How to assess a female child for vulvar swelling and erythema (redness)?

From the Guidelines

To assess a child female for vaginal swelling and redness, a gentle external examination in good lighting is recommended, looking for visible redness, swelling, discharge, or signs of trauma, while ensuring a comfortable and private setting with a parent or guardian present for reassurance. This approach is supported by the American Academy of Pediatrics 1 and is crucial in minimizing discomfort and potential psychological trauma to the child. The examination should include inspection of the external genitalia, noting any signs of inflammation, redness, or swelling, as well as any pigmentary changes 1. It is also essential to ask about recent symptoms, hygiene practices, potential irritants, and any history of similar issues.

When performing the examination, it is crucial to:

• Ensure a comfortable and private setting with a parent or guardian present for reassurance
• Use good lighting to visualize the external genitalia
• Look for visible redness, swelling, discharge, or signs of trauma
• Note the distribution and severity of redness, any discharge characteristics, and associated symptoms like itching or pain
• Document findings objectively using anatomically correct terms

According to the guidelines for sexually transmitted diseases treatment 1, examinations and collection of vaginal specimens in prepubertal children should be performed by an experienced clinician to avoid psychological and physical trauma to the child. The decision to obtain genital or other specimens from a child to evaluate for STDs must be made on an individual basis, considering factors such as evidence of recent or healed penetrative injury, abuse by a stranger, or signs and symptoms of STDs 1. If internal examination is required, it should be performed by a pediatric specialist, and treatment depends on the cause, which may include improved hygiene practices, avoiding irritants, or medication for specific infections.

From the Research

Assessing Vaginal Swelling and Redness in a Child Female

To assess a child female for vaginal swelling and redness, the following steps can be taken:

• Obtain a focused history from the parent or guardian, including any symptoms or concerns they may have [ 2 ].
• Perform a gentle and non-traumatic clinical examination, taking into account the child's age and developmental stage [ 3 ].
• Use a good anatomical and physiological knowledge of the genital system in children, and learn non-aggressive examination technical skills associated with good communication skills [ 3 ].
• Consider the normal findings for the child's age group, and be aware of any potential biases in the literature [ 3 ].

Important Considerations

• A genitourinary assessment is an integral part of a complete physical examination, and can help to identify any potential issues or anomalies [ 2 ].
• Routine genital examinations can increase diagnostic skills, provide a baseline for future examinations, and may improve parent and child compliance with the examination [ 2 ].
• Developmental considerations and examination tips should be taken into account when performing a genitourinary examination on a child [ 4 ].

Additional Information

• Topical antibiotics may be used to reduce the incidence of infection in minor skin trauma, but their use should be guided by evidence-based practice [ 5 ].
• The interaction between neomycin and other antibiotics should be considered when using combination therapies [ 6 ].