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BENEATH THE SURFACE

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A 2 year 10 month old previously healthy girl called Lucy was brought to see her general practitioner because of a vaginal discharge that had developed three days previously. Her mother stated that the discharge was first noticed as a green staining on Lucy’s pants. Lucy had been toilet trained with occasional accidents at night, but several weeks before she had started to wet the bed most nights. Her mother mentioned that Lucy had talked about a child next door putting ‘a peg on her bum’.

The GP records showed that Lucy had been an uncomplicated full term normal delivery, and had no previous health concerns. She had undergone routine child health surveillance, which had been normal, and she was up to date with her immunisations.

When he inspected Lucy’s perineum, the GP noticed redness around the labia and a green discharge but no sign of introital injury. He sent a swab of the discharge for bacteriological investigation and started Lucy on topical antibiotics.

In the absence of introital injury or skin disease, the GP considers that the most likely diagnosis is a vulvovaginal infection. In his experience the onset of bed wetting is not unusual in a child of this age and he thinks that this may have caused vulval irritation and infection. He has seen vulvovaginitis in prepubertal girls quite often and decides to treat with topical antibiotics pending the swab (bacteriological) result. He considers that the “peg” episode amounts to normal childhood play.

COMMENT

  • Vulvovaginitis in prepubertal girls is common.1 Presenting symptoms include genital pain, pruritis, dysuria, frequency of micturition, vaginal discharge and vaginal bleeding. Physical signs include inflammation and excoriation of the labia majora, labia minora, clitoris and introitus, and a vaginal discharge. When a discharge is minimal, it may only manifest as stains on underwear. …

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