June Week 3 by Dr Turek
A 6 y.o. girl is brought to clinic by her mother for complaints of vaginal itching, burning, and intermittent dysuria for the past 2 weeks. Physical exam reveals vulvar erythema and no discharge.
1. Why is there an increased risk of vulvovaginitis in prepubertal girls?
2. What is the most common cause of vulvovaginitis in prepubertal girls? In postpubertal girls?
3. What if this child also described bleeding? What else would you worry about?
4. Candida is an uncommon cause of vulvovaginitis in prepubertal girls. What predisposing factors would serve to increase this risk?
5. What are the methods used for performing gynecologic exams in prepubertal girls?
6. Lab tests are often not necessary in making the the diagnosis of nonspecific vulvovaginitis. How could a wet prep be helpful if you are unsure of the etiology?
7. You believe this child has nonspecific vulvovaginitis secondary to poor hygiene. What recommendations will you give? What things should she avoid?
8. If this child has not improved with your suggestions and symptoms persist for another 2-3 weeks, what might be the next step?