Approach to the Problem
Swelling and masses found in the female external genitalia include acquired and congenital lesions. Acquired lesions typically present with symptoms including masses, pain, urinary symptoms, and/or bleeding, but may be found as incidental findings on examination. Congenital lesions are often recognized as masses in the perinatal period, but they may go unrecognized until later childhood. The presence or absence of symptoms and the location of the mass are essential pieces of information when considering the differential diagnosis. Some benign lesions may require surgical intervention. Malignant tumors are rare in childhood.
Key Points in the History
• Neonatal onset of swelling is common in paraurethral (Skene) duct cysts, mucocolpos or hematocolpos, and inguinal hernias, but these lesions may also appear later in life. Other masses are rarely present in the neonatal period.
• Painless genital bleeding or spotting is the presenting symptom in most cases of urethral prolapse and in some cases of genital tumors.
• Labial abscesses, incarcerated or strangulated hernias, or secondarily infected cysts are accompanied by acute pain, whereas other genital masses usually are not.
• Typically, a history of urinary tract infections (UTIs), incontinence, or voiding difficulties accompanies prolapsed ureteroceles, and occasionally accompanies Gartner duct cysts and urethral prolapse. They are rarely associated with other genital masses.
• A history of intermittent swelling, particularly increasing with crying or Valsalva maneuvers, is only typical for masses caused by hernias.
• Abdominal pain, lower abdominal mass or increasing abdominal girth, and amenorrhea are common symptoms of hematocolpos or hematometrocolpos.
• A positive family history is present in 10% of children with hernias.
Key Points in the Physical Examination
• Masses that originate or are present in the midline include urethral caruncle, urethral prolapse, prolapsed ureterocele, sarcoma botryoides, mucocolpos, and hematocolpos.
• Asymmetrical or nonmidline masses include most inguinal hernias; labial abscesses; and Bartholin, Gartner, and paraurethral duct cysts.
• Paraurethral duct cysts usually displace the urethral opening from the midline, whereas all other common genital masses do not.
• Urethral prolapse is the only vulvar or urogenital lesion producing a circular mass surrounding the urethral opening.
• Most urogenital masses are nontender to palpation except for labial abscesses, incarcerated or strangulated hernias, or secondarily infected cysts.
• If painful, enlarged inguinal nodes accompany the mass, the mass is either a labial abscess or a secondarily infected cyst.
•
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
