Pediatric Gyn

Question 1

Pinworm vaginitis

Answer 1

Single dose of mebendazole (Vermox)
100 mg chewable tablet, repeat in 2
weeks

All family members in home can be
treated to improve clearance and prevent
reinfection
 Wash linens/bedsheets
in hot water/bleach

Question 2

peds vulvovaginitis

Answer 2

 Empiric antibiotics reasonable (Amoxicillin, Augmentin,
Bactrim/Septra)
 Negative fungal culture very helpful in convincing
parents not yeast
 Educate about vulvar skin care and contact irritants (see
naspag.org for helpful Pediatric Vulvovaginitis parent
brochure)
 Short course of steroids for inflammation (triamcinolone
0.1% ointment if moderate, clobetasol 0.05% ointment if
severe)
 Antihistamines (non-sedating in AM, sedating at hs)

Question 3

Labial Adhesions of children

Answer 3

Betamethasone 0.05% ointment bid to adhesion line
OR
 Topical estrogen cream AM and hs x 2 weeks, then hs
only for up to 6 additional weeks

Advise to discontinue once completely open and call
for side effects (breast buds, vag bleeding for estrogens;
fine pubic hair, rash/irritation, skin atrophy for steroids)

At follow up visit, most adhesions will have
separated
 If still present, gentle traction +/- lidocaine gel
for topical analgesia will frequently accomplish
separation due to estrogenization of tissues
 If adhesions still too dense/fibrous to allow easy
office separation, consider lysis under
anesthesia

Use lubricated cotton swab to “push” through adhesions
and create an opening

Topical estrogen or steroid ointment for 4-5 days postop
to promote healing

Question 4

Lichen Sclerosus of children

Answer 4

High-potency steroid Clobetasol propionate ointment
0.05% (Temovate) bid for 2 weeks, then once daily for 2
weeks
 Taper to triamcinolone ointment 0.1% bid for 2 weeks,
then daily for 2 weeks
 Finally, hydrocortisone 2% daily to bid and slowly taper
off

Question 5

Ureteral Prolapse

Answer 5

Sitz baths
 Topical estrogen cream
 Rare need for foley catheter due to obstruction
from edema
 If no response to short course of medical therapy
(4-5 days), may need surgical excision of
prolapsed mucosa

Question 6

Adolescents with heavy bleeding

Answer 6

Postmenarchal anovulatory DUB
– PCOS-related anovulatory DUB
– Pregnancy-related bleeding
– Congenital or acquired bleeding disorder (5-15% of
teens/women with menorrhagia, 15% of Caucasians,
1.4% of African-Americans)
 Von Willebrand’s disease (1% population prevalence, 5-
24% of heavy bleeders)
 Thrombocytopenia
 Platelet function abnormalities
 Carrier states for Hemophilia A and B (factor VIII and IX
deficiency)
 Factor VII or Factor XI deficiencies