1
|
Choi H, Kim SE, Lee NH, Lee DY, Choi D. Clinical Characteristics of Gynecologic Problems During Childhood in the Korean Population. J Korean Med Sci 2023; 38:e279. [PMID: 37724492 PMCID: PMC10506899 DOI: 10.3346/jkms.2023.38.e279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/22/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND This study analyzed common gynecologic problems among Korean patients younger than ten years. METHODS We performed a retrospective analysis of medical records of patients younger than ten years who visited the Pediatric and Adolescent Gynecology Clinic at Samsung Medical Center between 1995 and 2020. RESULTS Among the 6,605 patients who visited the Pediatric and Adolescent Gynecology Clinic, data from 642 patients younger than ten years were analyzed in this study. The most common chief complaint was genital anomalies, followed by increased vaginal discharge and abnormal findings on clinical examinations. The most common disease entity was agglutination of the labia minora, which was commonly discovered incidentally during routine screenings. Vulvovaginitis, the second most common disease, was identified by symptoms of vaginal discharge, pruritus, and vaginal spotting. Neoplasm, issues with vaginal bleeding, and "other causes" were additional categories of gynecologic problems. 245 patients (38.2%) were referred from primary care sources, 175 patients (27.4%) sought care directly at the clinic, 169 patients (26.3%) were referrals from the institution's pediatric department, and the remainder were referrals from other departments. CONCLUSION This study provides information about the gynecologic problems most frequently encountered in pediatric patients. The study provides helpful insight for primary care physicians into the proper management and timing of referrals for these gynecologic problems of pediatric patients.
Collapse
Affiliation(s)
- Haewon Choi
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea
| | - Nae Hyun Lee
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea
| | - Dong-Yun Lee
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea
| | - DooSeok Choi
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Imperforate Hymen: Clinical Pearls and Implications of Management. Clin Obstet Gynecol 2022; 65:699-707. [PMID: 36260009 DOI: 10.1097/grf.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Imperforate hymen is a common condition that with classic appearance and presentation in puberty. This may be diagnosed in a neonate when mucocolpos is noted. There are many great pretenders of this condition, but the hallmarks include a bulging hymen with blue hue at puberty. If this is not seen on external genital exam, the provider should proceed with magnetic resonance imaging to better assess the reproductive tract anatomy before engaging in surgery. For providers uncomfortable in managing conditions often confused with an imperforate hymen, referral to a Pediatric and Adolescent Gynecologist or specialist comfortable managing these conditions, is recommended.
Collapse
|
3
|
Bragiel RM, Umasankar N, Burgis JT, Tomlin KV. Treatment of Clitoral Keratin Pearls with Topical Estrogen Cream: Case Report. J Pediatr Adolesc Gynecol 2022; 36:321-323. [PMID: 36209998 DOI: 10.1016/j.jpag.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Keratin pearls are intraepithelial accumulations of squamous cells and debris that can be an etiology of vulvovaginal irritation in pediatric patients and are often associated with clitoral adhesions. Historically, most cases have been managed with manual or operative lysis of adhesions. CASE Two prepubertal girls presented to our clinic with chronic clitoral irritation and were found to have clitoral adhesions with keratin pearls. Both were managed with topical estrogen cream, which resulted in resolution of their symptoms. SUMMARY AND CONCLUSION Keratin pearls can form when the overlying clitoral epithelium becomes blocked by clitoral adhesions. Hypoestrogenism is thought to be implicated in adhesion development; thus, topical estrogen cream is a reasonable option in initial management. Our results demonstrate a noninvasive alternative to the initial treatment of clitoral keratin pearls.
