Findings in physical examination of the external genitalia in pediatric age − different is not always pathological - Part II (female)


  • Nuno Teles Pinto General and Family Medicine, Unidade de Saúde Familiar Fânzeres, Agrupamento de Centros de Saúde do Grande Porto II - Gondomar
  • Diana Morais Costa General and Family Medicine, Unidade de Saúde Familiar Bom Porto, Agrupamento de Centros de Saúde do Grande Porto V - Porto Ocidental
  • Ana Sofia Marinho Department of Pediatric Surgery, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • João Moreira Pinto Department of Pediatric Surgery, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto; EPIUnit - Instituto de Saúde Pública, Universidade do Porto



child, female, external genitalia, anomalies, physical examination, children, male, urogenital abnormality


Introduction: Findings in the physical examination of the external genitalia in children are often a source of concern and anxiety for parents and caregivers. Due to the proximity and role in child’s periodic surveillance, the family physician is in a privileged position to identify and initially provide guidance on these situations, key for the success of future interventions.

Objectives: To review available evidence on the main variations and anomalies of the external female genitalia in pediatric age, focusing on diagnosis and clinical approach in primary health care.

Results: In most cases, anomalies of the prepubertal female external genitalia are only variants of normal and/or do not significantly affect function, hence not requiring intervention other than clinical surveillance – e.g., fusion of labia minora. However, others require referral to secondary health care − like congenital vaginal obstruction or clitoral hypertrophy –, with early intervention being crucial for the success of implemented measures in some cases.

Conclusion: Genital pathology in prepubertal children is most often diagnosed by systematic and careful physical examination and usually has a favorable outcome. It is important to distinguish variants of normal from situations requiring more specialized assessment, in order to optimize health care system resources without overloading it and decrease parental anxiety.


Download data is not yet available.


Ferreira V VI, Fernandes E, Oliveira T, Guimarães S. Fusão Labial na infância- revisão da literatura. Acta Obstet Ginecol Port 2012; 6:193-8.

Nurzia MJ, Eickhorst K M, Ankem M K, Barone J G.The Surgical Treatment of Labial Adhesions in Pre-pubertal Girls. Journal of Pediatric and Adolescent Gynecology. 2003; 16:21-3.

Leung AKC RW, Kao CP, Liu EKH, Fong JHS.Treatment of labial fusion with topical estrogen therapy. J Paediatr Child Health. 2003; 29:235–6.

Michala LaC S. M.Fused labia: a paediatric approach. The Obstetrician & Gynaecologist. 2009;11: 261-4.

Starr N B. Labial adhesions in childhood. J Pediatr Health Care. 2006; 10:6-7.

Bacon JL, Romano ME, Quint EH. Clinical Recommendation: Labial Adhesions. J Pediatr Adolesc Gynecol. 2015; 28:405-9.

Hoekelman Robert A, ed. Atención Primária en Pediatria, Elsevier Science, Mosby Inc., 2001;1994-5.

Pokorny SF. Prepubertal vulvovaginopathies. Obstet Gynecol Clin North Am. 1992; 19:39-58.

Tebruegge M MI, Nerminathan V. Is the topical application of oestrogen cream an effective intervention in girls suffering from labial adhesions?. Arch Dis Child. 2007; 92:268-71.

Eroglu E YM, Oktar T, Kayiran SM, Mocan H. How should we treat prepubertal labial adhesions? Retrospective comparison of topical treatments: estrogen only, betamethasone only, and combination estrogen and betamethasone. J Pediatr Adolesc Gynecol. 2011; 24:389-91.

Mayoglou L, Dulabon L, Martin-Alguacil N, Pfaff D, Schober J.Success of treatment modalities for labial fusion:a retrospective evaluation of topical and surgical treatments. J Pediatr Adolesc Gynecol 2009; 22:247-50.

Muram D. Labial adhesions in sexually abused children. JAMA. 1988;15: 259:352-3.

Gulia C, Zangari A, Briganti V, Bateni ZH, Porrello A, Piergentili R. Labia minora hypertrophy: causes, impact on women’s health, and treatment options. Int Urogynecol J. 2017;28:1453-61.

Nimkarn S GP, Yau M, New, M. 21-Hydroxylase-Deficient Congenital Adrenal Hyperplasia. 2002;26 [Updated 2016 Feb 4]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2018.

Fernandez-Aristi AR, Taco-Masias A A, Montesinos-Baca L. Case report: Clitoromegaly as a consequence of Congenital Adrenal Hyperplasia. An accurate medical and surgical approach. Urology Case Reports. 2018; 18:57-9.

Caloia DV, Morris H, Rahmani MR. Congenital transverse vaginal septum: vaginal hydrosonographic diagnosis. J Ultrasound Med. 1998; 17:261-4.

