Toddler Penetration In Vagina

Toddler Penetration In Vagina
Even though your child's vagina pretty much takes care of itself, it's good to know how to keep rashes and infections in a toddler vagina at bay.
What to Expect The First Year , 3rd edition, Heidi Murkoff and Sharon Mazel. What to Expect The Second Year , Heidi Murkoff and Sharon Mazel. American Academy of Pediatrics, Bathing Your Newborn , November 2009. American Academy of Pediatrics, Prevent Urinary Tract Infections in Children , November 2015. Mayo Clinic, Baby Bath Basics: A Parent's Guide , October 2016
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Vaginas are pretty good at self-maintenance, but sometimes it can get pretty uncomfortable down there — even in a toddler vagina. Just like fully grown ones, a child’s vagina is susceptible to itchiness, irritation or even infection. As a mom your challenge is to figure out when your little girl has a vaginal problem and how to solve it — or better still, how to prevent it in the first place. Tricky on all fronts (and bottoms), since your little one doesn’t yet have the body awareness or vocabulary to tell you what’s up down there — or the patience to perform proper vaginal hygiene (or any other part of her toddler grooming routine). Here are some tips on how to keep the toddler vagina healthy and avoid the most common causes of irritation.
If your toddler seems to be in pain after she pees, or her vaginal area seems red, she may have an inflammation of the vagina or vulva (also called vaginitis). If the steps above don’t help, check with your pediatrician for advice. You’ll also need to call the doc if your daughter experiences pain or stinging while she’s urinating — she could have a UTI.
From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You're Expecting . What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy .
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The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. This educational content is not medical or diagnostic advice. Use of this site is subject to our terms of use and privacy policy . © 2022 Everyday Health, Inc

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Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?
Selected Differential Diagnosis of an Abnormal Vaginal Opening in a Child

NIKHIL HEMADY, MD, AND DHARMESH SHAH, MD, North Oakland Medical Center, Pontiac, Michigan

