Box 1.

Contact/irritant vulvitis: key elements.

Box 2.

Management of dysfunctional uterine bleeding.

Farrington PF. Pediatric vulvo-vaginitis. Clin. Obstet. Gynecol. 40(1), 135-140 (1997).
Jamieson MA. Vaginal discharge and genital bleeding in childhood. In: Clinical Pediatric and Adolescent Gynecology. Sanfilippo JS, Lara-Torre E, Edmonds K, Templeman C (Eds). Informa Healthcare USA, Inc., NY, USA, 140-153 (2009).
••Concise review of vaginal discharge in the pediatric patient in the most recent clinical textbook on pediatric and adolescent gynecology. The textbook is especially designed for clinicians, providing the current evidence-based information and practical insights for the practitioner treating the pediatric— adolescent gynecology patient.
Koumantakis EE, Hassan EA, Deligeoroglou EK, Creatsas GK. Vulvovaginitis during childhood and adolescence. J. Pediatr. Adolesc. Gynecol. 10, 39-43 (1997).
Emans SJ. Vulvovaginal problems in the prepubertal child. In: Pediatric and Adolescent Gynecology (Fifth Edition). Emans SJ, Laufer MR, Goldstein DP (Eds). Lippincott Williams and Wilkins, PA, USA, 83-103 (2005).
Smith YR, Berman DR, Quint EH. Premarchal vaginal discharge: findings of procedures to rule out foreign bodies. J. Pediatr. Adolesc. Gynecol. 13, 227—230 (2002).
•Retrospective review of etiologies of vaginal discharge. Also includes the mechanism of diagnosing foreign bodies with the use of vaginoscopy or vaginal irrigation.
Gerstner GJ, Grungerger W, Boschitsch E, Rotter M. Vaginal organisms in prepubertal children with and without vulvovaginitis. Arch. Gynecol. 231, 247-252 (1982).
Sanfilippo JS, Wakim NG. Bleeding and vulvovaginitis in the pediatric age group. Clin. Obstet. Gynecol. 30(3), 653-661 (1987).
Shapiro RA, Schubert CJ, Siegel RM. Neisseria gonorrhea infections in girls younger than 12 years of age evaluated for vaginitis. Pediatrics 104(6), e72 (1999).
Cuadros J, Mazon A, Martinez R et al. The aetiology of paediatric inflammatory vulvovaginitis. Eur. J. Pediatr. 163, 105-107 (2004).
Heymann W. Streptococcal vulvovaginitis. J. Am. Acad. Dermatol. 61, 94-95 (2009).
Hansen MT, Sanchez VT, Eyster K, Hansen KA. Streptococcus pyogenes pharyngeal colonization resulting in recurrent prepubertal vulvovaginitis. J. Pediatr. Gynecol. 20, 315-317 (2007).
Yerkes EB. Urologic issues in the pediatric and adolescent gynecology patient. Obstet. Gynecol. Clin. North Am. 36, 69-84 (2009).
Tibaldi C, Cappello N, Latino MA, Masuelli G, Marini S, Benedetto C. Vaginal and endocervical microorganisms in symptomatic and asymptomatic non-pregnant females: risk factors and rates of occurrence. Clin. Microbiol. Infect. 15(7), 670-679 (2009).
Jasper JM, Ward MA. Shigella vulvovaginitis in a prepubertal child. Pediatr. Emerg. Care 22(8), 585-586 (2006).
Caputo RV. Fungal infections in children. Dermatol. Clin. 4(1), 137-149 (1986).
Deligeoroglou E, Salakos N, Makrakis E, Chassiakos D, Hassan EA, Christopouos P. Infections of the lower female genital tract during childhood and adolescence. Clin. Exp. Obstet. Gynecol. 31(3), 175-178 (2004).
•Comprehensive review of the pathogenesis, diagnosis and treatment of pediatric vulvovaginitis.
Rettig PJ, Nelson JD. Genital tract infection with Chlamydia trachomatis in prepubertal children. J. Pediatr. 99(2), 206-210 (1981).
