Since the introduction of antibiotics, the incidence of gonorrhoea in adult women has diminished, and the disease is less serious. In young girls with vulvo-vaginitis the infection is rarely due to the gonococcus in France. This is doubtless associated with diminished incidence of gonorrhoea but is also due to a better understanding of the pathology of vulvo-vaginitis in children. In the past, many cases were labelled gonococcal without evidence of the presence of the gonococcus. It was customary to speak of chronic infections, relapses, and recrudescence at puberty; but now we know that these were infections of non-specific origin or even merely physiological secretions, the frequency of which in those days was underestimated.All the same, except among specialists, the frequency of a gonococcal aetiology is often exaggerated, so that we feel it desirable to publish our observations over the past 10 years of pathological conditions of the genitalia in young children.Clinical Material A great majority of the children examined came from the medical out-patient departments of l'H6pital Bretonneau (and we are greatly obliged to Professors Morin and Musset, and Doctors Salet and Bouchard for sending us their young patients). In short, they were a fair paediatric sample drawn from a populous district of Paris. All girls with any sort of genital trouble were sent to our special department. A small minority of the children came from other hospitals in and around Paris, and a few were seen as private patients.The number of children with leucorrhoea of different sorts examined since 1956 was 872; all were under 15 years of age, and the majority of gonococcal infections were found in girls between 2 and 5 years old. ExaminationIn every case this included a complete endovaginal exploration, which was invariably carried out with the mother present and in circumstances which would have no adverse psychological effect upon the child. No difficulty was experienced except with the very young.(a) The gynaecological position was always used, for it is easier and more practical than the genupectoral position which few seem to prefer. No local or general anaesthetic was needed.(b) The instruments used included small speculat of different calibres, derived from an aural speculum to which is attached a tube several centimetres in length, special forceps,t snares, and a spatula for taking specimens. The use of these fine instruments allows a complete examination to be made without the slightest damage to the hymen.
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