Elsevier

The Journal for Nurse Practitioners

Volume 16, Issue 2, February 2020, Pages e35-e36, e37-e39
The Journal for Nurse Practitioners

Case Challenge
Vaginal Irritation in Prepubertal Girls: Age-Specific Considerations in Primary Care

https://doi.org/10.1016/j.nurpra.2019.08.021Get rights and content

Highlights

  • Vulvovaginal complaints in prepubertal girls are commonly managed in the primary care setting.

  • A comprehensive history and physical is required for accurate diagnosis and treatment.

  • Treatment is based on identified cause and should include improving vulvar hygiene.

Abstract

This is a case study that demonstrates the importance of recognizing and treating vulvovaginal complaints in the prepubertal girl. Vulvovaginal irritation and discharge are symptoms of commonly diagnosed gynecological conditions in this age group. As such, primary care nurse practitioners should be equipped to evaluate, diagnose, and manage these patients. A comprehensive history and physical examination are necessary to differentiate between nonspecific and pathogenic causes. This case demonstrates the importance of considering age-specific etiologies to guide the evaluation, diagnosis, and treatment of vulvovaginal complaints in prepubertal girls.

Section snippets

Case Study

R.B. is a 6-year-old female patient presenting with the complaint of vaginal irritation and discharge for 2 weeks. Her mother is present and speaks on behalf of and in conjunction with her. R.B.’s mother made the decision to bring her into the primary care clinic when her symptoms did not resolve. R.B. also complains of ear pain and a “scratchy” throat.

History of Present Illness

R.B. is a 6-year-old female patient who presents to the primary care clinic with complaints of vaginal itching and “dripping” from her vagina. R.B.’s mother states that her daughter first complained about vaginal itching 2 weeks ago. The itching is intermittent, but R.B. denies any increased itching at night. Within the past week, she has complained of “dripping” from her vagina that her mother believed was vaginal discharge. To confirm, R.B.’s mother inserted a panty liner in R.B.’s underwear

Case Study Questions

  • 1.

    What differential diagnoses should be considered for R.B. at this time?

  • 2.

    On the basis of the available information, what is the most likely diagnosis and why?

  • 3.

    What diagnostic tests would be helpful to determine a final diagnosis?

  • 4.

    What are the next steps in the management of this patient?

If you believe you know the answers to the following questions, then test yourself and refer to page e37 for the answers.

Case Study Questions with Answers

  • 1.

    What differential diagnoses should be considered for R.B. at this time?

    • Consideration of differential diagnoses should be based on R.B.’s presentation. R.B. complains of vaginal itching and discharge but denies any urinary frequency, urgency, or pain. She toilets and bathes herself with occasional assistance from her parents. R.B.’s mother denies any changes in her behavior or mood. R.B.’s physical examination is positive for labial erythema and white discharge without signs of trauma.

Conclusion

Vulvovaginitis is a common gynecological complaint of prepubertal girls. Therefore, nurse practitioners who manage this population in the primary care setting should be aware of the presentation, diagnosis, and treatment of the condition. Obtaining a thorough history and physical exam is paramount to the appropriate diagnosis and management in this group. Nurse practitioners should be cognizant of the age-specific etiologies of vulvovaginitis in pediatric populations, recognizing that the

Jannyse Starks DNP, FNP-BC, Assistant Professor of Nursing, Vanderbilt University School of Nursing. She can be reached at [email protected].

References (9)

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Jannyse Starks DNP, FNP-BC, Assistant Professor of Nursing, Vanderbilt University School of Nursing. She can be reached at [email protected].

In compliance with national ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest.

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