Littel two-year-old girl's mother was concerned that her daughter's vaginal opening appeared to be closed. The mother had noticed image a few months earlier when her daughter had severe diaper rash.
The patient did not have urinary problems or vaginal discharge, and her birth and development histories were unremarkable.
Genital examination revealed a thin vertical raphe over the site of the vaginal opening see accompanying figure. The labia majora were intact and separated, although only the upper third of the labia minora was identifiable.
Based on the patient's history and physical examination, which one of the following is the most likely diagnosis? The answer is C: Labial littel are acquired abnormalities involving the labia minora, but not littel labia majora. Adhesion is the most common interlabial abnormality in child urology patients. The abnormality is generally discovered between 13 and 23 months of age by the child's parents or teens the physician during a routine well-child examination. Most cases occur before six years of age. Children with labial adhesions usually hyman a history of a local inflammatory process, such as diaper rash.
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Most patients are asymptomatic; however, the adhesions occasionally cause local inflammation, recurrent vulvovaginitis, or recurrent urinary tract infections. Adhesions do not occur in newborns, presumably because of the hyman effect of circulating maternal estrogens.
Treatment of adhesions is nonsurgical and includes application of topical estrogen cream. Estrogen cream applied daily to the affected area for one to two weeks has an effectiveness rate between 49 and 90 percent. Cleaning the affected area and keeping the labia separated with short-term one to two months application of a petrolatum-based barrier ointment e. Simple hygienic measures may be sufficient for asymptomatic children because most adhesions resolve during early puberty. Bartholin's gland is a small vestibular gland located bilaterally between the labia minora and hymen.
Occasionally, the duct of the gland becomes obstructed, causing unilateral vulvar swelling. Bartholin's gland abnormalities are uncommon in children. An imperforate hymen is the image common congenital obstructive anomaly of the female reproductive tract, 1 although it may not be diagnosed until adolescence. The labia are intact in affected patients. An imperforate hymen should be suspected in an adolescent presenting with primary amenorrhea; cyclic abdominal pain; and a bluish, bulging hyman.
Newborns with this condition may have a bulge at the posterior introitus, representing retained vaginal fluid. Referral to a littel urologist is recommended for surgical repair perfect sexy cougar naked body the hyman.
A complete transverse vaginal septum may occur at various levels inside the vagina, although most are located in the upper vagina. Children are usually asymptomatic, but they may present with amenorrhea and a distended upper vagina during adolescence. Transperineal ultrasonography and magnetic resonance imaging MRI can littel establish the diagnosis and determine the location and thickness of the transverse septum. Treatment is surgical resection. Vaginal atresia is suspected when a vaginal teens cannot be identified and, instead, a shallow dimple is seen inferior to the urethral opening.
Failed formation of the lower portion of the vagina leads to the condition. The labia are intact and the upper vagina, cervix, and uterus are normal. Palpation of a distended vagina on rectal examination may help to distinguish vaginal atresia from agenesis failed formation of the upper vagina or testicular feminization. Ultrasonography with or without MRI is necessary to define the abnormal anatomy.
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Patients should be referred to a pediatric urologist for surgical reconstruction. Labia are intact; vaginal opening is intact, but obstructed by the hymen; congenital. Labia image are intact; however, labia minora are fused together; vaginal opening is obstructed to varying degrees; not present at birth, but typically develops between image and 23 months of age.
Labia are intact; vaginal opening is present, but obstructed by a transverse septum, hyman in the upper vagina. Labia are normal; distal vagina is absent; shallow dimple inferior to the urethral opening. Already image member or subscriber?
Log in. Reprints are not available from the authors. Rink R, Kaefer M. Surgical management of intersexuality, cloacal malformation, and other abnormalities of the genitalia in girls. Campbell-Walsh Urology. Louis, Mo.: Saunders; Nelson Textbook of Pediatrics.
Muram D. Treatment of prepubertal girls with labial adhesions. Hyman Pediatr Adolesc Gynecol. Aribarg A. Topical oestrogen therapy for labial adhesions in children. Br J Obstet Gynaecol. Omar HA. Management i want to see naked females photos from japan labial adhesions in prepubertal teens.
Betamethasone cream for the treatment of pre-pubertal labial adhesions. Guidelines for preparing and teens a Photo Quiz manuscript can be littel in best figures nude girls Authors' Teens at http: To be considered for publication, submissions must meet these guidelines. E-mail submissions to afpphoto aafp.
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Hymens: Types of Hymens | Center for Young Women's Health
Get Permissions. Read the Issue. Sign Up Now. Gastroenteritis in Children. Medications for Insomnia Treatment in Children. Feb 1, Issue. Question Based on the patient's history and physical examination, which one of the following is the most likely diagnosis? Bartholin cyst.
Examples of Unbroken Hymens | Betty Dodson & Carlin Ross
Imperforate hymen. Labial adhesions. Transverse vaginal septum. Vaginal atresia. Discussion The answer is C: Selected Differential Diagnosis of an Abnormal Vaginal Opening in a Child Condition Characteristics Imperforate hymen Labia are intact; vaginal opening is intact, but obstructed by the hymen; congenital Labial adhesions Labia majora are intact; however, labia minora are fused together; vaginal opening is obstructed to varying degrees; not present at birth, but typically develops between 13 and 23 months of age Transverse vaginal Septum Labia are intact; vaginal opening is present, but obstructed by a transverse septum, typically in the upper vagina Vaginal atresia Labia are normal; distal vagina is absent; shallow dimple inferior to the urethral opening.
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