Collapse
Affiliation(s)
- Ryan M Bragiel
- University of South Carolina School of Medicine-Columbia, Columbia, South Carolina.
| | - Nivedita Umasankar
- Department of Obstetrics and Gynecology, Prisma Health-USC Medical Group, Columbia, South Carolina
| | - Judith T Burgis
- Department of Obstetrics and Gynecology, Prisma Health-USC Medical Group, Columbia, South Carolina
| | - Kristl V Tomlin
- Department of Obstetrics and Gynecology, Prisma Health-USC Medical Group, Columbia, South Carolina
| |
Collapse
|
4
|
Hayes JA, Temple‐Smith MJ. New context, new content-Rethinking genital anatomy in textbooks. ANATOMICAL SCIENCES EDUCATION 2022; 15:943-956. [PMID: 35098676 PMCID: PMC9541205 DOI: 10.1002/ase.2173] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/01/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
It has been widely claimed that reductions in allocated teaching time and the widespread implementation of short-cut teaching methodologies have led to a shortfall in anatomy knowledge among graduating doctors. This decline in knowledge is evident in the failure of anatomy content to prepare graduates for contemporary clinical practice. The implications for postgraduate surgical training are addressed in the numerous extracurricular anatomy courses available to surgical candidates. This paper focuses on genital diversity and its relevance to non-surgical graduates, thus highlighting another potential impact of this knowledge shortfall on frontline clinic consultations. As the gender revolution and female genital cosmetic surgery industry flourish, nothing in contemporary anatomy textbooks addresses issues of diversification of female genitalia nor gives medical graduates a realistic view of what is normal regarding female genital appearance.
Collapse
Affiliation(s)
- Jennifer A. Hayes
- Department of General PracticeMelbourne Medical SchoolUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Anatomy and NeuroscienceSchool of Biomedical SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Meredith J. Temple‐Smith
- Department of General PracticeMelbourne Medical SchoolUniversity of MelbourneParkvilleVictoriaAustralia
| |
Collapse
|
5
|
Mohapatra I, Samantaray SR. Labial Fusion Recurrence in a Prepubertal Girl: A Case Report and Review of Literature. Cureus 2022; 14:e26059. [PMID: 35865425 PMCID: PMC9289966 DOI: 10.7759/cureus.26059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/13/2022] Open
Abstract
Labial fusion is the fusion of labia minora or majora and results in partial or complete fusion of the vaginal orifice. The condition is commonly seen in prepubertal girls and post-menopausal women, but it can sometimes be seen in reproductive age group women also. We present here a case of a three-year-old girl who presented with recurrence of labial fusion and dysuria. The patient had a similar labial fusion three months before, which was treated with manual separation followed by estrogen cream application. The recurrence of labial fusion was managed conservatively. This case report highlights the possibility of recurrence of labial fusion in prepubertal girls till they attain puberty, as well as its conservative management.
Collapse
|
6
|
ŞAHİN AH, YILMAZ MS. Retrospective evaluation of labial fusion in girls. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1054226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The aim of this study was to determine the factors affecting fusion in girls treated for labial fusion retrospectively over a three-year period.
Material and Method: The research has a cross-sectional design. The research sample consists of girls with ICD10 code Q52.5 who were brought to the hospital with labial fusion symptoms in a three-year period (January 2018-December 2020). The data were obtained from the hospital information system. Variables that were effective in labial fusion recurrence were determined by Chi-Square analysis, and the marginal effects of effective variables on recurrence were analyzed by Poison Regression analysis.
Results: 52.9% of 308 cases were younger than one year old (mean age 4.36±1.10 months). Symptom presentation is 10.4% in children younger than one year of age, and 84.83% in older. The most commonly presented symptoms are pain, burning, soiling of underwear, and bad odor during urination. Labial fusion recurrence is 14.1% in children younger than one year of age, and 62.8% in older. Manual opening was applied in all cases, and weekly follow-ups were performed with topical treatment. The Poison Regression analysis revealed that a history of allergy (1.31 times; z:3.61, p:0.000), winter (0.86 times; z:3.22, p:0.001), and diaper dermatitis (1.22 times; z:5.19, p:0.000) increased the number of labial fusion recurrence.
Conclusion: The findings of our study are similar to the literature in terms of factors causing labial fusion and treatment type. The recurrence rate was found to be higher in our study. It should be kept in mind that labial fusion is asymptomatic, especially in girls in the first year of life. Considering the possibility of recurrence of labial fusion, mothers and physicians examining the child should be aware of this issue.
Collapse
|
7
|
Srivastava S, Pandey A, Kumar P, Gupta SK, Singh S, Rawat J. Management of labial adhesion in a developing country—an observational study. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [DOI: 10.1186/s43054-021-00089-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Labial adhesion is the fusion of the labia minora or majora. The literature reports conservative management. However, the situation may be different in our setup, where management differs due to prevailing circumstances. The present study was conducted to evaluate labial adhesion presentation, management, and outcome in our center.