Orazi C, Lucchetti MC, Schingo PM, Marchetti P, Ferro F. Herlyn-Werner-Wunderlich syndrome: uterus didelphys, blind hemivagina and ipsilateral renal agenesis. Sonographic and MR findings in 11 cases. Pediatr Radiol. 2007; 37:657-65.

Deligeoroglou E, Iavazzo C, Sofoudis C, Kalampokas T, Creatsas G. Management of hematocolpos in adolescents with transverse vaginal septum. Arch Gynecol Obstet. 2012; 285:1083.

Ferreira DM, Bezerra RO, Ortega CD, Blasbalg R, Viana PC, Menezes MR, et al. Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making. Radiol Bras. 2015; 48:249-59.

Grynberg M, Gervaise A, Faivre E, Deffieux X, Frydman R, Fernandez H. Treatment of twenty-two patients with complete uterine and vaginal septum. J Minim Invasive Gynecol. 2012; 19:34-9.

Gholoum S, Puligandla PS, Hui T, Su W, Quiros E, Laberge JM. Management and outcome of patients with combined vaginal septum, bifid uterus, and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome). J Pediatr Surg. 2006; 41:987-92.

Halvorsen TB, Johannesen E. Fibroepithelial polyps of the vagina: are they old granulation tissue polyps?. J Clin Pathol. 1992; 45:235-40.

Alotay AA, Sarhan O, Alghanbar M, Nakshabandi Z. Fibroepithelial vaginal polyp in a newborn. Urology Annals. 2015; 7:277–8.

Hillyer S, Kim H, Gulmi F. Diagnosis and treatment of urethral prolapse in children: experience with 34 cases. Urology. 2009;73:1008–11.

Rudin JE, Geldt VG, Alecseev EB. Prolapse of urethral mucosa in white female children: experience with 58 cases. J Pediatr Surg. 1997; 32:423-5.

Ninomiya TaK H.Clinical characteristics of urethral prolapse in Japanese children. Pediatrics International. 2017; 59:578-82.

Trotman MD, Brewster EM. Prolapse of the urethral mucosa in prepubertal West Indian girls. Br J Urol. 1993; 72:503-5.

Wei Y, Wu S, Lin T, He D, Li X, Wei G. Diagnosis and treatment of urethral prolapse in children: 16 years experience with 89 Chinese girls. Arab Journal of Urology. 2017; 15:248–53.

Moralioğlu S, Bosnalı O, Celayir A C, Şahin C. Paraurethral Skene’s duct cyst in a newborn. Urology Annals. 2013; 5:204–5.

Sá MI, Rodrigues AI, Ferreira L, Rodrigues M do C. Fetal vulvar cysts with spontaneous resolution. BMJ Case Rep. 2014; 2014:bcr2014206180.

Dwyer PL, Rosamilia A. Congenital urogenital anomalies that are associated with the persistence of Gartners duct: A review. American Journal of Obstetrics and Gynecology. 2006; 195:354–9.

Lee MY, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A. Clinical Pathology of Bartholin’s Glands: A Review of the Literature. Current Urology. 2015; 8:22–5.

Dagher R, Helman L. Rhabdomyosarcoma: an overview. Oncologist. 1999; 4:34-44.

van Sambeeck SJ, Mavinkurve-Groothuis AM, Flucke U, Dors N. Sarcoma botryoides in an infant. BMJ Case Rep. 2014; 2014:bcr2013202080.

Mousavi A, Akhavan S. Sarcoma botryoides (embryonal rhabdomyosarcoma) of the uterine cervix in sisters. Journal of Gynecologic Oncology. 2010; 21:273–5.

L K Sahu RM. Prolapsed Ureterocele Presenting as a Vulval Mass in a Woman, The Journal of Urology. 1987; 138:136.

Sinha RK, Singh S, Kumar P. Prolapsed ureterocele, with calculi within, causing urinary retention in adult female. BMJ Case Rep. 2014; 2014:bcr2013202165.

Abraham N, Goldman HB. Transurethral excision of prolapsed ureterocele. Int Urogynecol J. 2014; 25:1435-6.

Torres Montebruno X, Martinez J M, Eixarch E, Gómez O, García Aparicio L, Castañón M, et al Fetoscopic laser surgery to decompress distal urethral obstruction caused by prolapsed ureterocele. Ultrasound Obstet Gynecol. 2015; 46:623-6.

Timberlake MD, Corbett ST. Minimally invasive techniques for management of the ureterocele and ectopic ureter: upper tract versus lower tract approach. Urol Clin North Am. 2015; 42:61-76.




How to Cite

Pinto NT, Costa DM, Marinho AS, Pinto JM. Findings in physical examination of the external genitalia in pediatric age − different is not always pathological - Part II (female). REVNEC [Internet]. 2021Apr.6 [cited 2023Dec.1];30(1):33-8. Available from:



Review Articles

Most read articles by the same author(s)