CHA PTE R 15 1
Genital Disease in Children
Gayle 0.Fischer
Th< Nonh<m Onal School Th< Un- of S,dn<y.Sid"'Y. Austral;,
Introduction, 151.1 Blisters and ulcers, 151.12
Inflammatory dermatoses of the genital Anatomical abnormalities, 151.16
region, 151.2 f.oroign bodies , 151.19
Birthmarks of the genital iirea. 151.5 Neoplasia, 151.20
Non·sexually acquired genital infections in
children. 151.B
Introduction
Genital skin disease in children is less common than in
adults and although many of the cond itions that affect
adults also affect child ren, there arc some important dif.
fercnces between the two groups. Inboth adults and chil·
dren of either sex, dermatitis and psoriasis are the most
common causes of a chronic genital rash, and in females
lichen sclerosus is also common [1]. However, acute,
recu rrent and chronic candidiasis are important compo-
nents of female adult vulva! disease that are not seen in
the non-oestrogenized vulva and vagina of the child, and
tinea of the groin, which is relatively common in men, is
rare in children (2(. Birthmarks of the genital area, par-
ticularly haemangiomas, arc an important issue in chil·
dren but not in adults, in whom they are likely to have
resolved long ago or have been diagnosed. Fusion of the
labia is a self-lim iting condition seen i n small girls but it
is seen in adults only in the setting of lichen sclerosus or
severe lichen planus. Group A 13-haemolytic streptococcal
vulvovaginitis, balanitis and perianal cellulitis are dis-
eases that affect mainly children but, apart from this,
infective genital disease is rare in children. Sexual abuse
is always an issue to be considered in any genital presen-
tation in children but, in fact, is rarely a cause of genital
skin disease.Malignancy of the skin of the genital skin is
also very rare in children, as opposed to ad ults,in whom
it is a real, if relatively uncommon, concern.
Within the paedia tric age group, gen ital skin disease
appears to be more common in girls than in boys. Very
Harptr's Textbookof Prdiatric Dm1wtology, 3rdedition. Edited by
A. Irvine,P.Hoeger and A. Yan. e2011 Blackwell Publishing Ltd.
Scrotal conditions, 151.22
G.nital signs of systemic diseas•, 151.23
Psychologial aspects of genital disease in
children, 151.24
little work on the specific subject of paediatric genital
disease has been published. Most of what exists focuses
on infective conditions, anatom ical abnorma lities and
tumours. Anatomica l abnorma lities and tumours are in
fact very rare in everyday practice, and even infection is
unusual.
In articles on paediatric vulva! d isease, it is often
asserted that the skin of the prepubertal vulva is fragile
and sensitive because it is poorly ocstrogcnizcd. In fact,
there is no evidence to back this up.It is physiological for
a child's \'Ulva to be low in oestrogen, and the fact that
child ren have much less trouble with vulva! rashes than
do adu lts does not support the assumption that vulva !
skin of a child is prone to disease.The presence of oestro-
gen is in fact a liability tha t predisposes to the vaginitis,
particularly cand idiasis,seen in adults.Furthermore, oes-
trogen creams are often very irritating when applied to
children.
Another common assertion is that genital and perianal
disease in children is due to 'poor hygiene' and 'faecal
contamination' . This is a facile statement that is also
poorly supported, and which trivia lizes and stigmatizes
this problem . In fact, mothers of small children are usua lly
highly conscientious about genital hygiene and are more
likely to be doing more washing than is necessary rather
than too little.
Vulvovaginitis (in more detail) and lichen sclerosus are
discussed in Chapter 152.
References
1 F"lSChe:r CO. The commonest Glwes or symptomatic vulval disease: a
derm.Hologis(s penpective.AustralM J Derrnatol 1996;37:12-18.
2 Fischer CO, Rogers M. Vulvar disease in children: a clinical audit of
130 ca<es. Pe.Hair Dermatol 2000;17:1-6.