Methods
It was a retrospective observational study from January 2015 to January 2020. The patients were evaluated for age at presentation, presenting symptoms, type of adhesions, treatment, recurrence, and follow-up. The treatment included the manual release of labial adhesion and Mupirocin ointment application for 15 days. They were advised to attend the outpatient department after 1 month for evaluation and later on in case of any problem.
Results
The total number of patients was 150, of which 104 (69.33%) were from rural backgrounds. The complaint was of the absent vaginal opening in all patients. Seventeen (11.33%) were advised ultrasonography of the abdomen elsewhere to look for the presence of internal genital organs. The local examination revealed poor hygiene in 65 (43.33%) patients. The patient with thick adhesions has minor erythema after the release of adhesions. Ten (6.66%) patients had a recurrence managed by repeat release with no recurrence.
Conclusion
Despite being a benign entity, labial adhesion may be a cause of severe concern. Manual separation and antibiotic ointment may be a viable first option in its management with minimal recurrence. Maintenance of local hygiene may be needed to prevent a recurrence. The overall outcome is excellent.
Collapse
|
8
|
Chanchlani N, Hodes D. Fifteen-minute consultation: Vulval soreness in the prepubertal girl. Arch Dis Child Educ Pract Ed 2021; 106:333-340. [PMID: 33246924 DOI: 10.1136/archdischild-2019-316905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/21/2020] [Accepted: 10/22/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Neil Chanchlani
- Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK .,Exeter IBD Pharmacogenetics, Exeter, UK
| | - Deborah Hodes
- Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
9
|
Morin JP, Tew CE, Puntney HL, Roser ML, Saltzman AF. Recurrence rates after surgical management of labial adhesions. J Pediatr Urol 2021; 17:705.e1-705.e5. [PMID: 34389233 DOI: 10.1016/j.jpurol.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Labial adhesions (LA) involves fusion of the labia minora in the midline. LA can range from involving just a small portion of the labia minora or the entire length, covering the urethra and vaginal opening. Treatment for labial adhesions includes the use of topical creams, manual lysis or surgical separation. The recurrence rate has been reported as 55%, 33% and 0% respectively. Only one study with a cohort of 9 patients examines recurrence rates after surgical release (0%). OBJECTIVE To verify the previous findings that surgical repair has low recurrence rate. We hypothesize the recurrence rate of LA after surgical repair to be lower than more conservative methods but that the recurrence rate is not 0%. STUDY DESIGN A retrospective review was performed of consecutive cases of LA that were treated surgically from August 2018 to October 2020. The surgical technique used involved opening the LA bluntly then oversewing each labia with fine absorbable suture. All patients were scheduled for clinic or telephone follow up 3 months postoperatively. Patient demographics, indication for procedure, history of prior treatment, operative time, complications, recurrence and length of follow up were recorded and are described using non-parametric methods. RESULTS Thirty-two female patients underwent surgical treatment of LA using the above-described technique. Median age at surgery was 3.7 y (IQR 2.7-5.3). Most patients (78.1%) had failed prior initial treatment, most commonly topical estrogen creams. Median follow up was 4.3 mos with 10 patients being lost to follow up. Only 2 patients experienced a recurrence at a median of 3.5 months. CONCLUSIONS This series verifies prior findings that, in the short-term, surgical repair has a lower recurrence rate than topical treatment or manual lysis. However, the recurrence rate is 9%, higher than previously reported. Further studies into longer-term follow up are underway.
Collapse
Affiliation(s)
| | - Catherine E Tew
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Hannah L Puntney
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Margaret L Roser
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | | |
Collapse
|
10
|
Goutham Krishna TC, Sagili H, Jayalakshmi D. Labial adhesions in a pre-pubertal girl: The importance of awareness. Trop Doct 2021; 51:661-662. [PMID: 34096385 DOI: 10.1177/00494755211020901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Labial adhesion affects up to 0.6-5% of pre-pubertal girls. They may be congenital or acquired. Patients usually are asymptomatic, and thus, labial adhesions are found incidentally on routine examination. If the patient is indeed truly asymptomatic, there is no need for any treatment, and reassurance only is needed. When treatment is indicated, topical application of oestrogen cream is advised, but when this fails, surgical intervention is recommended. Recurrence is common regardless of the treatment. We present the case of a three-year-old girl managed by release of adhesions under topical anaesthesia and topical application of oestrogen cream.
