Gynecologic Examination of the Prepubertal Girl

Amanda M. Jacobs, MD* 2. Elizabeth M. Alderman, MD* 1. *Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY. * Abbreviations: AAP: : American Academy of Pediatrics HPV: : human papillomavirus NAAT: : nucleic acid amplification test The prepubertal genitalia in girls varies in appearance and function compared with the pubertal genitalia of adolescent girls and as such is subject to a unique spectrum of disorders that require appropriate screening, identification skills, and management. After completing this article, readers should be able to: 1. Describe techniques necessary for examining the external genitalia of prepubertal girls. 2. Identify the normal variations and natural history of the female prepubertal external genitalia. 3. Identify, evaluate, and manage common vulvar symptoms in prepubertal girls: labial adhesions, vaginal irritation, bleeding, itching, discharge, and ulcers. Genital examination should be a routine part of a comprehensive physical examination for any girl at any age. The vulva of a prepubertal girl has a unique appearance compared with that of a postmenarchal girl. It is important to become familiar with the normal variations of the genital anatomy of a prepubertal girl, including the vulva’s features and characteristics, so that abnormalities are recognized (Fig 1). Abnormalities, such as the imperforate hymen, signs of sexual abuse, or rare malignant tumors, require prompt evaluation and treatment. Labial adhesions are frequently noted; vulvar symptoms, such as irritation and erythema, are common, and most causes are benign. Causes of vaginal discharge in prepubertal girls vary from those of pubertal females. Figure 1. Anatomical terms for structures of the prepubertal female introitus. Reprinted from Figure 1 in Fortin K, Jenny C. Sexual abuse. Pediatr Rev . 2012;33(1):19-32. The performance of a thorough genital examination can be challenging and anxiety provoking for young patients, their caregivers, and health care clinicians. Patients may be apprehensive about the examination because many children have been counseled not to allow that area …