Schachter J, Grossman M, Holt J, Sweet R, Spector S. Infections with Chlamydia trachomatis: involvement of multiple anatomic sites in neonates. J. Infect. Dis. 139(2), 232-234 (1979).
Hammerschlang MR. Chlamydial infection. J. Pediatr. 114(5), 727-734 (1989).
Black CM, Driebe EM, Howard LA et al. Multicenter study of nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in children being evaluated for sexual abuse. Pediatr. Infect. Dis. J. 28(7), 608-613 (2009).
Kellogg ND, Baillargeon JL, Lukefahr KL, Menard SW. Comparison of nucleic acid amplification tests and culture techniques in the detection of Neisseria gonorrhoeae and Chlamydia trachomatis in victims of suspected child sexual abuse. J. Pediatr. Adolesc. Gynecol. 17, 331-339 (2004).
Williams T, Callen J, Owen L. Vulvar disorders in the prepubertal female. Pediatr. Ann. 15(8), 588-589 (1986).
Yu HT, Chao A, Wang CJ et al. Integrated imaging studies and endoscopic management of purulent vaginal discharge in a 6-year-old: vaginal ectopic ureter associated with ipsilateral dysplastic kidney. Eur. J. Obstet. Gynecol. Reprod. Biol. 142, 160-162 (2008).
Hansen KA, DeWitt J. Premenarchal, recurrent vaginal discharge associated with an incomplete obstructing longitudinal vaginal septum. J. Pediatr. Adolesc. Gynecol. 18, 423-426 (2005).
Striegel AM, Myers JB, Sorensen MD, Furness PD, Koyle MA. Vaginal discharge and bleeding in girls younger than 6 years. J. Urol. 176, 2632-2635 (2006).
•Retrospective review of girls presenting to a referral practice with persistent vaginal discharge despite antibiotics, and in whom an vaginoscopy was performed.
Paradise JE, Willis ED. Probability of vaginal foreign body in girls with genital complaints. Am. J. Dis. Child. 139(5), 472-476 (1985).
Benjamins LJ. Genital trauma in pediatric and adolescent females. J. Pediatr. Adolesc. Gynecol. 22, 129-133 (2009).
•Basic 'just the facts' article in the Teach the Teacher section of the journal with good photo images of genital trauma that could be used for teaching purposes.
Spitzer RF, Kives S, Caccia N, Ornstein M, Goia C, Allen L. Retrospective review of unintentional female genital trauma at a pediatric referral center. Pediatr. Emerg. Care 24(12), 831-835 (2008).
•Retrospective review of unintentional pediatric genital trauma in a quaternary care referral center. Treatment, surgical intervention and patient outcomes are discussed.
Bond GR, Dowd MD, Landsman I, Rimza M. Unintentional perineal injury in prepubescent girls: a multicenter prospective report of 56 girls. Pediatrics 95, 628-631 (1995).
Gabriel NM, Clayton M, Starling SP. Vaginal laceration as a result of blunt vehicular trauma. J. Pediatr. Adolesc. Gynecol. 22, e166-e168 (2009).
Scheidler MF, Shultz BL, Schall L, Ford HR. Mechanisms of blunt perineal injury in female pediatric patients. J. Pediatr. Surg. 35, 1317-1319 (2000).
Dowd D, Fitzmaurice L, Knapp JF, Mooney D. The interpretation of urogenital findings in children with straddle injuries. J. Pediatr. Surg. 29, 7-10 (1994).
Jones JG, Worthington T. Genital and anal injuries requiring surgical repair in females less than 21 years of age. J. Pediatr. Adolesc. Gynecol. 21, 207-211 (2008).
Merritt DF. Vulvar and genital trauma in pediatric and adolescent gynecology. Curr. Opin. Obstet. Gynecol. 16, 371-381 (2004).
