Pediatric Vaginal Discharge Evaluation

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Pediatric Vaginal Discharge Evaluation

Introduction

Vaginal discharge in pediatric patients can be concerning, requiring a thorough assessment to determine the underlying cause. In a 6-year-old girl with yellow vaginal discharge and an otherwise normal examination, the etiology could range from benign non-specific vulvovaginitis to more serious concerns such as foreign body, infection, or trauma. This paper will discuss the key history and physical examination findings, compare the approach to a sexually active 16-year-old, and highlight both similarities and differences in evaluation and management.

Key Points in History and Physical Examination

History

A detailed history is critical in identifying the cause of vaginal discharge. The following aspects should be explored:

1. Onset and Duration

   • When did the discharge start?
   • Is it persistent, intermittent, or worsening?

2. Color, Consistency, and Odor

   • Is the discharge thin, thick, foul-smelling, or associated with bleeding?
   • A malodorous discharge suggests bacterial or foreign body etiology.

3. Associated Symptoms

   • Itching, redness, dysuria, abdominal pain, fever, or urinary symptoms (suggestive of infection).
   • Bleeding (may indicate trauma, foreign body, or infection).

4. Hygiene Practices

   • Wiping technique (front to back vs. back to front).
   • Use of soaps, bubble baths, or scented wipes (can cause irritation).
   • Underwear type and frequency of changing (tight or non-breathable fabrics may contribute to irritation).

5. Recent Illness or Antibiotic Use

   • Recent respiratory or gastrointestinal infections may lead to bacterial spread to the perineal area.
   • Antibiotic use can predispose to yeast infections.

6. Foreign Body Exposure or Accidental Contamination

   • Young children may inadvertently insert small objects into the vaginal area, causing persistent discharge.

7. History of Trauma or Abuse

   • While most cases are benign, concern for sexual abuse must be considered if there are …