Ask the GP: My 10-year-old gets stabbing pains in her vagina. What could this be?

​Dr Grant replies: You are right not to worry about your daughter’s complaint for now but it’s always wise to keep an eye on the situation and keep a diary/record of her symptoms.

I am going to make three assumptions. Firstly, that she has not yet had her menarche (first menstrual period). Secondly, there is no possibility anyone has interfered with her otherwise healthy, normal genitalia. Thirdly, there is no possibility of a vaginal foreign body.

In prepubertal girls, the most common cause of pelvic pain is due to a disturbance in the gastrointestinal or urinary tract systems —so clarify that her bowel and urinary function is normal. Make sure she is not using any bath/shower products that may cause her vaginal irritation and pelvic pain. It is best to use a soap substitute like aqueous cream to wash with.

Taking pain history is a fundamental learning in medical training. One of the oldest mantras goes ‘pain is what the patient says it is.’ In other words, you must listen closely in order to understand what the patient is experiencing.

Ask your daughter to describe the sensation. Is the pain sharp, dull, stabbing, burning, itching or tingling? How long does it last? Where exactly does the pain start and does it spread or radiate? How severe is the pain on a scale of 1 to 10? When the pain starts, is it constant or does it come and go? How often does the pain occur? Is there anything that makes the pain better or worse? Are there any other symptoms such as pain on passing urine, nausea, vaginal discharge or foul smell?

One thing to remember with children and adolescents is how the parent responds to their child’s pain can impact the child’s behaviour. It can be hard to get the balance right. If you don’t listen or take her seriously enough she may exaggerate symptoms in order to get more attention. Conversely, if you overreact and rush her to a doctor, she may panic and refuse to go. It is better to give attention, show empathy and discuss the importance of basic first aid as you perform it, then return to normal activities.

In adolescents, you also need to assess any impact her pain may be having on her participation in school, social events, activities and relationships, as there could be an underlying psychosocial reason for her complaint. For example, her best friend may be describing painful menstrual periods and this has led your daughter to believe her own periods will be painful. Does she have any underlying fears about her future menstrual or sexual health that might play into her complaint?

Lastly, trust your maternal instinct and bring her to a doctor if you feel this is escalating. Her GP may refer her to an adolescent gynaecologist for further investigation. It is rare to find a problem with the ovaries, womb, cervix, vagina or even the vulva. Ovarian tumours occur in approximately 2pc of adolescents, with germ cell tumours being the most common type. These are not typically life-threatening but need to be surgically removed.

Dr Jennifer Grant is a GP with Beacon HealthCheck