Smith Yolanda R, Berman Deborah R, Quint Elisabeth H
Department of Obstetrics and Gynecology, The University of Michigan Hospitals Health Systems, Ann Arbor, MI 48109-0276, USA.
J Pediatr Adolesc Gynecol. 2002 Aug;15(4):227-30. doi: 10.1016/s1083-3188(02)00160-2.
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 referred to our institution and assess outcome and diagnosis in those who required irrigation or vaginoscopy to rule out a foreign body.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 December 2001. The records were reviewed for age, length of time of discharge, aspects of discharge, procedures done to rule out foreign bodies, and findings of such procedures.
The study was performed in a tertiary care university hospital.
Forty-one premenarchal girls were evaluated for vaginal discharge. The average age was 6.0 yr (range 3 months-11 yr).
The average duration of vaginal discharge prior to presentation was 13.7 months (range 1-42 months). Of the 41 girls, 18 girls underwent 1 procedure each, 2 girls underwent 2 procedures each, and 1 girl underwent 5 procedures. Ten vaginal irrigations in clinic were performed in 7 girls, 3 by the referring physician and 7 by us. These irrigations removed a foreign body (tissue paper) in 4 of 10 (40%) cases, 3 at our institution and 1 at an outside institution. In the three irrigation cases with foreign bodies performed at our institution, the foreign body was visible on genital examination prior to the irrigation. Seventeen vaginoscopies under anesthesia were performed in 16 girls, 5 by the referring physician and 12 by us. In the girls who underwent a vaginoscopy under anesthesia a foreign body was found in 3 of 17 (17.6%). The other findings of the vaginoscopies included: biopsy-proven severe dermatitis with no infection in 1 patient, lymphatic duct chylous drainage in 1 patient, nonspecific vulvovaginitis in 11 patients, and normal exam with eventual diagnosis of malingering in 1 patient. In all cases where a foreign body was identified, the patient presented with bloody or brown discharge.
Foreign bodies as a cause of persistent vaginal discharge in a tertiary care referral clinic were identified in 4 of 41 girls (9.8%) and 7 of 27 procedures (25.9%). One child had recurrent foreign bodies removed during 4 of 5 procedures for discharge. In children with persistent vaginal discharge, vaginal irrigation was feasible in older children (average age 7.7 yr). However, no foreign bodies were removed by irrigation that had not already been visually identified prior to the procedure. Exam under anesthesia and vaginoscopy allowed the identification of foreign bodies, and it facilitated the diagnosis of other unusual conditions.
儿童阴道分泌物异常是常见的妇科问题，可能对对症治疗和/或抗生素治疗无效。对于复发或治疗无反应的患者，传统上建议进行评估以排除异物。本研究的目的是回顾转诊至我院的阴道分泌物异常病例，并评估那些需要冲洗或阴道镜检查以排除异物的患者的诊断结果和治疗结局。
对1996年6月至2001年12月期间在密歇根大学儿科与青少年妇科诊所数据库中确诊的所有青春期前女孩进行了回顾性病历审查，这些女孩因阴道分泌物异常前来就诊。审查记录包括年龄、分泌物持续时间、分泌物特征、为排除异物所做的检查以及这些检查的结果。
本研究在一家三级医疗大学医院进行开展。
41名青春期前女孩因阴道分泌物异常接受评估。平均年龄为6.0岁（范围3个月至11岁）。
就诊前阴道分泌物异常的平均持续时间为13.7个月（范围1至42个月）。41名女孩中，18名女孩各接受了1次检查，2名女孩各接受了2次检查，1名女孩接受了5次检查。7名女孩在门诊进行了10次阴道冲洗，其中3次由转诊医生操作，7次由我们操作。这10次冲洗中有4次（40%）取出了异物（卫生纸），3次在我院，1次在外部机构。在我院进行的3次冲洗出异物的病例中，冲洗前在体格检查时异物可见。16名女孩接受了17次麻醉下阴道镜检查，其中5次由转诊医生操作，12次由我们操作。在接受麻醉下阴道镜检查的女孩中，17次中有3次（17.6%）发现异物。阴道镜检查的其他结果包括：1例经活检证实为严重皮炎且无感染，1例淋巴管乳糜引流，11例非特异性外阴阴道炎，1例检查正常最终诊断为诈病。在所有发现异物的病例中，患者均表现为血性或褐色分泌物。
在一家三级医疗转诊诊所中，41名女孩中有4名（9.8%）、27次检查中有7次（25.9%）发现异物是持续性阴道分泌物异常的原因。一名儿童在5次分泌物异常检查中有4次取出复发性异物。对于持续性阴道分泌物异常的儿童，阴道冲洗在年龄较大的儿童（平均年龄7.7岁）中是可行的。然而，冲洗前未肉眼识别的异物冲洗后未被取出。麻醉下检查和阴道镜检查可发现异物，并有助于诊断其他异常情况。
