Vulval disorders in Paeds and adolescents TOG 2023

Question 1

Anatomy of vulva in young patient

Answer 1

Hypoestogenism, atrophic
Ph neutral absence of lactobacillus
Close proximity recutum

@ puberty vaginal pH become more acidic & increasing oestrogen levels

Question 2

Focused Hx for vuvlal disorders

Answer 2

Question 3

Can vaginal swabs be taken from children

Answer 3

Only from perineum or fourchette if vaginal swabs taken should be done under GA

Question 4

Most common Dx if yong patients with vulval symptoms?

Answer 4

Vulvovaginitis

Question 5

Most common presenting symptoms in Vulvovaginitis

Answer 5

vulval erythema
Peak age 3-7 years old

Question 6

Most common cause of Vulvovaginitis in children

Answer 6

80% non infectious - dermatosis or cmehcial irritant

Question 7

Most common infectious organisms

Answer 7

E coli, Group A strep, Strep, Haemostasis influenza

• Gut/resp bateria

Question 8

Vaginal yeast infection should raised suspicion of what conditions in children?

Answer 8

Immunocomprimsed
DM

Question 9

STI disease should raise suspicion of what in children?

Answer 9

Safeguarding concerns

Question 10

Management for vulvovaginitis

Answer 10

Often resolves as reaches puberty

Question 11

What proportion of lichen sclerosis if Dx in children?

Answer 11

7-15%, peal prepubertal girls

Question 12

What proportion of girls with LS will have 1st degree relative with this condition?

Answer 12

10%

Question 13

What proportion of girls will LS will experience symptomatic relief at menarche?

Answer 13

75%
Latent relapsed in 2/3

Question 14

How can LS present

Answer 14

vulval symptoms include pruritus, bleeding, pain, burning, dysuria and painful defaecation.

Hallmark signs are of white, demarcated, thin lesions in a classic figure-of-eight pattern involving the labia minora, clitoral hood and perianal region, excluding the hymen and vaginal mucosa

Question 15

Treatment of LS in young patients?

Answer 15

Topical steroid clobetasol propionate 0.05% or betamethasone valerate 0.05% in combination with an emollient.

Close FU every 6 months

Question 16

How common are labial adhesions?

Answer 16

2-39% from 3 months to 3 years, mostly asymptomatic

Some urinary Sx

Question 17

Treatment for labrial adhesions

Answer 17

Conservative as all cases resolve at puberty

If symptmaoc small amount of topical estrogen cream 2 x weekly, 80% success

Surgical separation almost never required

Question 18

Most common cause of cliteromegaly?

Answer 18

CAH 21 hydroxalst defieicny 90%

Question 19

What can be surgical management be offered for imperforate hymen? What can be give after surgery to prevent healing wound edges?

Answer 19

perform when tissue estrogneised post puberty

Topical estrogen

Question 20

How can urethral protrusion present? Cause

Answer 20

Bloodstain discharge, dysuria, straining @ micturition

Increased intra-abdominal pressure - cough, overweight constipation

Question 21

How to manage infantile perineal pyramidal protrusion?

Answer 21

Conservative - usually resolves 1-3 months

Question 22

Most communal vulval trauma?

Answer 22

80% straddle injury

Question 23

Most common HPV causing any-gential warts in
1) Young patients
2) Paeds and adolescent

Answer 23

1) Young patients HPV 1-4
2) Paeds and adolescent HPV 6,11(sexual contact)

Question 24

Incubation of HPV?

Answer 24

8 weeks to 19 months and can lay dormant for years

Question 25

Management of anogenital warts in children?

Answer 25

Conservative, 50% resolve spontaneously.

If does not resolve - cryotherapy, medical Tx imiquimod/podophyllin