Collapse
Affiliation(s)
- T C Goutham Krishna
- MBBS Intern, Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Haritha Sagili
- Additional Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - D Jayalakshmi
- Additional Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
11
|
Huseynov M, Hakalmaz AE. Labial Adhesion: New Classification and Treatment Protocol. J Pediatr Adolesc Gynecol 2020; 33:343-348. [PMID: 32224247 DOI: 10.1016/j.jpag.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/03/2020] [Accepted: 03/19/2020] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To determine the subtypes of labial adhesion (LA) and arrange treatment options accordingly. DESIGN AND SETTING Patients who presented to our clinic with LA between July 2016 and February 2018 were divided into 4 groups. Location of the adhesion area, thickness of the adhesive tissue, and response to topical steroid (betamethasone valerate 0.1% ointment) therapy were identified as common features. PARTICIPANTS Seventy-five prepubertal girls. INTERVENTIONS AND MAIN OUTCOME MEASURES To determine the subtypes of the LA and evaluate the treatment response of patients in each subtype group. RESULTS LA was divided into 4 subtypes according to their common characteristics. For patients with type I, 2 weeks of topical steroid treatment resulted in complete recovery (100%). For those with type II, 12 (80%) patients had complete response to topical steroid treatment for an average of 3 weeks. Type III and IV patients were completely unresponsive to topical steroid treatment. CONCLUSION Classification of LA patients into subtypes and determination of treatment on the basis of this classification make a major contribution in planning the treatment of patients, not by trial-and-error, but using a predetermined strategy.
Collapse
Affiliation(s)
- Mirzaman Huseynov
- Department of Pediatric Surgery, Private Safa Hospital, Istanbul, Turkey.
| | - Ali Ekber Hakalmaz
- Department of Pediatric Surgery, Gaziosmanpasa Public Hospital, Istanbul, Turkey
| |
Collapse
|
12
|
Lorenzo AJ, Rickard M, Santos JD. The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children. Pediatr Nephrol 2020; 35:1395-1408. [PMID: 30671629 DOI: 10.1007/s00467-019-4193-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 02/03/2023]
Abstract
Urinary tract infections (UTIs) are a common reason for referral to pediatric specialists and the risk profile of these children is influenced by age, sex, and underlying urinary tract abnormalities. UTIs in toilet-trained children represent a different entity than confirmed, febrile UTIs that occur in infants, impacted by suboptimal bladder habits, bladder dysfunction, constipation, or a combination of these factors. A comprehensive literature search was conducted using PubMed and MEDLINE and search terms included recurrent UTI, VUR, bladder and bowel dysfunction (BBD), constipation, lower urinary tract symptoms, and voiding dysfunction. Common presenting symptoms of UTI in children include fever (> 38 °C) with or without "traditional" lower urinary tract symptoms (LUTS) such as dysuria, malodorous urine, frequency, urgency, and incontinence. However, many infections in older children are afebrile episodes-consisting primarily of LUTS-which may or may not be confirmed with biochemical and/or microbiological evidence. Therefore, when evaluating toilet-trained children with recurrent UTIs, it is paramount to consider dysfunctional elimination as an underlying cause, diagnose, and treat it prior to indicating surgical options, even in the presence of VUR or other anatomical abnormalities. Although the impact of bladder function on the risk of infections is important, so is the accurate diagnosis and initial evaluation. This review article will focus on an often overlooked yet critical factor: the impact of bladder function, particularly for toilet-trained children, as well as the importance of implementing bladder training strategies, aggressive management of constipation, and pharmacological management as necessary.
