Comparison of Short and Chronic Duration Premenarchal Vulvar Complaints

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Abstract Study Objective To compare clinical characteristics, treatment histories, and microbiology of premenarchal girls presenting to a pediatric gynecology specialty clinic with short-duration and chronic vulvar symptoms. Design Retrospective cohort study Setting Pediatric and adolescent gynecology clinic at a tertiary care children’s hospital Participants One hundred eighty two premenarchal patients ages 2-14 years presenting to a pediatric gynecology specialty clinic with vulvar complaints and evaluated with a yeast and/or bacterial culture Interventions None Main Outcome Measures: Chronic and short duration vulvar symptoms, microbiology, and diagnosis. Results Patients with chronic symptoms were more likely to present with itching (57.8% v 42.5%, p=0.04), redness or rash (52.0% v 27.5%, p=0.0009), and discomfort (57.8% v 37.5%, p=0.006), compared to patients with short-duration symptoms. Overall 44.5% of patients had a history of antifungal treatment, with a greater proportion of patients with chronic symptoms having received antifungal treatment compared to those with short-duration symptoms (52.0% v 35.0%, p=0.02). Despite a history of antifungal treatment in nearly half of patients, Candida albicans was isolated in only 3/144 (2.1%) yeast cultures. Bacterial vulvar cultures were positive in 75/159 (47.2%), and there was no difference among the symptom duration groups (53.5% v 42.1%, p=0.15). Conclusions Vulvovaginitis is a common gynecological diagnosis among premenarchal girls with both short-duration and chronic vulvar symptoms. Regardless of symptom duration, yeast cultures are rarely positive. Antifungal treatment should be avoided in toilet trained prepubertal girls.