Mok-Lin EY, Laufer MR. Management of vulvar hematomas: use of a Word catheter. J. Pediatr. Adolesc. Gynecol. 22, e156-e158 (2009).
Emans SJ, Laufer MR, Goldstein DP. Pediatric and Adolescent Gynecology (Fifth Edition). Lippincott Williams and Wilkins, PA, USA, 950-968 (2005).
Abou-Jaoude W, Sugarman JM, Fallat ME, Casale AJ. Indicators of genitourinary tract injury or anomaly in cases of pediatric blunt trauma. J. Pediatr. Surg. 31(1), 86-90 (1996).
McAleer IM, Kaplan GW, Scherz HC, Packer MG, Lynch FP. Genitourinary trauma in the pediatric patient. Urology 42(5), 563-568 (1993).
Golan A, Lurie S, Sagiv R, Glezerman M. Continuous-flow vaginoscopy in children and adolescents. J. Am. Assoc. Gynecol. Laparosc. 7(4), 526-528 (2000).
Habek D, Kulas T. Nonobstetrics vulvovaginal injuries: mechanism and outcome. Arch. Gynecol. Obstet. 275(2), 93-97 (2007).
Barton DJ, Sloan GM, Nichter LSReinisch JF. Hair-thread tourniquet syndrome. Pediatrics 82, 925-928(1988).
Kuo JH, Smith LM, Berkowitz CD. A hair tourniquet resulting in strangulation and amputation of the clitorus. Obstet. Gynecol. 99(5), 939-941 (2002).
Pomeranz M, Schachter B, Capua T, Beyth Y. Hair-thread tourniquet syndrome of labia minor. J. Pediatr. Adolesc. Gynecol.22, 111-113 (2009).
Bacon JL, Burgis JT. Hair thread tourniquet syndrome in adolescents: a presentation and review of the literature. J. Pediatr. Adolesc. Gynecol. 18, 155-156 (2005).
Emans SJ. Dysfunctional uterine bleeding. In: Pediatric and Adolescent Gynecology (Fifth Edition). Emans SJ, Laufer MR, Goldstein DP (Eds). Lippincott Williams< and Wilkins, PA, USA, 270-283 (2005).
Hallberg L, Hogdal AM, Nilsson L, Rybo G. Mentstrual blood loss - a population study. Variation at different ages and attempts to define normality. Acta Obstet. Gynecol. Scand. 45, 320-351 (1966).
Grover S. Bleeding disorders and heavy menses in adolescents. Curr. Opin. Obstet. Gynecol. 19, 415-419 (2007).
American College of Obstetricians and Gynecologists Committee Opinion No. 349, November 2006. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstet. Gynecol. 108(5), 1323-1328 (2006).
••First publication as joint opinion between the American College of Obstetricians and Gynecologists and American Academy of Pediatrics regarding the importance of menstrual history as an indicator of health in girls and adolesents, presenting background information concerning the current understanding of what constitutes normal and abnormal menses.
Strickland JL, Wall JW. Abnormal uterine bleeding in adolescents. Obstet. Gynecol. Clin. North Am. 30, 321-325 (2003).
Rimsza M. Dysfunctional uterine bleeding Pediatr. Rev. 23, 227-233 (2002).
Gidwani GP. Vaginal bleeding in adolescents. J. Reprod. Med. 29(6), 417-420 (1984).
Matytsina LA, Zoloto EV, Sinenko LV, Greydanus DE. Dysfunctional uterine bleeding in adolescents: concepts of pathophysiology and management. Prim. Care Clin. OfficePract. 33, 503-515 (2006).
Mikhail S, Varadarajan R, Kouides P. The prevalence of haemostasis in adolescents with menorrhagia referred to a haemophilia treatment centre. Haemophilia 13, 627-632 (2007).
•Retrospective chart review of disorders of bleeding seen in 61 consecutive adolescent patients presenting to a hemophilia treatment center.
