Abstract
Vulvovaginal concerns remain one of the most common reasons prepubertal patients present for gynecologic care. This chapter addresses vulvovaginal disorders resulting from anatomical and structural differences, as well as vulvovaginal disorders that present as vaginal discharge and prepubertal vaginal bleeding.
Anatomical and structural conditions discussed in this chapter include labial adhesions, labial hypertrophy, and hymenal variants. This chapter will introduce a new classification system for labial adhesions to better guide management. Labial hypertrophy and hymenal variants will be reviewed, including identification compared to normal anatomy and conservative management versus surgical management. Discussion of vulvar angiomyxomas and potential clinical implications will also be presented.
This chapter will review the common etiology of vulvovaginitis in the prepubescent and adolescent patient and the appropriate evaluation and management. Vulvar ulcerations (vulvar aphthous ulcers) that are not associated with sexually transmitted infections will also be discussed. To conclude the chapter, rare but clinically significant conditions that present as vaginal bleeding in the prepubescent population will be reviewed.