What are similarities and differences in the approach?

A 6-year-old has a yellow vaginal discharge. The examination is otherwise normal. What are key points in the history and physical examination? How would you approach differ if the patient were a sexually active 16-year-old? What are similarities and differences in the approach?Student response to questions you are to reply to:Vaginal discharge in children may be very distressing to parents and the child when it’s associate with pain, itching, and abnormal discharge. Parents most concerned about pelvic infection, lack of cleanliness, and sexual abuse when they see their child experience an abnormal vaginal discharge. However, sexually transmitted infections (STIs) are a rare cause of vaginal discharge in a pre-pubertal girl. The common cause of abnormal discharge in children is called vulvovaginitis, which is caused by bacterial agent call group A beta-hemolytic streptococcus, which is related to an upper respiratory tract infection or sore throat which is transmitted from the throat to the vulva. In addition, Haemophilus influenza and candida are also common causes of vulvovaginitis (Hayes, 2011).Furthermore, an accumulation or deposit of a foreign body in the vagina is a common cause of vaginal discharge and vaginitis in children. It accounts for about four percent of symptoms in pediatric gynecology outpatient visits. Symptoms include foul-smelling discharge, dysuria, and, less commonly, pain. Foreign body lodgment may result from age-appropriate exploratory behavior or sometimes may due to sexual abuse. Some of the foreign bodies include hairpins, toilet tissue paper, parts of a toy, and tips of plastic markers, crayons, and gravel. They are most commonly found in children between three and nine years of age and are often due to age-appropriate curiosity and tendencies of self-exploration, introduction by playmates, or siblings in up to 25% cases, or as a result of sexual abuse. The latter must be ruled out by thorough history-taking, a physical exam, and diagnostic tests for sexually transmitted infection. Girls with developmental delays and behavioral disorders are at a higher risk of having retained vaginal foreign objects (Ganguli, Liu, Tsoumpariotis, Raparport, & Fakiolu, 2018).To examine the child, the parent of the child would be in the room, and the child would be put in in knee-chest position for a vaginal otoscopy to better visualize the inside of the child.In the case of a 16-year-old female who present with yellow vaginal discharge, sexually transmitted disease concern would be a priority. The examination would take the same approach as the 6-year-old girl, which would include careful inspection of the vagina with the correct instruments. However, the adolescent patient would be the one to provide a history of the condition in a private setting without the parent in the room and would ask the patient if she would want a parent in the room.In conclusion, parents should be taught the importance of hygiene in children, avoiding bubble baths, and to monitor their children so they do not insert any foreign body in their vagina. In the case of the adolescent girl, she should be advised to avoid using local irritants, like perfumed soaps and shower gels, and to be wary of feminine hygiene products such as wipes, powders, and sprays, which may upset the vaginal flora or cause allergic reactions. In addition, information about vaginal douching would be given so it can be avoided because it is associated with bacterial vaginosis and pelvic inflammatory disease. Reference Ganguli, S., Liu, Q., Tsoumpariotis, A., Raparport, S., & Fakiolu, E. (2018). Vaginal discharge in a pre-pubertal girl posing a diagnostic challenge. Cureus, 10(4). https://doi.org/ 10.7759/cureus.2424Hayes, L. (2011, January 24). Prepubertal vaginal discharge. Obstetrics & Gynaecology, 9. https://doi.org/10.1576/toag.9.3.159.27335