Gynaecological problems in children and adolescents

Abstract A wide range of mostly unrelated conditions can affect the female genitalia in children and adolescents. Labial adhesions develop after birth, as the oestrogen level falls and may cause some minor leakage of urine after micturition. Vulvovaginitis has several causative factors and can usually be managed by simple local measures. Perineal and vaginal pain may be caused by pinworms or vestibulodynia. Delayed puberty raises the possibility of a 46,XY disorder of sex development such as gonadal dysgenesis or androgen insensitivity syndrome. The post-pubertal girl with an imperforate hymen may present with lower abdominal pain and ultrasonography will reveal a pelvic mass. Cyclical pain with menses has several patterns, which give clues to the underlying causes. Ovarian torsion is managed by laparoscopic detorsion of the ovary—it should be conserved if viable. Ovarian cysts present with abdominal pain or incidentally at laparoscopy or ultrasonography. A complex cyst on ultrasonography is likely to be a dermoid cyst (ovarian teratoma).