Collapse
Affiliation(s)
- Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. .,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| |
Collapse
|
13
|
Cizek SM, El-Bietar J, Rubinstein J, Dandoy C, Wallace GH, Nelson A, Khandelwal P, Myers KC, Hoefgen HR. Pediatric and Young Adult Vulvovaginal Graft-versus-Host Disease. Biol Blood Marrow Transplant 2019; 25:2408-2415. [DOI: 10.1016/j.bbmt.2019.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 11/15/2022]
|
14
|
Dowlut-McElroy T, Higgins J, Williams KB, Strickland JL. Treatment of Prepubertal Labial Adhesions: A Randomized Controlled Trial. J Pediatr Adolesc Gynecol 2019; 32:259-263. [PMID: 30385397 DOI: 10.1016/j.jpag.2018.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/21/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE Although various treatment options have been proposed for the treatment of labial adhesions, there are currently no clearly outlined limits on the duration of topical therapy, amount of lateral traction to apply, and methods to decrease the recurrence. This clinical trial was undertaken to assess the need for estrogen for treatment of prepubertal labial adhesions. DESIGN Randomized, double-blinded, controlled trial. SETTING Pediatric and Adolescent Gynecology Clinic at a children's hospital in a metropolitan area. PARTICIPANTS Prepubertal girls ages 3 months to 12 years with labial adhesions. INTERVENTIONS Lateral traction with topical estrogen or topical emollient. MAIN OUTCOME MEASURES The primary outcome was resolution of labial adhesions. The secondary outcome was the change in severity of labial adhesions over time between the 2 groups. RESULTS Forty-three girls were enrolled and 38 (88%) completed the study. The difference in complete resolution between the topical emollient group (19%) and the topical estrogen group (36%) was not statistically significant (P = .21). There was a statistically significant decrease in severity of labial adhesions over time, with the magnitude of improvement favoring the topical estrogen group. CONCLUSION Although labial adhesion severity decreased when treated with lateral traction and topical emollient or topical estrogen, the magnitude of the effect was significantly greater for topical estrogen.
Collapse
Affiliation(s)
- Tazim Dowlut-McElroy
- Department of Surgery, Children's Mercy Hospitals, Kansas City, Missouri; Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Jeanette Higgins
- Department of Surgery, Children's Mercy Hospitals, Kansas City, Missouri
| | - Karen B Williams
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Julie L Strickland
- Department of Surgery, Children's Mercy Hospitals, Kansas City, Missouri; Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, Missouri
| |
Collapse
|
15
|
Peng MY, Ker CR, Long CY. Voiding difficulty caused by old split scar of labia minor. Taiwan J Obstet Gynecol 2018; 57:911. [PMID: 30545558 DOI: 10.1016/j.tjog.2018.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mei-Yu Peng
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Chin-Ru Ker
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
16
|
Norris JE, Elder CV, Dunford AM, Rampal D, Cheung C, Grover SR. Spontaneous resolution of labial adhesions in pre-pubertal girls. J Paediatr Child Health 2018; 54:748-753. [PMID: 29436045 DOI: 10.1111/jpc.13847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/05/2017] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Abstract
AIMS This study sought to observe the rate and timing of spontaneous resolution of labial adhesions that had been diagnosed in pre-pubertal girls. The secondary aim was to evaluate the conservative approach to management of labial adhesions that has been advocated by the Gynaecology Department, by assessing the rates of concurrent uro-gynaecological symptoms in this population, as well as parent satisfaction with their child's management. METHODS A retrospective chart review was performed of all patients diagnosed with labial adhesions in the Department of Paediatric and Adolescent Gynaecology between 2000 and 2017. Patients and their parents (depending on the age of the patient at the time of this study) were then invited to participate in follow-up surveys and questionnaires and clinical examination. RESULTS Of 148 girls identified, the median age of the follow-up participants (n = 45) was 6.1 years (2.6-27.2 years), compared with that of the entire cohort of 7.4 years (1-27 years). After a median follow-up period of 2.6 years (0.4-20.7 years), 40% (18/45) of girls reported and/or had findings that supported resolution of labial adhesions without treatment. Two parents (4%) sought treatment elsewhere after their appointment. A history of UTI was reported in 30% (14/45) of patients, and 16% (7/45) had a known history of vulvovaginitis. CONCLUSIONS Our findings support the natural history of spontaneous resolution of labial adhesions. Concurrent uro-gynaecological conditions that developed were successfully treated according to standard treatments. A conservative approach to the management of labial adhesions is associated with very low rates of parental concern and intervention.
