Premenarchal vaginal discharge: Findings of procedures to rule out foreign bodies

Abstract

BACKGROUND: Vaginal discharge in children is a common gynecologic complaint and may be resistant to symptomatic and/or antibiotic treatment. In recurrent or unresponsive patients, an evaluation to rule out a foreign body is traditionally recommended. The objective of this study is to review cases of vaginal discharge treated at our institution and determine the findings of procedures to rule out foreign bodies.METHODS: The University of Michigan Pediatric and Adolescent Gynecology Clinic database was reviewed to identify premenarchal girls seen for evaluation of vaginal discharge between 1996 and 2000. The records were reviewed for age, length of time of discharge, procedures done to rule out foreign bodies, and findings of such procedures.RESULTS: Thirty-one premenarchal girls were evaluated for vaginal discharge. The average age was 6.1 yrs (range 3 months-11 yrs). The average duration of vaginal discharge prior to presentation was 13 months (range 1-42 months). Of the 31 girls, 15 underwent 1 and 1 girl underwent 2 procedures to rule out a foreign body (52% of patients). A vaginal irrigation in clinic was performed in 7 girls. A vaginoscopy under anesthesia was performed in 10 girls who had failed symptomatic and antibiotic treatment, 2 by the referring M.D. and 8 by us. In the girls who underwent a vaginal irrigation in clinic, the average age was 7.7 yrs (range 6-10 yrs). The vaginal irrigation demonstrated a foreign body (tissue paper) in 2/7 (29%) cases. In both cases, the foreign body was visible on genital examination prior to the irrigation. In the girls who underwent a vaginoscopy under anesthesia a foreign body was not found in any case (0/10). The findings of the vaginoscopies included: biopsy proven severe dermatitis with no infection in 1 patient, lymphatic duct chylous drainage in 1 patient, non-specific vulvovaginitis in 7 patients, and normal exam with eventual diagnosis of Munchausen's syndrome in 1 patient. Those with the unusual diagnoses of chylous drainage and Munchausen's syndrome had copious discharge that soaked undergarments.CONCLUSIONS: Foreign bodies as a cause of vaginal discharge in a tertiary care referral clinic are unusual (2/31, 6%). In children with persistent vaginal discharge vaginal irrigation was feasible in older children, but only removed a foreign body in those where it was identified prior to the irrigation. Exam under anesthesia and vaginoscopy did not identify any foreign bodies; however, it facilitated the diagnosis of other unusual conditions.