Paediatric Gynaecology

Question 1

What are common differentials to include in paediatrics for someone with PV discharge?

Answer 1

• vulvovaginitis
• foriegn body
• STI
• trauma
• Crohn’s
• Pinworms

Question 2

What are some common differentials for vaginal bleeding?

Answer 2

• severe vaginitis
• foriegn body
• trauma
• lichen sclerosus
• urethral prolapse
• sarcoma btryoides
• precocious puberty

Question 3

What would you do for examination of a paediatric gynaecology case?

Answer 3

General:

• exam/height/weight/obs/head/neck /chest

Genital Inspection:

• parent consent - child consent not extremely necessary
• frog leg position - mother’s lap may be more comfortable
  
  • knee chest may be appropriate
• can get a view of lower vagina with labial traction
• don’t insert anything
• be specific about anatomy (neonates, effect of oestrogen and neonatal minipuberty)

Question 4

What is Vulvovaginitis and how does it present?

Answer 4

• inflammation/irritation of the vagina/vulva common in most girls
• can cause:
  
  • itching
  • discharge
  • redness of the skin between labia majora
  • dysuria
• contributing factors:
  
  • thin vaginal mucosa (prepubescent)
  • moisture (synthetic fibre underwear)
  • irritants (soap, residue, bubble baths, antiseptics)

Question 5

What investigations would you consider for vulvovaginitis?

Answer 5

• mild not necessary
• if discharge is profuse/offensive:
  
  • introital swab (not vaginal)
  • sometimes one organism and treatment with an appropriate antibiotic will help.
  • candida is unusally from 2years-puberty

Question 6

What is the treatment of vulvovaginitis?

Answer 6

• mild - no Tx, severe referral
• explain with reassurance (not thrush) - go away when oestrogen HPA activates at 8years.
• avoid causal factors:
  
  • wear loose clothes
  • control weight
  • don’t overwash
  • limit intense activities that pub pressure on the vulva (e.g. bike riding)
• soothing creams (e.g. soft parafin, nappy rash creams)
• avoid itching with cool compresses