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Picture of the Month

Robert A. Dershewitz, MD; Lynne L. Levitsky, MD; Murray Feingold, MD
Am J Dis Child. 1984;138(9):887-888. doi:10.1001/archpedi.1984.02140470085030.
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Denouement and Discussion 

Vulvovaginitis: A Cause of Clitorimegaly 

Manifestations  The major manifestation is an enlarged, erythematous, edematous clitoris. The patient is usually afebrile but may have discomfort, a burning sensation, erythema, edema, and a discharge in the vulvovaginal area. Dysuria and urinary retention may occur if the urethra is affected. Following appropriate therapy, the enlarged clitoris returns to normal size. The vast majority of patients with vulvovaginitis do not have an enlarged clitoris.

Origin  Although a variety of infectious agents can cause vulvovaginitis, enlargement of the clitoris has been mainly associated with herpes simplex virus, usually type II. The clinical diagnosis of herpes genitalis can be confirmed by tissue culture, viral titers, or a demonstration of multi-nuclear giant cells on Tzanck stain.

Treatment  The specific therapy depends on the causal agent. Topical acyclovir ointment has been used in the treatment of the initial herpes genitalis infection. Symptomatic treatment may also


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