392 Obstetrics and Gynecology Board Review •••
❍ Name three common organisms that cause prepubertal vulvitis.
(1) Candida.
(2) Pinworms.
(3) Group A β-hemolytic streptococcus.
❍ What is the classic symptom of Enterobius vermicularis infestation?
The classic presentation of pinworm infestation is nocturnal itching of the vulvar and perianal areas.
❍ What medication is used to treat pinworms?
Mebendazole.
❍ What is the most common foreign body found in the vagina of a child?
Toilet paper.
❍ List the differential diagnosis of persistent vaginal bleeding in a preadolescent female.
(1) Neoplasia.
(2) Precocious puberty.
(3) Ureteral prolapse.
(4) Trauma.
(5) Sexual assault.
(6) Vulvovaginitis.
(7) Exposure to exogenous estrogen.
(8) Shigella infection.
(9) Group A & Beta hemolytic streptococcal infection.
(10) Foreign body in vagina.
❍ List five indications of vaginoscopy in a female child.
(1) Recurrent vulvovaginitis.
(2) Persistent bleeding.
(3) Suspicion of foreign body.
(4) Suspicion of neoplasm
(5) Congenital anomalies.
❍ What strategies could be employed if a bimanual examination could not be performed in a child or
adolescent?
(1) A rectal-abdominal examination in the dorsal lithotomy position.
(2) Inserting a cotton-tip swab in the vagina to evaluate for agenesis or a transverse septum.
(3) Ultrasonography.