Gynecologic examination of the prepubertal

In summary, on the basis of strong evidence, (5) nonspecific or irritant vulvovaginitis is the most common cause of genital concerns in prepubertal girls. An empiric trial of hygiene and environmental measures should be used if nonspecific vaginitis is suspected. If the symptoms continue despite hygiene and environmental measures, bacterial cultures should be performed. On the basis of strong evidence, (7) if discharge with a foul odor is present, consider a foreign body and a knee-chest examination to visualize the inner vagina for the cause. If sexual abuse is suspected, careful evaluation and/or referral to a child protection specialist is warranted with testing for sexually transmitted infections. If there are physical signs that indicate another diagnosis, such as the appearance of lichen sclerosis, trauma, urethral prolapse, or labia adhesions, evaluation and management of these specific problems should be used as described above.