Pediatric Gynaecological problems

Certain gynaecological problems are confined to Pediatric population i.e. from birth to adolescence. In children the most common gynaecological problems are those related to vulva and vagina.

Vulvovaginitis – It is the inflammation or infection of the vulva and the vaginal tissues caused by bacteria, fungi, or parasites and also thread worms. Use of irritants such as perfumed soaps, bubble baths, and antiseptics also cause vulvovaginitis. Itching, burning sensation, vaginal discharge, and redness of the labia are the some of the symptoms observed in young girls. Tight clothes will worsen the condition because of the moisture around the vulva which may promote the growth of pathogens.

Mild condition will improve once your child reaches puberty. Maintaining hygiene will help to prevent the infections. Avoid use of tight inner wear, teach children to wash hands before and after using bathroom, avoid bubble baths, and use of antiseptics for baths. Topical applications of clotrimazole, mycostatin and soothing creams such as soft paraffin, nappy rash creams may provide relief from rashes. Surgical treatment is very rarely advised in children with vulvovaginitis.

Labial adhesions – Labial folds are the two folds of the skin that cover the vagina from outside and labial adhesion is the fusion of the labial folds. It occurs after an infection and/or inflammation. Estrogen deficiency, vulvovaginitis, and inflammation of labia because of wet diapers, perfumed soaps or tissues may cause labial adhesion. This condition will be resolved once your child reaches puberty and does not require treatment unless your child has difficulty while urinating or develop urinary tract infection.

Estrogen containing cream, premarin, may be used to treat labial adhesion. Following separation of folds lubricants may be advised. Avoid using perfumed soaps and apply petroleum jelly after a diaper change to prevent irritation. In rare cases surgery, labioplasty may be required.

Imperforate Hymen – The membrane that surrounds the vagina is called as hymen. In imperforate hymen, the hymen extends out of the vagina blocking the vaginal opening. Extended hymen will appear bulged membrane. It is caused by accumulation of mucous and blood secretions that were not drained out during embryonic development. Children with imperforate hymen may have abdominal pain and difficulty in urination.

Hymen blockage will be corrected by surgery where a vertical incision is made on the bulge and the hymen tissues are removed.

Genital warts – It is also referred to as ‘Condyloma acuminata’ which is caused by human papilloma virus. They are fleshy tumours that grow inside the vulva region. In children who are less than 3 years, genital warts are transmitted from mother to child at the time of birth. Sexual abuse may also be the cause for genital warts in children aged less than 3 years. If left untreated it may lead to cancer and other problems.

Various treatment options are available such as Treatment for genital warts includes laser treatment, cryotherapy, electrodessication; use of medications such as Imiquimod and interferon alfa-n3; and surgical excision.

Precocious Puberty – Precocious puberty is the condition where child shows signs of puberty early in life, before the age of 7 or 8 years. Precocious puberty is caused by genetic problems, brain injuries, and from tumours which releases the human chorionic gonadotropin hormone. These children exhibit early growth of arm pit hairs and pubic hairs, breasts development, onset of menstruation, maturation of genitals, and quick growth in height. Precocious puberty may have socially and emotional impact on the child.

Treatment approach is to removal of tumour or hormone therapy for lowering the hormone levels. Hormonal preparations containing luteinizing hormone
releasing hormone are used to treat the condition. This drug blocks the production of the sex hormones and helps in decreasing the breast size, height, and makes the body growth and behaviour normal.

Vulvitis – It is inflammation of the vulva, soft tissue folds outside the vagina. This condition results from an infection by bacteria, virus, injuries, allergies, and irritants such as scented toilet paper, perfumed soaps, or bubble baths, synthetic undergarments, hot tub bath, and others. It is most common condition occurring in pre-pubertal girls. The symptoms include redness, swelling of labia, itching, burning sensation, and fluid-filled blisters.

Your doctor may advise to avoid irritants that provoke vulvitis, prescribe hydrocortisone creams and suggest sitz baths which will provide symptomatic relief.

Urethral prolapse – It occurs when the inner lining of the urethra (an opening to pass out urine) protrudes out, which appears as a bright red mass above the urethral opening. It is commonly observed in pre-pubertal girls because of low levels of estrogen hormone. Urethral prolapse may also be caused by other disease conditions such as severe cough, constipation, urinary tract infections, obesity, and trauma because these conditions increase pressure on the stomach causing urethral prolapse. You may observe blood in your child’s diaper and very often your child may feel pain and discomfort during urination

Treatment for urethral prolapsed includes oestrogen cream, premarin, use of sitz baths, and antibiotics if the infection is by bacteria. Surgery will remove the prolapse tissue after which primarin cream and sitz baths will be recommended to provide relief.

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