Pediatric/adolescent gyn

Question 1

what are classification for vulvovaignitis in peds/adolescent?

Answer 1

• non-specific

- infectious

Question 2

how do you diagnose non-specific vulvovaginitis?

Answer 2

• diagnosis of exclusion

- history and physical

Question 3

treatment non-specific vulvovaginitis?

Answer 3

perineal hygeine

• wiping front to back after BM
• sitz baths
• cotton underwear/loose fitting clothing

Question 4

what are infectious causes of vulvovaginitis in PAG?

Answer 4

both respiratory and fecal source

• group A strep
• strep pyogenes
• H. influenza
• e. Coli
• Shigella
• yersinia
• pinworms (enterobiasis) -> scotch tape test-> tx with mebendazole

always consider G/C/T
in girls, GC needs to be cx not NAAT

Question 5

management of labial adhesions?

Answer 5

• if asymptomatic -> observe with emphasis on vulvar hygeine
• if symptomatic:
  topical estrogen twice daily x 6 weeks (rub cream into line of scar with qtip and gentle lateral traction of labia)

if severely symptomatic:

• can consider manual release with topical anesthetic
• surgical intervention

post-release care: bland emollient on labia to maintain separation

Question 6

what is differential for vulvar conditions of PAG?

Answer 6

non-infectious

• lichen sclerosus
• lichen simplex chronicus, atopic or contact dermatitis
• labial adhesions

infectious

• molluscum contagiosum
• hsv
• condyloma accuminata

Question 7

how do you diagnose/treat molluscum contagiosum?

Answer 7

• clinical impression: 1-5 mm plaque like, dome shaped, smooth, “umbilicated lesion”
• typically due to overcrowded/hygeine
• usually observation
• if tx needed, can try cryosurgery, silver nitrate, curettage, imiquimod approved for age > 12

Question 8

how to manage condyloma accuminata in PAG?

Answer 8

• can be perinatal transmission of HPV, but have to consider sexual abuse
• observation if possible
• if tx desired: destructive or excisional options; topical immiquimod age > 12
• high recurrence rate

Question 9

HSV in PAG

Answer 9

beyond neonatal period, sexual abuse has to be considered

- acyclovir approved in children over 2 years

Question 10

lichen sclerosus diagnosis and management in PAG?

Answer 10

• diagnosis by exam. treat with high dose topic corticosteroid. if persistent or lesion is atypical, only then bx. if failed corticosteroid, can try topical calcineurin inhibitor (tacrolimus, pimecrolimus)
• high risk of recurrence after stopping treatment up to 80%
• unknown cancer risk
• recommended surveillance q6-12 mo
• evaluation for other autoimmune conditions