnoses of diaper dermatitis.Pediatr Dermatol. 2018; 35: s10
- Vulvovaginitis—presentation of more common problems in pediatric and adolescent gynecology.Best Pract Res Clin Obstet Gynaecol. 2018; 48: 14
- Clinical and microbiological findings of vulvovaginitis in prepubertal girls.J Pediatr Adolesc Gynecol. 2019; 32: 574
- Clinical recommendation: vulvovaginitis.J Pediatr Adolesc Gynecol. 2016; 29: 673
- Childhood lichen sclerosus--a challenge for clinicians.Pediatr Dermatol. 2013; 30: 444
- 4-year-old girl · genital discomfort and dysuria · clitoral hood swelling · blood blister on the labia minora · Dx?.J Fam Pract. 2019; 68: E8
Article info
Publication history
Published online: November 23, 2020
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
