Vulvar/vaginal pathology

Key points

Labial adhesions

Can manage conservatively

1st line - betnovate

2nd line - oestrogen cream

3rd line - division under anaesthesia

Use steroid cream first -no systemic side effects

Will resolve at puberty

Lichen sclerosis (BXO)

Topical steroids

Resolves at puberty

No evidence for malignancy later in life

Hypertrophic labial hypertrophy

No indication for cosmetic surgery

Can excise/wedge resection if trauma, interferes with daily life

Vulvovaginitis

Hygiene measures only

Antibiotics only for suspected bacterial infection

Vaginal septum

Presents with leakage of menstrual blood/inability to use tampons

Resect if symptomatic

Foreign body

Recurrent brown/bloody discharge

80% is toilet paper

Management: vaginal flush

If fails - EUA

Anogenital warts

Mean age 3-5 years

Can be abuse (50%), vertical transmission, autoinoculation

HPV types not predictive of cause

Referral to safeguarding for all

Spontaneous resolution in 75% at 3-5 years

Podophyllotoxin cream and imiquimod

Recurrence 20-30%

Imperforate hymen

Blue mass at introitus

May have haematocolpos

Management is EUA and cruciate incision + drainage

References

Essentials of Pediatric Urology, 3rd edition, 2022, Chapter 25 Pediatric and Adolescent Gynecology

Succeeding in Paediatic Surgery Examinations Volume 1 2012, Chapter 67 Gynaecological disorders in

children Allen L, Spitzer R