Physiologic Bleeding in Newborn
Vaginal bleeding in response to loss of exposure to maternal estrogen
Usually occurs within first days of life and should have resolved by 2nd week of life

Normal physiologic vaginal discharge
Gray white or light yellow in color
Non purulent
Develops early in puberty
Desquamation of vaginal epithelium due to transition to acidic vaginal environment

Labial Adhesions
Partial or complete fusion of labia minora
Usually begins posteriorly and extends upward
Acquired rather than congenital, due to labial irritation/inflammation

Imperforate Hymen
Usually missed in newborn period
Often not picked up until puberty and development of hematocolpos
Presenting symptoms
 Cyclical abdominal pain
 Abdominal distention/mass
 Urinary retention

Why are prepubescent children physiologically more susceptible to vulvovaginitis?
Non-estrogenized vulvar and vaginal epithelium is thinner and more susceptible to irritation
Neutral or alkaline ph- good medium for bacterial growth
Vagina of prepubescent child is colonized with 9 different organisms

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