Prepubertal Vulval Disorders Flashcards

1
Q

What is the definition of vulvovaginitis?

A

Inflammation of the vulva and vagina with associated discharge

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2
Q

What is the commonest gynaecological problem in young girls?

A

Vulvovaginitis

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3
Q

What are the organisms that can cause vulvovaginitis?

A

Group A haemolytic streptococcus
Haemophilus influenzae

Less common
Threadworms
Candida rare in prepuberty, but may be isolated in diabetes, after a recent course of antibiotics or if still wearing nappies

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4
Q

Why are prepubertal girls prone to vulvovaginitis?

A
Thin vaginal mucosa
Alkaline pH
Absence of vulval fat pads
Absence of pubic hair
Close proximity of vagina to anus
Poor hygiene
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5
Q

What is the definition of labial adhesions?

A

Adhesions between the labia minora

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6
Q

What is the incidence of labial adhesions in prepubertal girls

A

1-3%

Never present at birth
Peak incidence is between the first and second year of life

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7
Q

What is the pathophysiology of labial adhesions?

A

Exact cause unknown

Combination of low oestrogen levels and local inflammation

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8
Q

What are the risk factors for labial adhesions?

A

Nappy dermatitis

Poor hygiene

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9
Q

What is the management of vulvovaginitis?

A

Antibiotics if pathogen isolated
General advice on hygiene
Avoidance of irritants - bubble baths, harsh soaps
Loose cotton underwear preferable to tight synthetic underwear
Careful evaluation for sexual abuse

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10
Q

What is the management of labial adhesions?

A

Local oestrogen cream application (daily for 6 weeks)

For severe cases refractory to oestrogen treatment, the labia can be separated surgically under LA or GA
Surgical separation
Oestrogen cream should be used post-operativelyto prevent recurrence

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11
Q

What symptoms are seen with severe labial fusion?

A

Urinary symptoms
As urine accumulates behind the fused labia

Post-micturition dribble
Dysuria
Recurrent UTIs
Urinary retention

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12
Q

What are risk factors for prepubertal lichen sclerosus?

A

Autoimmune disorders
Infections
Local trauma

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