Philipp CS, Faiz A, Dowling N et al. Age and prevalence of bleeding disorders in women with menorrhagia. Obstet. Gynecol. 105, 61-66 (2005).\
••Prospective evaluation of 115 women aged 13—55 years presenting with a physician diagnosis of menorrhagia.
James AH. Bleeding disorders in adolescents. Obstet. Gynecol. Clin. North Am. 36, 153-162 (2009).
••Comprehensive review of coagulation disorders causing menorrhagia and a focus on therapeutic interventions specific to women with these disorders.
Falcone T, Desjardins C, Bourque J, Granger L, Hemmings R, Quiros E. Dysfunctional uterine bleeding in adolescents. J. Reprod. Med. 39, 761-764 (1994).
James AH. More than menorrhagia: a review of the obsteric and gynecological manifestations of bleeding disorders. Haemophilia 11, 295-307 (2005).
Lopez JA, Andrews RK, Afshar-Kharghan V, Berndt MC. Bernard Soulier syndrome. Blood 91(12), 4397-4418 (1998).
George, JN, Caen JP, Nurden AT. Glanzmann's thrombasthenia: the spectrum of clinical disease. Blood 75(7), 1383-1395 (1990).
Kulp JL, Mwangi CN, Loveless M. Screening for coagulation disorders in adolescents with abnormal uterine bleeding. J. Pediatr. Adolesc. Gynecol. 21, 27-30 (2008).
ACOG Committee on Gynecologic Practice. Committee Opinion: number 451, December 2009. Von Willebrand's disease in women. Obstet. Gynecol. 1239-1241 (2009).
Minjarez DA. Abnormal bleeding in adolescents. Semin. Reprod. Med. 21(4), 363-373 (2003).
Frishman GN. Evaluation and treatment of menorrhagia in an adolescent population. J. Minim. Invasive Gynecol. 15, 682-688 (2008).
Janssen CAH, Scholten PC, Heintz APM. A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Obstet. Gynecol. 85, 977-982 (1995).
Claessens EA, Cowell CA. Acute adolescent menorrhagia. Am. J. Obstet. Gynecol. 139(3), 277-280 (1981).
Torres A, Baszak-Radomanska E, Torres K, Paszkaowski T, Staskiewicz G, Wozniakowska E. A case of unusual course of adolescent menorrhagia: decidual cast as a side effect of treatment. Fertil. Steril. 92, 1748.e5-1748.e7 (2009).
Foster PA. The reproductive health of women with von Willebrand disease unresponsive to DDAVP: results of an international survey. Thromb. Haemost. 74(2), 784-790 (1995).
American College of Obstetricians and Gynecologists committee opinion No 392, December 2007. Intrauterine device and adolescents. Obstet. Gynecol. 110, 1493-1495 (2007).
Kingman CE, Kadir RA, Lee CA, Economides DL. The use of levonorgestrel-releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders. Br. J. Obstet. Gynaecol. 111(12), 1425-1428 (2004).
• Prospective study showing the benefit of intrauterine device use in women with coagulation disorders.
Paterson H, Ashton J, Harrison-Woolrych M. A nationwide cohort study of the use of levonorgestrel intrauterine device in New Zealand adolescents. Contraception 79, 433-439 (2009).
Hall P, Maclachlan N, Thorn N, Nudd MW, Taylor CG, Garrioch DB. Control of menorrhagia by the cyclo-oxygenase inhibitors naproxen sodium and mefenamic acid. Br. J. Obstet. Gynaecol. 94(6), 554-558 (1987).
Lethaby A, Farquhar C, Cooke I. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst. Rev. 4, CD000249 (2000).
DeVore GR, Odell O, Kase N. Use of intravenous premarin in the treatment of dysfunctional uterine bleeding - a double blind randomized control study. Obstet. Gynecol. 59(3), 285-290 (1982).
