Voiding Disorder (Discharge, Genital Bleeding)

Figure gebl_14a_n.jpg: 7-month-old girl with only dripping micturition, muddy discharge, and recurrent urinary tract infections. In front of the frenulum, no distinct labia minora are recognizable, and instead of an introitus of the vagina, there is a groove with a drop of muddy discharge in two places. gebl_14b_n.jpg: Following the separation of the midline with a probe and rinsing, a normal vulva is visible with a slight bleeding on the right labium minus. Notice the course of the frenulum. gebl_14a_n.jpg and gebl_14b_n.jpg: The diagnosis is synechia of labia minora which may be congenital or - more frequently - acquired in infants and toddlers. The secondary type of synechia is a sequel of insufficient hygiene and leads to voiding disorders with micturition into the vagina, dripping from the vagina, and seeming incontinence and enuresis, recurrent urinary tract infections, and vaginitis. The latter leads to inflamed external genitals, genital pain, and discharge from the vagina. Because discharge in vulvovaginitis is combined in one fifth of the girls with bloody spots on the diapers or panties, vulvovaginitis is an important differential diagnosis of genital bleeding.