Columbus: pediatric gynecology Flashcards
What factors predispose prepubertal girls to vulvovaginitis?
Hypoestrogenization of genital tissue Minimal fat in labia majora Close proximity to anus Poor toileting hygiene No pubic hair to keep clothing off skin
Describe approach to examining pediatric patients
Frog leg or knee to the chest position
No speculum
Saline moistened small Dacon swabs
Avoid touching the hymen
What history should be considered for vaginal irritation in girls?
Laundry including type of detergent fabric softener and bleach
Bath including soap, baths or showers, rinsing and bubble bath
Clothing such as swimsuits, leotards, leggings or tight pajamas
Toileting including wiping technique, underwear staining, diapers
Any discharge or staining in underwear
How are pinworms treated? What other precautions are needed?
Mebendazole 100 mg tablet, repeat in two weeks
All family members in home can be treated
Wash linens in hot water and bleach
What is the parasite responsible for pinworm vulvovaginitis?
How is it spread?
What are predominant symptoms?
Enterobius vermicularis
Fecal oral spread
Itching worse at night and early morning
What is the most common vaginal foreign body in girls?
How does this present?
How is it treated?
Toilet tissue
Malodorous discharge, brownish blood daily
Apply 2% lidocaine gel to hymen manually, use catheter-in-catheter technique for vaginal irrigation with normal saline
How are pinworms treated?
What other precautions are needed?
Mebendazole 100 mg tablet, repeat in two weeks
All family members in home can be treated
Wash linens in hot water and bleach
How is vulvovaginitis in girls treated empirically?
Antibiotics including amoxicillin, Augmentin, or Bactrim
Vulvar skin care guidelines
Short course of triamcinolone 0.1% ointment for moderate inflammation
Antihistamines, sedating at night
How are labial adhesions managed operatively?
Pretreat with topical estrogen for at least 7 days
Conscious sedation or monitored anesthetic
Lubricated cotton swab to push through opening
Post procedure lidocaine gel
Expect dysuria for 36 hours, use warm bathtub to void if necessary
Topical estrogen for 5 days postop
Avoid irritants to prevent recurrence
How are labial adhesions treated?
Topical estrogen cream twice per day for two weeks then at night for up to six weeks
Discontinue once completely open
Call for estrogen-related side effects
Follow up visit in 2-6 weeks
How is lichen sclerosus treated in girls?
Clobetasol oint 0.05% b.i.d. for 2 weeks, then daily for 2 weeks
Taper to triamcinolone oint 0.1% b.i.d. for 2 weeks, then daily for 2 weeks
Hydrocortisone 2% daily to b.i.d. and slowly taper
May need anabiotic treatment for concomitant bacterial infection
How does lichen sclerosus present in girls?
Intense, intractable itching
May include dysuria, pain, bleeding
“Figure 8 pattern” with pale, fine wrinkled skin
Vaginal sparing
How should parents be counseled about prognosis for lichen sclerosus in girls?
Average flares 2.2 times per year
Flares can be treated with triamcinolone or hydrocortisone
Strict adherence to vulvar skin care guidelines helps prevent scarring
How is penetrating vaginal trauma evaluated?
Examination under anesthesia and possible surgical evaluation to assess for retroperitoneal injury
How does urethral prolapse present?
What ethnic group is most commonly involved?
How was it treated?
Prolapsed intraurethral mucosa beyond the meatus causes constriction with edema and possible necrosis. Patients usually present with spotting, frank bleeding or dysuria
Most common in African-American girls
Treated with sitz baths and topical estrogen cream. Rarely Foley catheterization is needed to relieve obstruction. If no response after five days, may need surgical excision of mucosa