Bowkley CW, Dubel GJ, Haas RA, Soares GM, Ahn SH. Uterine artery embolization for control of life-threatening hemorrhage at menarche: brief report. J. Vasc. Interv. Radiol. 18, 127-131 (2007).
Markovitch O, Ellis M, Holzinger M, Goldberger S, Beyth Y. Severe juvenile vaginal bleeding due to Glanzmann's thrombasthenia: case report and review of the literature. Am. Hematol. 57(3), 225-227 (1998).
Zurawin RK, Pramanik S. Endometrial balloon ablation as a therapy for intractable uterine bleeding in an adolescent. J. Pediatr. Adolesc. Gynecol. 14, 119-121 (2001).
Meirow D, Rabinovici J, Katz D, Or R, Shufaro Y, Ben-Yehuda D. Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer 107, 1634-1641 (2006).
Laufer MR, Goldstein DP. Gynecologic pain: dysmenorrhea, acute and chronic pelvic pain, endometriosis and premenstrual syndrome. In: Pediatric and Adolescent Gynecology (Fifth Edition). Emans SJ, Laufer MR, Goldstein DP (Eds). Lippincott Williams and Wilkins, PA, USA, 439-460 (2005).
Sampson JA. The development of the implantaion theory for the origin of peritoneal endometriosis. Am. J. Obstet. Gynecol. 40, 549-557 (1940).
Halme J, Becker S, Haskill S. Altered maturation and function of peritoneal macrophages: a possible role in pathogenesis of endometriosis. Am. J. Obstet. Gynecol. 156, 783-789 (1987).
Bontis JN, Vavilis DT. Etiopathology of endometriosis. Ann. N. Y. Acad. Sci. 817, 305-309 (1997).
ACOG Committee Opinion Number 310, April 2005. Endometriosis in adolescents. Obstet. Gynecol. 105, 921-927 (2005).
Laufer MR, Goitein L, Bush M, Cramer DW, Emans SJ. Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J. Pediatr. Adolesc. Gynecol. 10(4), 199-202 (1997).
Marsh EE, Laufer MR. Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly. Fertil. Steril. 83, 758-760 (2005).
Ebert AD, Fuhr N, Matthias D, Schneppel L, Papadopoulos T. Histological confirmation of endometriosis in a 9-year-old girl suffering from unexplained cyclic pelvic pain since her eighth year of life. Gynecol. Obstet. Invest. 67, 158-161 (2009).
Yamamoto K, Mitsuhashi Y, Takaike T, Takase K, Hoshiai H, Noda K. Tubal endometriosis diagnosed within one month after menarche: a case report. Tohoku J. Exp. Med. 181, 385-387 (1997).
Goldstein DP, deCholnoky C, Leventhal JM, Emans SJ. New insights into the old problem of chronic pelvic pain. J. Pediatr. Surg. 14, 675-680 (1979).
Reese KA, Reddy S, Rock JA. Endometriosis in an adolescent population: the Emory experience. J. Pediatr. Adolesc. Gynecol. 9, 125-128 (1996).
Doyle JO, Missmer SA, Laufer MR. The effect of combined surgical-medical intervention on the progression of endometriosis in an adolescent and young adu lt population. J. Pediatr. Adolesc. Gynecol. 22, 257-263 (2009).
•Retrospective review that highlights the importance of combination medical and surgical approach to treating endometriosis. Discusses lack of disease progression with subsequent laparoscopy when medical therapy is used.
Broach AN, Mansuria SM, Sanfilippo JS. Pediatric and adolescent gynecologic laparoscopy. Clin. Obstet. Gynecol. 52(3), 380-389 (2009).
Mahmood TA, Templeton A. The impact of treatment on the natural history of endometriosis. Hum. Reprod. 5, 965 -970 (1990).
Howard FM. Chronic pelvic pain. Obstet. Gynecol. 101(3), 594-611 (2003).
Templeman C. Adolescent endometriosis. Obstet. Gynecol. Clin. North Am. 36, 177-185 (2009).
