Pediatric and adolescent gynecology

focuses on a unique subset of gynecologic

disorders among younger females.
 Introduction

• In the pediatric patient, gynecologic issues often present as vulvar and

vaginal problems,
• while
• in the adolescent patient, complaints of abdominopelvic pain and
abnormal menstrual bleeding commonly result in a gynecologic evaluation.
Vulvovaginitis

• Inflammation of the vulvar and vaginal tissues and complaints of vaginal

discharge are common gynecologic problems.
• In children, the hypoestrogenic state of the vagina contributes to the
susceptibility of infection. The vaginal mucosa is thin and the vagina
has an alkaline pH, making it different from the vagina of adolescents
and adults. Children are also at an increased risk from behavioral
aspects, such as poor perineal hygiene leading to fecal contamination,
poor hand washing, and frequent play that can allow dirt or sand to
cause irritation or infection. A child may present with discharge,
irritation, pruritis, urinary symptoms, abnormal odor or erythema of
the vulva.[1,2]
• In adolescents, the increase in estrogen further develops the vaginal
epithelium, making it more resistant to infection. Vaginitis, cervicitis
and salpingitis are therefore more common than vulvovaginitis in this
age group.[3]
• Initial history should include home remedies, prescription creams or other medications that may have already
been used. Medical history of eczema, contact dermatitis, other recent upper respiratory, pharyngeal or
gastrointestinal infections, and diabetes should also be assessed. The question of sexual abuse should not be
overlooked, and when indicated, a review of the social situation should be conducted to record who is
involved or comes in contact with the child on a daily basis. [1] After a complete physical examination, a
genital examination can be performed in the frog-leg or knee-chest position, and using a sterile moist swab,
samples should be obtained for Gram stain, wet mount, and aerobic and anaerobic cultures. [4] When obtaining
samples, a smaller caliber urethral swab is better tolerated than a typical cotton-tipped swab. In children who
are not cooperative with examination, an examination under anesthesia with or without vaginoscopy can help
facilitate the diagnosis.[5]