Vulval Pain in Pediatric and Adolescent Patients

Abstract

Study objective: To describe the experience of a tertiary pediatric and adolescent gynecology service that provides care to children and adolescents who present with vulval pain. Their presentation, associated symptoms, and management is described.

Design: A retrospective analysis of all girls younger than 18 years of age who presented to the gynecology clinic of our tertiary referral Children's Hospital between Jan 2010 and July 2016. Electronic medical records were reviewed and parameters recorded using a standardized data sheet.

Setting: Gynecology clinic of a tertiary referral children's hospital and private rooms of our director of gynecology.

Participants: Young women younger than 18 years who presented with symptoms suggestive of vulvodynia.

Interventions and main outcome measures: Presenting symptoms, characteristics of associated features, treatment options, and treatment outcomes.

Results: Forty-seven patients with a mean age of 11 years (range, 3-18 years) were identified. At the time of diagnosis 31/47 (65.9%) were premenarchal. Many presented with a symptom other than pain alone. In particular, 35/47 (74.4%) presented with coexisting or previous urinary symptoms. Of patients examined, most had positive cotton tip examination findings (16/17 (94.1%) and 11/13 (84.6%) for pre- and postmenarchal, respectively) with clinical inspection otherwise unremarkable.

Conclusion: Children and adolescents with vulval pain have varied presentations. Many of the pre- and postmenarchal patients had coexisting urinary tract symptomatology at the time of diagnosis. This review of patients seen over 5.5 years at a pediatric tertiary referral center provides information on the presenting symptoms, examination features, and response to clinical management.

Keywords: Adolescent; Pediatric; Vulvar pain; Vulvodynia.