【導(dǎo)讀】Itaccountsfor40-80%ofvisitsto. BEHAVIORALFACTORS. ANATOMICFACTORS. PHYSIOLOGICFACTORS. ANATOMICFACTORS:. development:Birth-8wk,8wk-7Y,7-8Y—menarche.driesonskin?local. (duration,color,odor,quantity,bleeding,Hygienichabits. Clothing. Systemicinfection. Chronicillness. Medications. Allergies. Newdetergents. Nocturnalpruritis,bed-wetting. Newhouseholdpets. Favoriteplaysites. Requirespatience&gentleness. Inspectthepanties. P/R. Colposcopy?Anus. Obtainingasample. Vaginal. NotrespondingtoRx. Diphtheroid78%. Staphepid73%. α-hemolyticstrep39%. Lactobacilli39%. Non-hemstrep34%. Ecoli34%. Kleibsiella15%. Gardnerella%

　　

【正文】 GIENE amp。 RELIEVING SYMPTOMS ? Frequent sitz bath using warm water only ? Unscented toilet paper ? Front to back wiping after bowel movement ? Avoidance of harsh soaps 60 White cotton underwear change frequently Avoid exposure to potential bacteria Wash underwear well with water to remove any remnant of detergents MANAGEMENT NONSPECIFIC VV 61 MANAGEMENT NONSPECIFIC VV ? Avoid tight pants /pantyhose especially in summer ? Pat vulva dry after washing Relieving symptoms in acute inflammation ? Colloidal oat meal (aveeno) added to sitz bath ? Simple emolients ? Topical steroids (Hydrocortisone %) 62 Improving Perineal Hygiene Avoiding Local Irritants Avoiding pathogenic bacteria Relieving Symptoms of A inflam Vaginoscopy ve +ve Foreign body Ectopic ureter Neoplasm Topical estrogen for 714 days Same Ab Bedtime for 2months MANAGEMENT NONSPECIFIC VULVOVAGINITIS Emperical Antibiotic Rx 710 D Recurrent After initial Successful Ab Rx 63 MANAGEMENT SPECIFIC VULVOVAGINITIS Rx DEPENDS ON THE PATHOGENIC ORGANISM ISOLATED ON VAGINAL C/S ? 1Pathogenic bacteria antibiotics are used according to sensitivtiy ? 2Pinworms Mebendazole 100mg po ? 3Candida Antifungal cream ? 4HPV Podophylline, TCA, cryocautery, laser 64 MANAGEMENT SPECIFIC VULVOVAGINITIS ?5Herpes ? symptomatic Rx ? 6Rx systemic illness ?7Rx skin diseases ?8Foreign body ? EUA amp。 VAGINOSCOPY ?9Proper management amp。 referral of sexual abuse cases 65 Premenarchal Vaginal Discharge Findings of Procedures to Rule Out Foreign Bodies Journal of Pediatric and Adolescent Gynecology, Vol 15, issue 4 October 2020, Pages 227230 Yolanda R. Smith MD, , Deborah R. Berman MD and Elisabeth H Quint ? A retrospective chart review ? June 1996 Dec 2020 ? 41 girls with vaginal discharge ? Age 3 M–11 Y 66 RESULTS ? 10 vaginal irrigations in clinic ? A foreign body (tissue paper) 4 / 10 (40%) ? 17 vaginoscopies under GA ? A foreign body 3/ 17 (%) ? Total 7/27 procedures % ? Nonspecific vulvovaginitis 11 pt 67 Conclusions ?EUA amp。 vaginoscopy allowed the identification of foreign bodies, and the Dx of other conditions ?Vaginal irrigation (in clinic) was feasible in older children (average age yr) ?In all cases with a foreign body, the patient presented with bloody or brown discharge 68 Continuousflow vaginoscopy in children and adolescents J Am Assoc Gynecol Laparosc 2020 Nov。7(4):5268 Golan A, Lurie S, Sagiv R, Glezerman M, Holon, Israel ? 22 children evaluated for VV (15) Vaginal trauma (4) Bleeding (2) Genital malformation (1) ? Continuousflow vaginoscopy with a 4mm hysteroscope under GA 69 RESULTS ? No pathologic findings 16 ? A foreign body 3 ? Vaginal lacerations 3 ? No plications occurred ? The patients were discharged 4 to 24 hours after the procedure CONCLUSION ? Continuousflow vaginoscopy is quick and easy to perform in childr amp。 adoles. It should be used for the Dx of Gyn problems in this age gp 70 LABIAL AGGLUTINATION ? Etiology Chronic inflam (vulvovaginitis) + estrogen deff ? Most girls are asymptomatic ? Sympt pt C/O: Pain with activity Recurrent UTI Abnormal urinary stream 71 LABIAL AGGLUTINATION TREATMENT 1 Medical ? Estrogen cream bd for 714 days ? Sitz bath ? Advice about perineal hygiene 2Surgical ? Pt not responding amp。 symptomatic ? Followed with topical estrogens 72 CONCLUSION ? PPVV is a mon amp。 easily managed problem ? A broad differential diagnoses must be considered ? Sexual abuse must be suspected if there are signs of trauma or STD isolated ? Familiarity with potential causes amp。 treatment will improve pt car