Skip to main content
SpringerLink
Log in

Vaginal microbiocoenosis and cytology of prepubertal and adolescent girls: their role in health and disease

  • Review Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

Clinicians and investigators often do not appreciate the importance of vaginal microbiocoenosis and vaginal cytology in the health of prepubertal and adolescent girls.

Data sources

Based on recent publications in human medicine and our own experience with vaginal cytology and microbiology in children and adolescent girls, we review the principles of vaginal microbiocoenosis and cytology and their roles in disease prevention in prepubertal and adolescent girls.

Results

The main role of vaginal microbiocoenosis and cytology in diagnosing as well as developing vulvovaginitis is demonstrated. Clinicians can identify states of vaginal health and disease by important well-known diagnostic tools, including vaginal cytology. Lactobacilli are infrequently observed in the prepubertal girls, but become more abundant in adolescent girls. Three basic types of vaginal smears are presented in addition to a classification of inflammatory urogenital diseases. Management of common types of vulvovaginitis is also considered.

Conclusions

This essential shift in vaginal biocoenosis is important to prevent the growth of potentially pathogenic flora in the vagina. The detection of vaginal microbiocoenosis problems and recognition of changing cytology in vaginal development can provide helpful clues to identifying and preventing vaginal diseases in this pediatric population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gurkin Y. “New” sexual transmitted diseases in girls. Guide for doctors. St.-Peterburgh: Medical Press, 1999: 5–64.

    Google Scholar 

  2. Schmidt F, Grulich-Henn J, Heinrich UE, Bettendorf M. Mucosal cytology in the determination of the pubertal status in girls. Horm Res 2002;58:223–228.

    Article  CAS  PubMed  Google Scholar 

  3. Bowen R. Classification of vaginal epithelial cells, 1998. http://www.vivo.colostate.edu/hbooks/pathphys/reprod/vc/cells.html (accessed March 2, 2009).

  4. Kokolina V. Vulvavaginitis. In: Kokolina V, eds. Paediatric gynaecology: guide for doctors. Moscow: Medical Informational Agency, 2003: 78–112.

    Google Scholar 

  5. Kuznetsova Y, Zeltonozenko L. Role of bacterioscopic investigation in diagnostic inflammatory diseases of genitals in girl and adolescent girl. In: Chayka V, Matytsina L, eds. Actual problem of rehabilitation of reproductive health. Donetsk: Lebed, 2004: 115–117.

    Google Scholar 

  6. Chaika V, Matytsina L, Onipko A. Prophylactic, diagnostic and treatment urogenital infection in girls and adolescents. In: Chayka V, Matytsina L, eds. Diagnostic and correction of disorders of reproductive system in children and adolescents. Donetsk: Lebed, 2000: 106–116.

    Google Scholar 

  7. Hammerschlag MR, Alpert S, Rosner I, Thurston P, Semine D, McComb D, et al. Microbiology of the vagina in children: normal and potentially pathogenic organisms. Pediatrics 1978;62:57–62.

    CAS  PubMed  Google Scholar 

  8. Pierce AM, Hart CA. Vulvovaginitis: causes and management. Arch Dis Child 1992;67:509.

    Article  CAS  PubMed  Google Scholar 

  9. Piippo S, Lenko H, Vuento R. Vulgar symptoms in pediatric and adolescent patients. Acta Paediatr 2000;89:431.

    Article  CAS  PubMed  Google Scholar 

  10. Greydanus DE, Omar H, Patel DR. What’s new: cervical cancer screening in adolescents. Pediatr Rev 2009;30:23–25.

    Article  PubMed  Google Scholar 

  11. Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2008: a review of current American Cancer Society guidelines and cancer screening issues. CA Cancer J Clin 2008;58:161–179.

    Article  PubMed  Google Scholar 

  12. Johnson J. The Gynecology System and the Child. In: Greydanus D, Feinberg A, Patel D, Homnick D, eds. The Pediatric Diagnostic Examination. NY: McGraw-Hill Medical Publishers, 2008: 685–699.

    Google Scholar 

  13. Johnson J. Sexually transmitted diseases in the adolescent. In: Greydanus D, Patel D, Pratt H, eds. Essential Adolescent Medicine. New York: McGraw-Hill Medical Publishers, 2006: 511–542.