Harel Z. Dysmenorhea in adolescents and young adults: from pathophysiology to pharmacological treatments and management strategies. Expert Opin. Pharmacother. 9 (15), 2661-2672 (2008).
Roy SN, Bhattacharya S. Benefits and risks of pharmacological agents used for the treatment of menorhagia. Drug Saf. 27(2), 75-90 (2004).
Kistner RW. Current status of the hormonal treatment of endometriosis. Clin. Obstet. Gynecol. 9, 271-292 (1966).
Edelman AB, Gallo MF, Jensen JT, Nichols MD, Schulz KF, Grimes DA. Continuous or extended cycle vs. cyclic use of combined oral contraceptives for contraception. Cochrane Database Syst. Rev. 3, CD004695 (2005).
Miller L, Notter KM. Menstrual Reduction with extended use of combination oral contraceptive pills: randomized controlled trial. Obstet. Gynecol. 98(5), 771-778 (2001).
Prentice A, Deary AJ, Bland E. Progestins and anti-progestins for pain associated with endometriosis. Cochrane Database Syst. Rev. (2), CD002122 (2000).
Sanfilippo JS, Lara-Torre E. Adolescent gynecology. Obstet. Gynecol. 113(4), 935-947 (2009).
Gold MA, Johnson LM. Intrauterine devices and adolescents. Curr. Opin. Obstet. Gynecol. 20(5), 464-469 (2008).
Yisa SB, Okenwa AA, Husemeyer RP. Treatment of pelvic endometriosis with etonogestrel subdermal implant (Implanon®). J. Fam. Plann. Reprod. Health Care 31, 67-69 (2005).
Petta CA, Ferriani RA, Abrarao MS et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum. Reprod. 20, 1993-1998 (2005).
Dlugi AM, Miller JD, Knittle J. Lupron depot (leuprolide acetate for depot suspension) in the treatment of endometriosis: a randomized, placebo-controlled, double-blind study. Fertil. Steril. 54, 419-427 (1990).
Ling FW. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Obstet. Gynecol. 93, 51-58 (1999).
Dawood MY, Lewis V, Ramos J. Corical and trabecular bone mineral content in women with endometriosis: effect of gonadotropin releasing hormone agonist and danazol. Fertil. Steril. 52, 21-26 (1989).
Hornstein MD, Surrey ES, Weisberg GW, Casino LA. Leuprolide acetate depot and hormonal add-back in endometriosis: a 12 month study. Lupron Add-Back Study Group. Obstet. Gynecol. 91, 16-24 (1998).
Surrey ES, Judd HL. Reduction of vasomotor symptoms and bone mineral density loss with combined norethindrone and long-acting gonadotropin-releasing hormone agonist therapy of symptomatic endometriosis: a prospective randomized trial. J. Clin. Endocrinol. Metab. 75 (2), 558-563 (1992).
Kiesel L, Schweppe KW, Sillem M, Siebzehnrubl E. Should add-back therapy for endometriosis be deferred for optimal results? Br. J. Obstet. Gynaecol. 103(Suppl. 14), 15-17 (1996).
DiVasta AD, Laufer MR, Gordon CM. Bone density in adolescents treated with a GnRH agonist and add-back therapy for endometriosis. J. Pediatr. Adolesc. Gynecol. 20, 293-297 (2007).
•Discusses the use of gonadotropin-releasing hormone agonists specifically in adolescents, and the benefit of add-back therapy when used in this age group to stabilize bone mineral density while also treating refractory pelvic pain.
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Laufer MR. Current approaches to optimizing the treatment of endometriosis in adolescents. Gynecol. Obstet. Invest. 66, 19-27 (2008).
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Author(s)

