Study Objective: 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.

Design: A retrospective chart review was performed on all premenarchal girls identified through the University of Michigan Pediatric and Adolescent Gynecology Clinic database who were seen for evaluation of vaginal discharge between June 1996 and October 2000. The records were reviewed for age, duration of vaginal discharge, procedures performed to rule out foreign bodies, and findings of such procedures.

Setting: The study was performed in a tertiary care university hospital

Participants: Thirty-one premenarchal girls were evaluated for vaginal discharge. The average age was 6.1 years (range 3 months – 11 years.)

Results: The average duration of vaginal discharge prior to presentation was 13 months (range 1- 42 months.) Of the 31 girls, 15 underwent 1 procedure and 1 underwent 2 procedures to rule out a foreign body (52% of patients.) A vaginal irrigation in clinic was performed on 7 girls. Vaginoscopy under anesthesia was performed in 10 girls who had failed symptomatic and antibiotic treatment, 2 by referring M.D. and 8 by us. In the girls who underwent a vaginal irrigation in clinic, the average age was 7.7 years (range 6 – 10 years.) 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 examination with eventual diagnosis of malingering in 1 patient.

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. Examination under anesthesia and vaginoscopy did not identify any foreign bodies; however, it facilitated the diagnosis of other unusual conditions.

Future Plans - Dr. Berman will begin her HOIV year at the University of Michigan in July, 2002