Majority resolve spontaneously, provide reassurance.Provided the child is able to void easily, no treatment is needed.Usually asymptomatic, rarely may present with urinary frequency and postvoid dribbling if urinary outflow obstruction.Occur when the medial edges of the labia minora become adherent due to a combination of thin vaginal mucosa (normal prepubescent state) and minor irritation.Normal variant which develops from 3 months (not present at birth) and resolves spontaneously by 6 to 8 years old when oestrogen levels increase at puberty.If persistent, recurrent or multiple presentations, discuss with gynaecology.Sexual abuse occasionally presents as vulvovaginitis and should be considered.Significant erythema and pain caused by respiratory or enteric flora eg group A streptococci or E.Precautions to minimise spread including treatment of all household contacts (see.6 months and ≤10 kg) or 100mg (>10 kg) oral single dose and repeat after 2 weeks Precocious puberty (consider when secondary sexual characteristics.Excoriation due to moderate-to-severe vulvovaginitis, lichen sclerosus et atrophicus or pinworms.Vaginal foreign body (toilet paper, small toys or money).Vaginal bleeding in the first week of life can be caused by the normal withdrawal of maternal oestrogens (requires no investigation or treatment)Ībnormal vaginal bleeding in children may be caused by

Systemic conditions eg eczema, psoriasis.

Candida infection (unusual in children from 2 years to puberty).

Persistent pain in vulval area for ≥3 months without an identifiable cause.

Environmental eg poor hygiene, excess moisture or contact irritants.

Vulval and vaginal pain is common in prepubertal children and many conditions affecting the vulva can be painful including

Menarche usually occurs 2-3 years after thelarche.

From 3 months of age until puberty, vaginal discharge is usually minimal.

It is common to have breast buds, mucoid white vaginal discharge, small volume vaginal blood loss and/or hymenal skin tags Newborns are affected by maternal oestrogens crossing the placenta.Genitalia will change in appearance between infancy, prepuberty and puberty due to the hormonal environment.Do not perform an internal vaginal examination or take internal vaginal swabs in prepubescent childrenīackground Normal anatomy and development.Children with recurrent urinary tract infection symptoms but negative cultures should be assessed for vulvodynia.Pinworms should be considered when pre-pubertal children present with distressing nocturnal vaginal or perineal pain and/or itch.Vulvovaginitis is common and will usually resolve with simple measures.Adolescent gynaecology - lower abdominal painĪdolescent gynaecology - heavy menstrual bleeding Key Points

Pictures of female genital skin tags