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Differential Diagnosis

Vulva is all external genitalia of female to border of hymen

  • HSV should have a single or multiple vesicals typically 1cm or less. Alternatively can present with history of unroofed vesicles.
  • Screen to determine if concerns of child sexual abuse.
    • Caregiver and Child should be questioned separately.
      • Sample caregiver questions: “Sometimes children experience genital pain after trauma or injury. Do you have any concerns that your child could have been hurt by someone or sexually abused? If yes, then more history will be needed. SW should be involved to help gather more information and complete Patient At Risk. Determine if SANE consult needed.
      • Sample question for the child: “Part of my job is to help make sure kids are healthy and safe. I understand you are having some pain on your _Private parts, etc_ (use their language here) why do you think that is?
        • Follow up question: “Has anyone ever touched you on your private parts or done something to your private parts that you didn’t like or that made you feel uncomfortable?” If the answers are no and there are no concerns for sexual abuse then proceed down the decision tree. If the answers are yes or there are additional concerns for possible Child Sexual Abuse then consult with SW for Patient At Risk and determine if SANE consult should be activated.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.