Collapse
Affiliation(s)
- Jean E Norris
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Charlotte V Elder
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Angela M Dunford
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Deepti Rampal
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Peninsula Health, Melbourne, Victoria, Australia
| | - Charleen Cheung
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China
| | - Sonia R Grover
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Lee IO, Pak HY, Chung JE. Demographic characteristics of labial adhesion in South Korea: a population-based study from 2010 to 2014. BMJ Paediatr Open 2018; 2:e000276. [PMID: 29942866 PMCID: PMC6014193 DOI: 10.1136/bmjpo-2018-000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the demographic features of labial adhesion (LA) in South Korea. DESIGN A population-based nationwide study. SETTING Census population of South Korea. PARTICIPANTS With the entire population of South Korea (n=47 990 761), patients under age 7 who were newly diagnosed with LA from January 2010 to December 2014 were included. MAIN OUTCOME MEASURE The average incidence and the peak age of LA occurrence were estimated. RESULTS A total of 4934 newly diagnosed LAs were analysed. The incidence of LA has constantly increased since 2008, the year that the Korean Developmental Screening Test for InfantsandChildren registry began. The average incidence of LA was 55.0 cases/100 000 person-years (95% CI 53.5 to 56.6). The highest incidence was 183.6 cases/100 000 person-years (95% CI 175.8 to 191.6) in the age group of13 to 24 months. The relative risk of acquiring LA in the age group of 13 to 24 months was 1.481 (95% CI 1.381 to 1.587) compared with the age group of 0 to 12 months. CONCLUSIONS The demographic characteristics of LA including the average incidence and the highest incidence age group in South Korea were revealed in this nationwide, population-based study including a total of 4934 newly developed LA cases. Further studies are needed to reveal the natural disease course and the significance of diagnosing asymptomatic LA cases.
Collapse
Affiliation(s)
- In Ok Lee
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Hae Yong Pak
- Institute of Health Insurance and Clinical Research, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jae Eun Chung
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| |
Collapse
|
18
|
Tubo-Ovarian Abscess in a Virginal Adolescent with Labial Agglutination Due to Lichen Sclerosus. J Pediatr Adolesc Gynecol 2017; 30:646-648. [PMID: 28522404 DOI: 10.1016/j.jpag.2017.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/07/2017] [Accepted: 05/04/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND We describe an unusual presentation of lichen sclerosus in a postmenarchal, virginal girl. CASE A 14-year-old girl first presented with acute urinary retention due to labial agglutination and developed bilateral tubo-ovarian abscesses in 10 days of the conservative management period. Abscesses were treated with antibiotherapy and percutaneous drainage; simple division of the labial agglutination and vulvar biopsies were performed with a preliminary diagnosis of lichen sclerosus. Postoperative follow-up with antibiotherapy and clobetasol propionate 0.05% ointment was uneventful. SUMMARY AND CONCLUSION Lichen sclerosus should be considered in cases of labial agglutination with atypical presentations. Finally, this case reminds us that pelvic inflammatory disease and tubo-ovarian abscess must be kept in mind even in virginal adolescents, especially in the presence of obstructive lesions of the genital tract.
Collapse
|
19
|
Fernandez S. A Pediatrician's Take on a Few Common Infant Urologic and Gynecologic Issues. Pediatr Ann 2017; 46:e397-e399. [PMID: 29131917 DOI: 10.3928/19382359-20171018-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Urologic and gynecologic issues are common in a pediatric primary care office. This article focuses on the evaluation and management of a few common diagnoses in infants and young children: fetal hydronephrosis, labial adhesions, physiologic phimosis, and hydrocele. This article can help pediatricians decide when these common issues can be managed in the primary care office and when they need subspecialty guidance. [Pediatr Ann. 2017;46(11):e397-e399.].
