Before it is discovered and it runs a chronic course of weeks and months and is extremely rebellious to treatment. One author has reported finding gonococci in the discharges after the disease had existed for four years. W. J. Butler and J. P. Long (Journ. Amer. Med. Asso., Oct. 17, 1908, p. 1301) state that in their experience in institutional epidemics of vulvo-vaginitis in children during ten years, the disease is quite as intractable to treatment as in adult women. Diagnosis of Vulvo-Vaginitis — On separating the labia the entire vulva is found to be red. It is wiped with a pledget of absorbent cotton and by pressure on the perineum from behind, pus — generally of a greenish color — comes from the vagina and the urethra. The physician should not introduce his finger into the rectum in cases of suspected infection of the genitals because of the very great danger of introducing infective matter in that organ. Cover glasses are prepared from the pus for microscopic examination as described on page 61. Usually the gonococci are easily demonstrated in the cells by the Gram method. The disease is differentiated from simple vaginitis by the bacteriological examination. Very rarely injuries of the vulva are found and only then are we justified in diagnosing rape. The inflammatory symptoms generally last from four to six weeks and the discharge changes from profuse purulent to scanty and mucoid as the disease progresses. The most frequent complication seems to be arthritis. Gonorrheal peritonitis has been reported as a sequel of gonorrheal vulvo-vaginitis by at least twelve different authors, therefore it may be regarded as a serious complication.
<Callout type="important" title="Critical Diagnosis">Differentiating between simple vaginitis and more severe conditions like vulvo-vaginitis is crucial for effective treatment.</Callout> Tuberculosis of the Vulva — Whether tuberculosis of the external genitals is ever primary in those organs seems to be doubtful. Briining, according to Langstein (Pfaundler and Schlossmann, 'Diseases of Children'), collected forty cases in which the disease seemed to start in the tubes, and then affected in order, — the ovaries, uterus, vagina, and vulva. He is of the opinion that primary tuberculosis of the external genitals has not been proven because the diagnosis in the cases reported has been made clinically, whereas definite pathological proof of the absence of tuberculosis elsewhere in the body is necessary before deciding that the disease has originated in the vulva.
Diphtheritic Vulvitis — Diphtheria of the vulva, secondary to pharyngeal diphtheria, is an occasional disease of childhood. Several cases of primary diphtheria of the vulva have been reported. Jacobi (Archives of Pediatrics, Feb., 1891) reported firm occlusion of the vulva and vagina as a result of diphtheritic inflammation, and Hydrup-Pederson, according to W. A. Edwards, reported the case of a girl of fifteen, who during an attack of diphtheria passed a complete cast of the vagina. Later the child developed a marked atresia of the vagina which was cured by operation.
Gangrene of the Vulva, or Noma Vulvae — Gangrene of the vulva, a disease similar to cancrum oris, may attack the vulva (usually one of the nympha)), in the case of dirty and underfed children, 570 INFANCY AND CHILDHOOD or as a complication or sequela of measles, scarlatina, erysipelas, or typhoid fever. The disease is not so common as it was formerly, especially in hospitals, because of the improved hygienic surroundings and aseptic treatment.
Sarcoma of the Vagina — Sarcoma of the vagina is by no means a rare affection in children. Although there are only forty or so authentic cases reported in the literature, there have been numerous cases of polyp of the vagina reported without microscopic examinations of the tumor.
Key Takeaways
- Vulvo-vaginitis is a chronic condition that can be difficult to treat and may persist for years.
- Gonococci are often found in the pus discharge of patients with vulvo-vaginitis, making bacteriological examination crucial.
- Tuberculosis of the external genitals is usually secondary to pulmonary tuberculosis.
Practical Tips
- Use absorbent cotton and pressure on the perineum from behind to collect pus for microscopic examination.
- Differentiate between simple vaginitis and more severe conditions like vulvo-vaginitis based on bacteriological examination results.
Warnings & Risks
- Avoid introducing infective matter into the rectum during diagnosis of suspected genital infections.
- Gonorrheal peritonitis is a serious complication that can occur as a sequel to gonorrheal vulvo-vaginitis.
Modern Application
While this chapter focuses on medical diagnoses and treatments from over a century ago, the principles of identifying and differentiating between various gynecological conditions remain relevant. Modern diagnostic techniques have improved accuracy, but understanding historical perspectives can provide valuable context for contemporary practice.
Frequently Asked Questions
Q: What are the typical symptoms of vulvo-vaginitis?
The typical symptoms include redness of the entire vulva upon separating the labia, pus discharge from the vagina and urethra when pressure is applied to the perineum, and a greenish coloration in the pus.
Q: Why should the rectum not be examined during diagnosis?
Introducing a finger into the rectum can introduce infective matter, posing significant risks of infection or exacerbating existing conditions.
Q: What is the significance of bacteriological examination in diagnosing vulvo-vaginitis?
Bacteriological examination helps differentiate between simple vaginitis and more severe conditions like gonorrheal vulvo-vaginitis, which can be crucial for effective treatment.