Vulvovaginal Complaints in the Prepubertal Patient: An Update

Background: Vulvovaginal complaints account for the majority of childhood visits to gynecologists. In these cases, patients most commonly present with nonspecific complaints including itching, vaginal bleeding, vulvar pain or dysuria. Because of the nonspecific nature of the presenting complaints, patients are frequently misdiagnosed or over-treated.

Recent Findings: The etiology of pediatric vulvovaginitis is often nonspecific; however vaginitis in prepubertal girls may also have other treatable causes that are inflammatory (i.e. lichen sclerosus), anatomic (i.e. labial adhesions) or infectious (genital ulcers) in nature. These conditions are particularly common prior to puberty due to the hypoestrogenic vulvovaginal tissue of the girls in this age group as well as their prepubertal anatomy.

Conclusion: Providers should be aware of normal prepubertal vulvovaginal anatomy as well as the most common etiologies of vulvovaginal complaints in this age group. Most of these conditions can be addressed safely on an outpatient basis if clinicians are able to appropriately diagnose them in a timely manner.