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This Article Full Text Full Text (PDF) Take the CME quiz: Vol. 27 No. 6, June 2006 Suggested Reading Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sugar, N. F. Articles by Graham, E. A. Search for Related Content PubMed Articles by Sugar, N. F. Articles by Graham, E. A. Related Collections Adolescent Medicine/Gynecology Growth and Development

(Pediatrics in Review. 2006;27:213-223.)
© 2006 American Academy of Pediatrics

Common Gynecologic Problems in Prepubertal Girls

Naomi F. Sugar, MD^*
Elinor A. Graham, MD, MPH

^* Clinical Associate Professor, Department of Pediatrics, Division of General Pediatrics, University of Washington, Seattle, Wash
Associate Professor, Department of Pediatrics, Division of General Pediatrics, University of Washington, Seattle, Wash

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Describe techniques to perform an adequate and gentle genital examination in a school-age girl.
   
2. Discuss the differential diagnosis for vaginal bleeding in the prepubertal girl.
   
3. Identify a strategy to diagnose and treat vaginitis in the prepubertal child.
   

	Introduction

 
Assessing gynecologic symptoms and signs in prepubertal children can be a challenge for pediatricians. Adult pelvic examinations are a standard part of medical school education, and learning objectives for the American Board of Pediatrics emphasize knowledge of adolescent gynecology. Pediatric practice standards recommend routine external examinations for girls of all ages at health supervision examinations. Unfortunately, pediatricians often lack training in examination techniques, determination of normal findings, and gynecologic pathology of infants and prepubertal children.

In the past decade, a high level of concern for child sexual abuse and emphasis on the sentinel role of pediatricians in recognizing abnormalities due to child abuse paradoxically has left pediatricians and other child health clinicians more anxious and uncomfortable in performing these examinations. However, although child sexual abuse is common, it rarely is diagnosed primarily by physical complaints. It is much more likely that a girl who is brought to the physician because of genital symptoms has either normal variant findings or a nontraumatic disorder. (1) The aim of this article is to review normal anatomy and physiology in infants and prepubertal children, emphasizing developmental changes, normal variants, and the differential diagnosis for common signs and symptoms.

	Developmental Anatomy and Physiology

 
     Infant and Toddler
The newborn girl is affected by maternal estrogens that cross the placenta. Breast buds are usual, and a milky discharge from the nipples is not uncommon. Like her mother, the neonate may develop mastitis. Vaginal discharge is common in newborns, as are long hymenal tags that frequently are visible, extending outside the vestibule. The vaginal epithelium also demonstrates . . . [Full Text of this Article]

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This article has been cited by other articles:

				D. Nazer and V. J. Palusci Child Sexual Abuse: Can Anatomy Explain the Presentation? Clinical Pediatrics, February 1, 2008; 47(1): 7 - 14. [Abstract] [PDF]