    Google Scholar 

  14. Holland-Hall C. Sexually transmitted diseases, syndrome and symptoms. Prim Care: Clin Office Pract 2006;33:433–454.

    Article  Google Scholar 

  15. Gardner JJ. Comparison of the vaginal flora in sexually abused and nonabused girls. J Pediatr 1992;120:872–877.

    Article  CAS  PubMed  Google Scholar 

  16. Gerstner GJ, Grünberger W, Boschitsch E, Rotter M. Vaginal organisms in prepubertal children with and without vulvovaginitis. A vaginoscopic study. Arch Gynecol 1982;231:247–252.

    Article  CAS  PubMed  Google Scholar 

  17. Bartley D, Morgan L, Rimsza M. Gardnerella vaginalis in prepubertal girls. Am J Dis Child 1987;141:1014.

    CAS  PubMed  Google Scholar 

  18. Matytsina LA, Kuznetsova YI. Vaginal biocoenosis in prepubertal and adolescent girls. In: Chayka V, Matytsina L, eds. Actual problem of rehabilitation of reproductive health. Donetsk: Lebed, 2004: 116.

    Google Scholar 

  19. Siegel R, Schubert C, Myers P, Shapiro R. The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: rationale for limited STD testing in prepubertal girls. Pediatrics 1995;96:1090–1094.

    CAS  PubMed  Google Scholar 

  20. Ingram DL, Everett VD, Flick LA, Russell TA, White-Sims ST. Vaginal gonococcal cultures in sexual abuse evaluations: evaluation of selective criteria for preteenaged girls. Pediatrics 1997;99:E8.

    Article  CAS  PubMed  Google Scholar 

  21. Goodyear-Smith F. What is the evidence for nonsexual transmission of gonorrhoea in children after the neonatal period? A systematic review. J Forensic Leg Med 2007;14:489–502.

    Article  PubMed  Google Scholar 

  22. Palusci VJ, McHugh MT. Abuse in the child and adolescent. In: DE Greydanus, DR Patel, HD Pratt, eds. Behavioral Pediatrics, 2nd ed. NY: iUniverse Publishers, 2006: 769–811.

    Google Scholar 

  23. Paek SC, Merritt DF, Mallory SB. Pruritus vulvae in prepubertal children. J Am Acad Dermatol 2001;44:795–802.

    Article  CAS  PubMed  Google Scholar 

  24. Paradise JE, Willis ED. Probability of vaginal foreign body in girls with genital complaints. Am J Dis Child 1985; 139:472–476.

    CAS  PubMed  Google Scholar 

  25. Loening-Bauecke V. Lichen sclerosus et atrophicus in children. Am J Dis Child 1991;145:1058–1061.

    Google Scholar 

  26. Greydanus DE, Omar HA. Sexuality issues and gynecologic care of adolescents with developmental disabilities. Pediatr Clin North Am 2008;55:1315–1335, viii.

    Article  PubMed  Google Scholar 

  27. Hillard PJA. Vaginal signs and symptoms: vaginal discharge. In: Adams PJA, eds. The 5-Minute Obstetrics and Gynecology Consult. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008: 48–49.

    Google Scholar 

  28. Merritt D. Evaluating and managing acute genital trauma in premenarchal girls. J Pediatr Adolesc Gynecol 1999; 12: 237–238.

    Article  Google Scholar 

  29. Imai A, Horibe S, Tamaya T. Genital bleeding in premenarcheal children. Int J Gynaecol Obstet 1995;49:41–45.

    Article  CAS  PubMed  Google Scholar 

  30. Greydanus D, Bhave S, Patel D. Reproductive tract infections and sexually transmitted diseases. In: Bhave S, Nair M, Parthasarathy A, Menon P, Greydanus D, eds. Bhave’s Textbook of Adolescent Medicine. New Delhi, India: JayPee Brothers Medical Publishers, 2006: 199–210.

    Google Scholar 

  31. Greydanus D, Patel D. Sexually Transmitted Diseases in Adolescents. In: Burg F, Ingelfinger J, Polin R, Gershon A, eds. Current Pediatric Therapy. Philadelphia: Elsevier, 2006: 326–329.

