If you believe you know the answers to the following questions, then test yourself and refer to page e37 for the answers.
Case ChallengeVaginal Irritation in Prepubertal Girls: Age-Specific Considerations in Primary Care
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?
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].
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Cited by (0)
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.