Collapse
|
20
|
Beyitler I, Kavukcu S. Familial labial adhesion. Pediatr Int 2017; 59:1126. [PMID: 29081072 DOI: 10.1111/ped.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/25/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Ilke Beyitler
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Salih Kavukcu
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Near East University, Nicosia, Cyprus
| |
Collapse
|
21
|
Loveless M, Myint O. Vulvovaginitis- presentation of more common problems in pediatric and adolescent gynecology. Best Pract Res Clin Obstet Gynaecol 2017; 48:14-27. [PMID: 28927766 DOI: 10.1016/j.bpobgyn.2017.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
Vulvovaginitis is one of the most common gynecological complaints presenting in the pediatric and adolescent female. The common causes of vulvovaginitis in the pediatric patient differ than that considered in adolescent females. When a child present with vulvar itching, burning and irritation the most common etiology is non-specific and hygiene measures are recommended. However these symptoms can mimic more serious etiologies including infection, labial adhesion, lichen sclerosis, pinworms and foreign body must be considered. Yeast infection is rare in the pediatric population but common in the adolescent. In the adolescent patient infections are more common. Yeast and bacterial vaginosis are commonly seen but due to the higher rate of sexual activity in this population sexually transmitted infections must also be considered.
Collapse
Affiliation(s)
- Meredith Loveless
- Norton Children's Hospital, University of Louisville, Dutchman Lane Plaza 2 Suite 303, Louisville, KY, United States.
| | - Ohmar Myint
- University of California Los Angeles, Department of Obstetrics and Gynecology, United States
| |
Collapse
|
22
|
Knudtzon S, Haugen SE, Myhre AK. Labial adhesion - diagnostics and treatment. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:31-35. [PMID: 28073227 DOI: 10.4045/tidsskr.16.0101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Labial adhesion is relatively common, but the condition is little known among doctors and parents. The article assesses treatment in the specialist health service. MATERIAL AND METHOD The treatment and course are assessed in 105 girls in the age group 0 – 15 years who were referred to St. Olavs Hospital in the period 2004 – 14. RESULTS The majority of the girls (n = 63) were treated topically with oestrogen cream. In 26 of 51 girls (51 %) for whom the final result is known, the adhesion opened after one treatment. When 1 – 4 oestrogen treatments were administered, the introitus had opened completely in two out of three (65 %). Fewer than half of those who received supplementary surgical treatment achieved permanent opening. INTERPRETATION Treatment for labial adhesion had a limited effect in this study. As the literature suggests that the condition results in few symptoms and resolves spontaneously in virtually all girls in puberty, no compelling medical reason exists for opening the adhesion in asymptomatic girls. It is important that doctors are aware of the condition in order to prevent misdiagnosis and to provide parents with adequate information. For parents it is important to know that spontaneous resolution may result in soreness and dysuria. Knowledge of the condition can most likely prevent unnecessary worry.
Collapse
Affiliation(s)
| | | | - Arne Kristian Myhre
- Institutt for samfunnsmedisin Norges teknisk-naturvitenskapelige universitet og Barne- og ungdomsklinikken St. Olavs hospital
| |
Collapse
|
23
|
Fadul-Elahi T, Janjua NB. Laser-induced synlabia, cryptomenorrhea, and urine retention: A case report and literature review. Urol Ann 2017; 9:380-383. [PMID: 29118543 PMCID: PMC5656966 DOI: 10.4103/ua.ua_7_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cosmetic laser use has many pros and cons. The worldwide use of laser for body hair removal has led to many medical complications. Unsupervised use of the laser for hair removal in vulva may result in many problems and can merely damage the vulva, although rarely, affecting the body image. This rare and novel case report is a 21 year old virgin who presented with acute urinary retention and cryptomenorrhea due to complete synlabia secondary to unsupervised vulval laser hair removal. The urinary retention was relieved by suprapubic catheterization initially. During examination under anesthesia, the fused labia were separated by a surgical incision with drainage of hematocolpos and then, a Foley's urethral catheter was inserted. She had an uneventful recovery. We report this case to emphasize on the supervised use of laser by trained and qualified personnel for hair removal in vulva to minimize its complications.
Collapse
Affiliation(s)
- Thoraya Fadul-Elahi
- Department of Obstetrics and Gynecology, Ohud Hospital, Madinah, Saudi Arabia
| | - Nusrat Batool Janjua
- Department of Obstetrics and Gynaecology, Letterkenny University Hospital, Co Donegal, Ireland
| |
Collapse
|
24
|
|
25
|
Pediatric and adolescent gynecology: improving the reproductive health of youth. Curr Opin Obstet Gynecol 2016; 28:337-8. [PMID: 27454853 DOI: 10.1097/gco.0000000000000306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|