Am Fam Physician. 2008;77(3):355-356
Author disclosure: Nothing to disclose.
A two-year-old girl's mother was concerned that her daughter's vaginal opening appeared to be closed. The mother had noticed this a few months earlier when her daughter had severe diaper rash. The patient did not have urinary problems or vaginal discharge, and her birth and development histories were unremarkable. Genital examination revealed a thin vertical raphe over the site of the vaginal opening (see accompanying figure) . The labia majora were intact and separated, although only the upper third of the labia minora was identifiable.
The answer is C: labial adhesions. Labial adhesions are acquired abnormalities involving the labia minora, but not the labia majora. Adhesion is the most common interlabial abnormality in child urology patients. 1 The adhesion usually begins at the posterior fourchette and extends to varying degrees superiorly to the clitoris. The abnormality is generally discovered between 13 and 23 months of age by the child's parents or by the physician during a routine well-child examination. Most cases occur before six years of age. 2
Children with labial adhesions usually have a history of a local inflammatory process, such as diaper rash. Most patients are asymptomatic; however, the adhesions occasionally cause local inflammation, recurrent vulvovaginitis, or recurrent urinary tract infections. Adhesions do not occur in newborns, presumably because of the protective effect of circulating maternal estrogens.
Treatment of adhesions is nonsurgical and includes application of topical estrogen cream. Estrogen cream applied daily to the affected area for one to two weeks has an effectiveness rate between 49 and 90 percent. 3 , 4 Occasionally, six to eight weeks of therapy is needed. 5
Cleaning the affected area and keeping the labia separated with short-term (one to two months) application of a petrolatum-based barrier ointment (e.g., Vaseline) can help prevent recurrence. Simple hygienic measures may be sufficient for asymptomatic children because most adhesions resolve during early puberty. 5 Topical steroids may also be effective, but they have not been prospectively studied. 6 Surgical treatment is reserved for patients with unresponsive cases.
Bartholin's gland is a small vestibular gland located bilaterally between the labia minora and hymen. Occasionally, the duct of the gland becomes obstructed, causing unilateral vulvar swelling. Bartholin's gland abnormalities are uncommon in children.
An imperforate hymen is the most common congenital obstructive anomaly of the female reproductive tract, 1 although it may not be diagnosed until adolescence. The labia are intact in affected patients. An imperforate hymen should be suspected in an adolescent presenting with primary amenorrhea; cyclic abdominal pain; and a bluish, bulging hymen. Newborns with this condition may have a bulge at the posterior introitus, representing retained vaginal fluid. Referral to a pediatric urologist is recommended for surgical repair of the hymen.
A complete transverse vaginal septum may occur at various levels inside the vagina, although most are located in the upper vagina. 1 Patients have a vaginal opening, and the labia are intact and separated. Non-fusion or canalization of the urogenital sinus and müllerian ducts cause the abnormality. Children are usually asymptomatic, but they may present with amenorrhea and a distended upper vagina during adolescence. Transperineal ultrasonography and magnetic resonance imaging (MRI) can help establish the diagnosis and determine the location and thickness of the transverse septum. Treatment is surgical resection.
Vaginal atresia is suspected when a vaginal opening cannot be identified and, instead, a shallow dimple is seen inferior to the urethral opening. Failed formation of the lower portion of the vagina leads to the condition. The labia are intact and the upper vagina, cervix, and uterus are normal. Palpation of a distended vagina on rectal examination may help to distinguish vaginal atresia from agenesis (failed formation of the upper vagina or testicular feminization). Ultrasonography with or without MRI is necessary to define the abnormal anatomy. Patients should be referred to a pediatric urologist for surgical reconstruction.
Address correspondence to Nikhil Hemady, MD, FAAFP, at nhemady@nomc.org . Reprints are not available from the authors .
Author disclosure: Nothing to disclose.
Rink R, Kaefer M. Surgical management of intersexuality, cloacal malformation, and other abnormalities of the genitalia in girls. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology . 9th ed. St. Louis, Mo.: Saunders; 2007.
Vulvovaginitis. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics . 17th ed. St. Louis, Mo.: Saunders; 2004.
Muram D. Treatment of prepubertal girls with labial adhesions. J Pediatr Adolesc Gynecol. 1999;12(2):67-70.
Aribarg A. Topical oestrogen therapy for labial adhesions in children. Br J Obstet Gynaecol. 1975;82(5):424-425.
Omar HA. Management of labial adhesions in prepubertal girls. J Pediatr Adolesc Gynecol. 2000;13(4):183-185.
Myers JB, Sorensen CM, Wisner BP, et al. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol. 2006;19(6):407-411.
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This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz .
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This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. See permissions for copyright questions and/or permission requests.
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Labia are intact; vaginal opening is intact, but obstructed by the hymen; congenital
Labia majora are intact; however, labia minora are fused together; vaginal opening is obstructed to varying degrees; not present at birth, but typically develops between 13 and 23 months of age
Labia are intact; vaginal opening is present, but obstructed by a transverse septum, typically in the upper vagina
Labia are normal; distal vagina is absent; shallow dimple inferior to the urethral opening

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A female juror looked to the ceiling, brought a tissue to her face and wiped tears from her eyes.
She couldn't bear to look at the injuries sustained by a 5-year-old girl abducted last year from her elementary school and raped with a sharp object.
"Gruesome," said attorney Tom Kline, who is handling the civil case on behalf of the now 7-year-old victim. "The photos are shocking and disturbing."
The evidence was so disturbing that Common Pleas Judge Jeffrey Minehart asked the public to leave the room.
The images were shown Tuesday as part of the Commonwealth of Pennsylvania's case against 21-year-old Christina Regusters. The woman, who allegedly committed the depraved acts on the girl over a 19 hour long period last January, stands as the only person charged in the case.
As the photos were flashed on a large projection screen in Criminal Justice Courtroom 1101, Regusters also diverted her glance -- looking down as her cheek rested in her left hand.
Police officers, jurors and media allowed to stay for the display were visibly jarred as Dr. Cindy Christian, a Children's Hospital of Philadelphia (CHOP) pediatrician who specializes in child sex abuse, detailed the damage done by the violent assault.
Breaking news and the stories that matter to your neighborhood.
The doctor said the object used in the rape, which could have been a wooden broom handle, prevented the girl from controlling her own bowels.
"I can’t imagine it being any more severe," said Christian, who also testified about injuries to the girl's vagina.

