Paediatric vulval conditions

In this episode we have a case based discussion with Dr Saman Moeed, covering 4 common paediatric vulval conditions. Vulvovaginitis, labial fusion, vulval pain, lichen sclerosis and worms.

Topics

intro
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Case 1
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What else do we need to know?
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Examination
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Do we need to order any tests?
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Why do girls get vulvovaginitis
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What is the treatment
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Thoughts on Bubblebath and talcum powder
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Case 2
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How can we differentiate between fusion and agenesis?
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What is the cause of labial fusion?
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What do we need to do?
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Would recurrent UTI’s change our management?
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What are the indications for surgery?
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Case 3
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Can young girls get lichen sclerosus?
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What else may we see on examination?
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What causes lichen sclerosus?
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Do we need to confirm this with a biopsy?
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What is the treatment?
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What is the prognosis and outcome?
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How do worms present?
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What are some other causes of vulval pain?
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Case 4
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We are seeing increasing requests for labiaplasty. What is going on?
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18:17
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Take-home messages
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Take home messages

Paediatric vulvovaginitis is common in pre-pubertal girls and generally responds to simple measures
Vulvovaginal candidiasis rarely occurs in the absence of estrogen (i.e. prior to breast budding)
Shooting vaginal pain can be a sign of worms & girls frequently need more than a single treatment
Labial fusion usually resolves spontaneously and only requires treatment if there are frequent UTIs or retention
Labiaplasty is rarely medically indicated and should be deferred until adulthood.

Resources

Vulval and Vaginal Conditions Royal Children's Hospital Melbourne
Threadworm Healthify
Are my labia normal? Labia Library
Vulvovaginitis Royal Children's Hospital Melbourne
Labial fusion Royal Children's Hospital Melbourne
So what is a vulva anyway booklet (pdf) The British Society for Paediatric and Adolescent Gynaecology

Presenter

Saman Moeed

Paediatric & Adolescent Gynaecologist

Dr Saman Moeed, BSc, BHB, MBChB, PGDipObstMedGyn, FRANZCOG Saman is a New Zealand-trained obstetrician and gynaecologist, and New Zealand's only fellowship-trained paediatric & adolescent gynaecologist. She worked at the Royal Children's Hospital Melbourne and is currently Service Clinical Director of Secondary Gynaecology at National Women's Health, Te Toka Tumai Auckland, and works in private gynaecology practice at Omnicare Women's Health.

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The Goodfellow Unit podcast is funded in part by the Royal New Zealand College of General Practitioners.