Differential Diagnosis for a 20-month-old Female with Vaginal Discomfort

• Single most likely diagnosis:
  • Urinary Tract Infection (UTI): This is a common condition in young children, especially females, and can cause discomfort during urination, leading to the child reaching for her vagina.
• Other Likely diagnoses:
  • Vaginal Irritation or Infection: This could be due to poor hygiene, bubble baths, or introduction of bacteria from the anal area, causing discomfort and leading the child to touch the area.
  • Constipation: Hard stools can cause discomfort in the genital area, especially in young children who may not be able to articulate their symptoms clearly.
  • Eczema or Dermatitis: Skin conditions around the genital area can cause itching and discomfort, prompting the child to touch the area.
• Do Not Miss diagnoses:
  • Sexual Abuse: Although rare and unfortunate, it's crucial for healthcare providers to consider this possibility, especially if there are other signs or symptoms suggestive of abuse.
  • Foreign Body in the Vagina: Young children may insert small objects into their vagina, leading to discomfort, infection, or other complications.
  • Lichen Sclerosus: A rare skin condition that can cause significant discomfort and needs early diagnosis and treatment to prevent long-term complications.
• Rare diagnoses:
  • Labial Adhesions: A condition where the labia minora become fused together, which can cause urinary discomfort and other symptoms.
  • Urethral Prolapse: A condition where the urethral mucosa protrudes from the urethral opening, which can cause discomfort and bleeding.
  • Congenital Anomalies of the Genitourinary Tract: Although present at birth, some anomalies might only become apparent during early childhood, causing urinary or genital discomfort.