Ilke Beyitler

Clinical presentation, diagnosis and treatment of vulvovaginitis in girls: a current approach and review of the literature

BackgroundVulvovaginitis is the most common cause of gynecological complaints in children and young girls. Some of the factors which cause vulvovaginitis include hypoestrogenism, the anatomical proximity of rectum and delicate vulvar skin and vaginal mucosa.Data sourcesWe made a literature search with Pubmed, Medline and Cochrane database from January 2002 to May 2015 in English language using the key words vulvovaginitis, children, clinical, diagnosis and treatment.ResultsVulvovaginitis in girls is usually caused by non-specific factors and hygiene measures, bioyoghurt and avoidance of chemical irritants are generally useful. Weight control if necessary and prevention of voiding dysfunction are effective. Vaginal flora is important in girls and results should be interpreted with clinical features to decide whether an isolated microorganism is part of the normal microflora or is the cause of symptomatic vulvovaginitis. Specific treatment is generally considered in case of a detected pathogen microorganism. Isolation of a sexually transmitted organism requires further investigation. Persistent disease may not always indicate a foreign body but it must be taken into account. Girls and parents are encouraged psychologically in all steps of evaluation, diagnosis and treatment. Probiotics, nanotechnology and petroleum jelly are other important treatment options used in vulvovaginitis.ConclusionsIn this review, we present current approach to the presentation and management of vulvovaginitis in childhood. This disorder requires a comprehensive evaluation in all steps of diagnosis, differential diagnosis and treatment.

A Case of van Neck-Odelberg Disease and Intermittent Overuse Injury

In van Neck-Odelberg disease, an enlarged anatomical structure called ischiopubic synchondrosis is susceptible to mechanical stress which causes delayed ossification of this temporary joint. Features of the disease, particularly if unilateral, may mimic other conditions such as neoplasm, stress fracture, or osteomyelitis. In this article, we present a seven-year-old male patient with right painful ischiopubic synchondrosis which was misinterpreted as a subacute fracture of which its symptoms resolved with rest and analgesics. Three and six months later, he developed patellofemoral pain syndrome on the left leg due to overuse of that contralateral side. Clinicians should be careful when evaluating leg pain on the overused side opposite to ischiopubic synchondrosis.

Use of Bioimpedance in Pediatrics

Bioimpedance analysis is an easy, rapid, cheap, noninvasive, effective, and portable technique that can be utilized in several pediatric health conditions. The fluid status evaluation, edema, obesity, malnutrition, inflammation, infection, pain, attention deficit/hyperactivity disorder, nephrourological evaluation, gastroesophageal reflux, and neonatal problems are some of the issues studied with bioimpedance. As the pediatric-age group is usually difficult to manage, such practical and accurate methods are promising for better results.

Familial labial adhesion

Labial adhesion, also known as labial fusion, labial synechiae or labial agglutination, is the partial or total fusion of the labia minora in prepubertal girls, most commonly in the 3 month– 3 year age group. The condition may be asymptomatic or may result in urinary tract infection (UTI), post-void dripping or obstruction. Although the etiology is not clear, vulvar irritation, poor hygiene or excessive cleaning may be responsible. Familial labial adhesion has not yet been reported in the literature. We present the case of a 3-year-old girl evaluated for recurrent UTI who was found to have labial fusion that did not disappear with topical estrogen. Surgical separation was needed, after which the UTI stopped. Her 16-month-old sister also had labial fusion without any symptoms, which disappeared with topical estrogen. We do not know if this is a coincidence or not. Maternal estrogen insufficiency was previously believed to cause neonatal labial adhesion that disappears at puberty. The estrogen level in children with and without labial adhesions, however, was not found to be different, therefore the hypoestrogenic theory is no longer accepted. Familial labial adhesion is not analogous to androgen insensitivity syndrome seen in familial hipospadias. Given that labial adhesions disappear with intense estrogen treatment, there may be an estrogen insufficiency or estrogen insensitivity in the local tissues of these children. Androgen insensitivity is defined for testosterone but there has been no study with regard to estrogen. The association of labial adhesion and familial phimosis that is not physiological has also not been investigated previously. Given that the present sisters do not have a brother, we were not able to assess this. The mother of these children may have had similar complaints in childhood, but could not remember if this was the case. As a result, the present case of labial adhesion in two sisters suggests the possibliity of a familial predisposition to the condition.