    Google Scholar 

  32. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2006. MMWR 2006;55(RR11):1–94.

    Google Scholar 

  33. Brown MR, Cartwright PC, Snow BW. Common office problems in pediatric urology and gynecology. Pediatr Clin North Am 1997;44:1091–1115.

    Article  CAS  PubMed  Google Scholar 

  34. ACOG Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol 2006;107:1195–1206.

    Google Scholar 

  35. Craighill MC. Pediatric and adolescent gynecology for the primary care pediatrician. Pediatr Clin North Am 1998;45: 1659–1688.

    Article  CAS  PubMed  Google Scholar 

  36. Joishy M, Ashtekar CS, Jain A, Gonsalves R. Do we need to treat vulvovaginitis in prepubertal girls? BMJ 2005;330:186–188.

    Article  PubMed  Google Scholar 

  37. Koumantakis EE, Hassan EA, Deligeoroglou EK, Creatsas GK. Vulvovaginitis during childhood and adolescence. J Pediatr Adolesc Gynecol 1997;10:39–43.

    CAS  PubMed  Google Scholar 

  38. Lacy J. Vaginitis: prepubertal valvovaginitis. In: Adams PJA, eds. The 5-Minute Obstetrics and Gynecology Consult. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008: 206–207.

    Google Scholar 

  39. Farrington PF. Pediatric vulvo-vaginitis. Clin Obstet Gynecol 1997;40:135–140.

    Article  CAS  PubMed  Google Scholar 

  40. Pokorny S. Pediatric & adolescent gynecology. Compr Ther 1997;23:337–345.

    CAS  PubMed  Google Scholar 

  41. Sobel JD. Vulvovaginal candidosis. Lancet 2007;369: 1961–1971.

    Article  PubMed  Google Scholar 

  42. Sobel JD. Vaginitis: vulvovaginal candidiasis. In: Adams PJA, eds. The 5-Minute Obstetrics and Gynecology Consult. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008: 208–209

    Google Scholar 

  43. Quint EH, Oakes MB. Vulvar lichen scherosus. In: Adams PJA, eds. The 5-Minute Obstetrics and Gynecology Consult. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008: 220–221.

    Google Scholar 

  44. Kass-Wolff JH, Wilson EE. Pediatric gynecology: assessment strategies and common problems. Semin Reprod Med 2003;21:329–338.

    Article  PubMed  Google Scholar 

  45. Merkley K. Vulvovaginitis and vaginal discharge in the pediatric patient. J Emerg Nurs 2005;31:400–402.

    Article  PubMed  Google Scholar 

  46. Sugar NF, Graham EA. Common gynecologic problems in prepubertal girls. Pediatr Rev 2006;27:213–223.

    Article  PubMed  Google Scholar 

  47. Perelman SE. Management quandary. Premenarchal vaginal bleeding. J Pediatr Adolesc Gynecol 2001;14:135–136.

    Article  Google Scholar 

  48. Wall JW, Strickland JL. Bleeding, abnormal uterine: prepubertal. In: Adams PJA, eds. The 5-Minute Obstetrics and Gynecology Consult. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008: 16–17.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Obstetrics, Gynecology, Perinatology and Pediatric & Adolescent Gynecology, Donetsk Medical University, Donetsk, Ukraine

    Lyubov A. Matytsina

  2. Peninsula Medical School, Plymouth, UK

    Lyubov A. Matytsina, Donald E. Greydanus & Yuriy A. Gurkin

  3. Pediatrics & Human Development, Michigan State University College of Human Medicine, Michigan State University/Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, Michigan, USA

    Donald E. Greydanus

  4. Pediatric Gynecology, St-Peterburgh Pediatric Academy, St-Peterburgh, Russia

    Yuriy A. Gurkin

Authors
  1. Lyubov A. Matytsina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donald E. Greydanus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuriy A. Gurkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lyubov A. Matytsina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matytsina, L.A., Greydanus, D.E. & Gurkin, Y.A. Vaginal microbiocoenosis and cytology of prepubertal and adolescent girls: their role in health and disease. World J Pediatr 6, 32–37 (2010). https://doi.org/10.1007/s12519-010-0003-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-010-0003-8

Key words

Search

Navigation