Paige Hertweck, MD

Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky

Disclosures

Disclosure: Paige Hertweck, MD, has disclosed the following relevant financial relationship:
Served as a speaker or a member of a speakers bureau for: Merck & Co., Inc.

Jennie Yoost, MD

Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky

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Disclosure: Jennie Yoost, MD, has disclosed no relevant financial relationships.

Editor(s)

Elisa Manzotti

Editorial Director, Future Science Group, London, United Kingdom

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Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author(s)

Désirée Lie, MD, MSEd

Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California

Disclosures

Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship:
Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services

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CME

Common Problems in Pediatric and Adolescent Gynecology

Authors: Paige Hertweck, MD; Jennie Yoost, MD
CME Released: 5/4/2010
THIS ACTIVITY HAS EXPIRED
Valid for credit through: 5/4/2011

Start Activity

Target Audience and Goal Statement

This activity is intended for pediatricians, gynecologists, and other specialists who care for female children and adolescents.

The goal of this activity is to review the more common gynecologic problems seen in girls and adolescents and their management.

Upon completion of this activity, participants will be able to:

Describe the difference between gynecologic problems in female children and adolescents
Identify the most common pathogens involved in prepubertal vulvovaginitis
Compare the accuracy of tests for gonorrhea and Chlamydia in children
Describe dermatologic gynecologic conditions in children
Describe the etiology and presentation of vaginal foreign bodies in children and adolescents

Disclosures

Author(s)

Paige Hertweck, MD

Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky

Disclosures

Disclosure: Paige Hertweck, MD, has disclosed the following relevant financial relationship:
Served as a speaker or a member of a speakers bureau for: Merck & Co., Inc.

Jennie Yoost, MD

Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky

Disclosures

Disclosure: Jennie Yoost, MD, has disclosed no relevant financial relationships.

Editor(s)

Elisa Manzotti

Editorial Director, Future Science Group, London, United Kingdom

Disclosures

Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author(s)

Désirée Lie, MD, MSEd

Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California

Disclosures

Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship:
Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services

CME Reviewer(s)

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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Introduction

Pediatric and adolescent gynecology focuses on a unique subset of gynecologic disorders among younger females. In the pediatric patient, gynecologic issues often present as vulvar and vaginal problems, while in the adolescent patient, complaints of abdominopelvic pain and abnormal menstrual bleeding commonly result in a gynecologic evaluation. This article focuses on two common vulvovaginal problems in the pediatric patient: vulvovaginitis and accidental genital trauma. Common infectious pathogens and treatments are reviewed along with other dermatologic and chemical causes of vulvovaginitis. The review of genital trauma focuses on various types of injury: straddle, penetrating and lacerations, and includes indications for surgical intervention. Pain and bleeding are the most common reasons for adolescents to frequent the gynecologist office, and this review focuses on these two topics, specifically menorrhagia and endometriosis. Etiologies of menorrhagia are reviewed with specific attention to anovulation and coagulation disorders. Hormonal therapy for these patients is addressed. The review of endometriosis provides insight into both medical and surgical management for optimum treatment of this disease.

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Vulvovaginitis

CME Information

Introduction
Vulvovaginitis
Etiologies
Trauma
Dysfunctional Uterine Bleeding: Menorrhagia in Adolescents
Endometriosis
Expert Commentary
Five-year View
Key issues

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Disclaimer

The material presented here does not necessarily reflect the views of Medscape, LLC or companies that support educational programming on www.medscapecme.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

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References

Faculty and Disclosures

Author(s)

Paige Hertweck, MD

Jennie Yoost, MD

Editor(s)

Elisa Manzotti

CME Author(s)

Désirée Lie, MD, MSEd

CME Reviewer(s)

Sarah Fleischman

CME

Common Problems in Pediatric and Adolescent Gynecology

Target Audience and Goal Statement

Disclosures

Author(s)

Paige Hertweck, MD

Jennie Yoost, MD

Editor(s)

Elisa Manzotti

CME Author(s)

Désirée Lie, MD, MSEd

CME Reviewer(s)

Sarah Fleischman

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Common Problems in Pediatric and Adolescent Gynecology

Introduction

Table of Contents