The role of cystovaginoscopy and hygienic advice in girls referred for symptoms of vulvovaginitis
- 1Department of Paediatric Surgery, University Hospital Wales, Heath Park, Cardiff, UK
- 2Medical School, Cardiff University, Cardiff, UK
- 3Department of Paediatric Surgery, Southampton University Hospital, Southampton, UK
- Correspondence to Ashok Daya Ram, Department of Paediatric Surgery, University Hospital Wales, UWIC, Howard Gardens Campus, Howard Gardens, Cardiff, South Glamorgan CF14 4XW, UK;
- Received 31 December 2011
- Accepted 2 January 2012
- Published Online First 30 January 2012
Vulvovaginitis is a common presenting symptom referred to a paediatric urology clinic. Some of these patients undergo diagnostic cystovaginoscopy to determine whether there is any underlying anatomical cause for the persistent infection. However, in the majority of the patients, no underlying abnormality is found and they are given hygienic advice and prescribed bio yoghurt postoperatively. This study examines the outcome in these patients after hygienic advice is given: determining whether cystovaginoscopy was really necessary and whether it changed the management of vulvovaginitis.
Vulvovaginitis is a frequent complaint in prepubertal girls and consequently a common presentation to a paediatric urology clinic. Young girls are particularly susceptible to vaginal infections because of their anatomy,1 and the loss of maternal oestrogens after birth. The lack of oestrogen causes a thinning of the vaginal epithelium and flattens the labia majora, allowing infectious organisms to enter the vagina more easily.2 3
Although urethral swabs are used initially to determine the cause of the infection in these children,4 many paediatricians and general practitioners refer them to paediatric urology clinics requesting cystovaginoscopy. These requests usually follow concerns regarding recurrent or chronic symptoms of vulvovaginitis.
Cystovaginoscopy was performed as a day case procedure to determine whether there was any underlying pathology that could cause recurrent infection. However, in the majority of cases no abnormalities were found and patients were given specific hygienic advice and prescribed bio yogurt postoperatively. This approach has been described in the literature before.5
The objectives of this study were to determine whether cystovaginoscopy has any value in the management of symptoms of vulvovaginitis and to determine the effectiveness of hygienic advice.
Patients and methods
Retrospective case notes review of 53 patients attending the paediatric urology clinic at the Southampton General Hospital over a period of 10 years from November 1998 to November 2008 referred for symptoms of vulvovaginitis. Outpatient appointment questionnaires were also distributed to the patients accordingly.
Of the 53 patients referred for symptoms of vulvovaginitis, 48 patients underwent diagnostic cystovaginoscopy as a day case procedure. The procedure was performed by the same consultant paediatric urologist.
▶ The patients' ages ranged from 4 to 15 years.
▶ The duration of symptoms ranged from 8 to 33 months with a median duration of 12 months.
▶ Preoperative ultrasound was carried out on 45 patients and 1 patient was found to have a solitary kidney.
▶ At cystovaginoscopy 15 patients had mild non-specific cystitis, 3 patients had labial adhesions and 1 child with a single right ureteric orifice later underwent laparoscopic left nephrectomy. The rest were entirely normal.
All patients received strict hygienic advice after the procedure and were followed-up 3–6 months postoperatively. Four patients were lost to follow-up. Thirty-nine patients reported marked improvement of symptoms or complete cure, which significantly improved their quality of life.
This study demonstrates that cystovaginoscopy does not alter the management of recurrent or chronic vulvovaginitis. With this in mind, we suggest that a child suffering from symptoms of vulvovaginitis need not be subjected to cystovaginoscopy and anaesthesia if the kidney–ureter–bladder ultrasound scan is normal.
We conclude from this study that hygienic advice that is rigorously followed significantly improves the symptoms of vulvovaginitis and therefore should be the first line of treatment.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.