Developmental anomalies are more likely to present in young patients. These may include clitoral hypertrophy, congenital labial fusion, hypertrophy of the labia majora or minora, imperforate or microperforate hymen, transverse or longitudinal vaginal septum, or ambiguous genitalia. Pediatric patients may also develop vulvovaginitis. Candida and Escherichia coli are the most common organisms causing this condition, but sexually transmitted infections may also be seen. Neonatal infections of pathogens such as HSV and HPV may be congenitally acquired, but the presence of these in older children should prompt the suspicion of sexual abuse. Young girls may insert foreign bodies such as small toys or pieces of tissue in the vagina, which may trigger vaginitis symptoms such as itching and discharge (12). In addition, dermatologic conditions such as irritant dermatitis (diaper dermatitis) and lichen sclerosus may be seen in prepubertal girls. In adolescents presenting with viral syndrome symptoms such as fever, fatigue, sore throat, and lymphadenopathy as well as vulvar ulcers, Epstein-Barr virus infection or mononucleosis should be considered (13).
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