How to approach the pediatric pelvic exam. (Diagnosing Vulvovaginopathies).

HOUSTON -- Familiarity with prepubertal anatomy and an appropriate examination are your best tools for diagnosing pediatric vulvovaginopathies, according to Dr. Susan Pokorny.

Signs and symptoms are less useful diagnostic aids but can help determine the pace and extent of the exam, she said at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.

Focus on the external genitalia first because in most cases that alone will allow you to identify and treat the problem, said Dr. Pokorny, a pediatric gynecologist in Houston.

Redness or irritation are clues that the child may be using a soap that's too strong or contains irritants such as perfume. Substituting a milder soap, plus thorough rinsing and drying, using a hairdryer if necessary, can improve symptoms dramatically, she said.

Good hygiene may also treat condylomata, which may appear and bleed in children as young as 18 months. Condylomata often resolve on their own by the time the child is from 2 to 2 1/2 years old.

Bleeding or discharge from the vagina or other symptoms in the presence of an unremarkable examination of the external genitalia are signals for a more extensive evaluation.

Sometimes looking at the child's soiled panties can help identify the nature of the discharge. Vaginal hyperkeratosis and polyposis could indicate the presence of a foreign body, although by the time you see the child it may be gone.