After being found partially clothed in an Upper Darby playground, the girl was transported to CHOP's emergency room where she was examined and forensic evidence collected.
The girl was also given anti-retrovirals to try and protect her body from any exposure to sexually transmitted diseases like HIV. Some of the drugs caused illness and vomiting, which the child endured for days after treatment in the ER.
Christian testified that the child’s mother called pediatricians days after leaving the hospital because the child remained in immense pain, had difficulty walking and was still not able to go to the bathroom.
The girl was taken to the hospital's Child Abuse, Referral and Evaluation Clinic where she was surgically examined under anesthesia. Christian said the internal exam helped them determine the need for a temporary colostomy bag to give her body time to heal.
That procedure was reversed in May, four months later, with another surgery, the doctor testified.
Christian said she has conducted “thousands and thousands” of exams on children who had been sexually abused. She said she can’t think of more than two handfuls of cases where the trauma and injury to the anus had been as severe as what the child went through in this case.

“Children shouldn’t have to have colostomies. They are very rare,” Christian said.
Regusters has maintained her innocence in the case. Her attorney has argued that prosecutors have the wrong person, despite the introduction of DNA evidence on the T-shirt the child was wearing when she was found.
Earlier in the day, the victim's brother and sister took the stand to recount the day of the abduction. The victim is expected to face her alleged rapist in court Wednesday.
Contact Sarah Glover at 610-668-5580, sarah.glover@nbcuni.com or follow @skyphoto on Twitter.

Man sleeps with 7-year-old daughter, inserts manhood into her mouth

Man sleeps with 7-year-old daughter, inserts manhood into her mouth

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A seven-year-old girl, Nneka (not real name) has narrated how her father usually play with her private part and insert his manhood in her mouth.
The victim, who lives with her parents at their Ojokoro Housing Estate, Meiran, Ijaiye, Lagos, said the father would pay her after making love with her.
The primary three pupil while narrating the incestuous incident to newsmen recently said, “My daddy usually gives me money after touching my private part or putting his penis in my mouth. He touches my private part when my mother is outside washing clothes or when she is not in the house.”
According to Vanguard report, the victim’s father, whose identity was given as Chukwuemeka Odunzie, allegedly started defiling his daughter early last year.
Narrating her ordeal, the victim’s mother, Mrs Odunzie, said: “Last year, my son told me that his younger sister was fond of playing with her private parts. It sounded strange that a seven-year-old child would be doing that.
“I will talk to her, scold her and sometimes beat her. There was a time I told my husband.
“All he said was that if she was acting strangely I should take her to any of these white garment churches. I was alarmed when one day, while we were in the sitting room, she started touching and playing with herself.
“Immediately, I called her inside the room and asked her what the problem was. I asked her if anyone was fiddling with her private parts. She said it was her father that always touched her private parts and that after touching her private parts, he would give her money.
“I confronted my husband when he returned from work but he denied vehemently. I reported a case of defilement to Ebenezer Divisional Police and the policemen invited my husband for questioning.
“He was arrested later by the police, who gave me a report to take my daughter to the hospital. The doctor said there had been no penetration, but that there is an opening in her vagina and advised that the victim be tested for infection.
“By the time we came back from the hospital, the IPO said it was a family issue and that we should go home and settle
the case.
“Members of his family were shouting, saying that I had no right to report the case to the police, that it was a family issue that should be treated as one. They pressurized me till I withdrew the case, after which he promised not to defile our daughter again.
“After I withdrew the case, my husband began to beat the children at the slightest provocation. And at times, he would beat them for no tangible reason.
“Two weeks ago, it happened again. I asked her what she did for her father that made him give her money without giving her siblings. That was when she said that daddy gave her the money after touching her private part.
“Her siblings said it had been ongoing for a while and that they refused to tell me because the last time they did, their daddy kept beating them.
“Her brother said whenever I was not around, or I was outside washing clothes, daddy would send him and his other siblings inside the bedroom, while he would ask the victim to kneel down in between his legs and bend her head towards his manhood.
“She also confirmed that after touching her, daddy would put his penis in her mouth.
“There was even a time my daughter was caught in the act with a four-year-old boy, who is a neighbour’s child.”
The accused, Chukwuemeka Odunzie, admitted that it was only once he abused his daughter and that he was not doing it for diabolic reasons.
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