The vulvar examination of the premenarchal child

The premenarchal child's vulva should be assessed at each physician visit, even in the absence of symptoms. Vulvar problems (eg, hymenal lacerations, vulvovestibulitis, or labial adhesions) account for a significant percentage of pediatric outpatient diagnoses, yet related symptoms may not be volunteered by patient or parent, underlining the necessity for physical examination in order to have a complete data base. Despite the importance of the vulvar examination, it is omitted in a large percentage of cases, reflecting deficits in undergraduate and postgraduate medical training.In order to facilitate the thorough examination of the premenarchal girl's vulva, the four premenarchal stages of development and the physical changes encountered at each stage are described. In addition, a checklist guide for the performance of the vulvar examination is included.