3 - Gynaecological problems in childhood

Summary

Vaginal discharge is the only gynaecological condition that could be considered common in the prepubertal child and it is certainly the most common paediatric gynaecological problem presenting to the paediatric gynaecologist. Other gynaecological problems seen in this age group include vulval irritation without discharge, labial adhesions and, occasionally, vaginal bleeding. Ambiguous genitalia, tumours and precocious puberty, although less common, warrant individual attention and are covered in the relevant chapters.

Vaginal discharge

The newborn female often has a clear or white odourless vaginal discharge, which is produced as a result of circulating maternal estrogen. Occasionally, in the neonatal period, the discharge may be bloodstained, owing to the breakdown of the endometrium, which has been stimulated by maternal estrogen levels.

As the child gets older, the most common cause of vaginal discharge is bacterial infection, commonly known as vulvovaginitis. Specific infections can occur in association with another focus of infection, such as a sore throat or a viral illness. The child transmits the infection from one part of the body to another digitally. This type of vulval infection causes few concerns, as it tends to resolve with the resolution of the primary infection. Recurrent non-specific infections, however, are difficult to manage. In the majority of cases, bacterial culture shows no growth or organisms of low virulence. Symptoms recur frequently, causing significant distress to both the child and parent, while proving difficult for the doctor to manage. This condition is known as recurrent bacterial vulvovaginitis.