Peer Reviewed
Feature Article Paediatrics

Vulval disease in children. Part 2: management and sexual abuse issues

Gayle Fischer
Abstract
Most conditions of the vulva in children can be successfully managed in general practice. However, some of the rashes, particularly those causing erosions or ulcers, may raise suspicions of sexual abuse, and further advice should be sought on these.
Key Points
  • If dermatitis is resistant to treatment with environmental modification and 1% hydrocortisone cream, consider noncompliance, infection and psoriasis.
  • In Australia, virtually all cases of acute infective vulvitis are due to Streptococcus pyogenes and first line treatment is penicillin, not antifungal cream.
  • Many rashes, particularly unusual ones such as lichen sclerosus and others that may cause erosions or ulcers, are often misdiagnosed as sexual abuse. If in doubt, refer to a dermatologist.
  • Many parents of children with vulval disease are worried about the possibility of sexual abuse but few will raise the issue unless prompted.
  • Sexually abused children usually have no physical signs.
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