Gynecologic Emergencies

Gynecologic conditions in infants, children, and adolescents are distinct from those seen in adults, due to fluctuating hormone levels from infancy to puberty. This chapter focuses on the prepubertal child as there is significant overlap between gynecologic complaints in postpubertal adolescents and adults. The content in this chapter will enable emergency providers to distinguish normal pediatric gynecologic conditions from urgent and emergent pathology, including ovarian torsion, dysfunctional uterine bleeding and straddle injuries. Guidance for the management and treatment of these conditions is also provided in this chapter.

Vaginal Discharge

Key Points Vaginal discharge is caused by infection, inflammation, or changes in the vaginal flora.Vaginal discharge in the prepubertal child can be caused by infection, congenital abnormalities, trauma, or dermatologic conditions.Nonspecific vaginitis is the most common gynecologic problem in the prepubertal child.Prepubertal hypoestrogenic tissues are more susceptible to local irritants, foreign bodies, and infections.Most common causes of vaginitis in postpubertal women are bacterial vaginosis and vaginal candidiasis (Candida vulvovaginitis).Laboratory documentation of etiology of vaginal discharge is mandatory prior to treatment.Target treatment to etiology.

Treatment-Emergent Mania in a Prepubertal Boy

Bipolar disorder among children has gained acceptance as a diagnostic entity but continues to pose diagnostic and management challenges due to the developmental differences in children and inadequate evidence for pharmacological management. We present the case of a prepubertal child presenting with an apparent depressive episode who developed treatment-emergent mania when commenced on sertraline. This case highlights the need for further research into the presentations and pharmacological management of prepubertal children with bipolar affective disorder.