Pictures without FGM/C and without lesions. This chapter will help the physician:

  • To make a vulvar examination (Figs. 3.1 and 3.2)

  • To provide a referential for surgeons undertaking procedures (Figs. 3.3, 3.4, and 3.5)

  • To recognize anatomical variations (Figs. 3.6, 3.7, 3.8, 3.9, 3.10, and 3.11).

  • To identify “ambiguous” genitals or mucocolpos (Figs. 3.12 and 3.13)

  • To identify dermatological conditions (Figs. 3.14, 3.15, 3.16, 3.17, 3.18, 3.19, and 3.20)

  • To identify urethral lesions (Figs. 3.21 and 3.22)

  • To identify genital trauma (Fig. 3.1 of chapter “Pictures with Potential Differential Diagnosis of FGM/C”)

  • To make differential diagnosis of FGM/C (Figs. 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 3.10, 3.11 of chapter “Pictures with Potential Differential Diagnosis of FGM/C”, and Fig. 3.1 of chapter “Pictures with FGM/C”)

1 Vulvar examination

Fig. 3.1
figure 1

Prepubertal vulvar examination (a) In supine frog-leg or butterfly position. (b) In knee-chest position [1]

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Fig. 3.2
figure 2

Prepubertal examination. (Courtesy of Elise Dubuc)

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Figures 3.3, 3.4, and 3.5 provide a reference for surgeons undertaking genital surgical repair procedures. The clitoral hood and inner labia are anatomically distinct structures.

Fig. 3.3
figure 3

Possible clinical measurements in prepubertal genitals [55]

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Fig. 3.4
figure 4

Ratios of distances measured in subjects younger than 13-years of age, with clitoris-posterior outer labia distance as the denominator [55]

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Fig. 3.5
figure 5

Anatomy of the prepubescent female external genitalia. (Please note that when it is referred to labium minus and major, it is now preferred to use the terms of inner and outer labium)

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Fig. 3.6
figure 6

Observed variations of the clitoral hood shapes. (a) Horseshoe, (b) Trumpet, (c) tent, (d) coffee bean [23]

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Fig. 3.7
figure 7

Physiological, uncut anatomy of the external female genitalia in girls up to 1-year-old referred for assessment of the presence or absence of FGM/C. (a) No FGM/C, age 3 months, from Senegal, ethnic group Malinke. (b) No FGM/C, age 6 months, from Mauritania (Courtesy of Céline Deguette). (c) No FGM/C, age 1 year, parents originally from Gambia (Courtesy of Birgitta Essén)

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Fig. 3.8
figure 8

Physiological, uncut anatomy of the external female genitalia in girls up to 3-years old referred for assessment of the presence or absence of FGM/C. (a) No FGM/C, lichenification, 18-months-old, daughter to a mother from Ivory Coast and a father from Mali. (b) No FGM/C. 20-months old, from Ivory coast. (c) No FGM/C. 24-months old, from Ivory Coast (Courtesy of Céline Deguette). (d) No FGM/C. 3-years old, parents originally from Gambia (Courtesy of Birgitta Essén)

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Fig. 3.9
figure 9

Physiological, uncut anatomy of the external female genitalia in 6–7 year-old girls referred for assessment of the presence or absence of FGM/C. (a) No FGM/C, 6-years old, from Chad. (b) No FGM/C, 6-years old, from Guinea. (c) No FGM/C, 7-years old, from Ivory Coast, Ethnic group: Dioula. (d) No FGM/C, 7-years old, from Ivory Coast. (Courtesy of Céline Deguette)

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Fig. 3.10
figure 10

Physiological, uncut anatomy of the external female genitalia in a 10-year-old girl referred for assessment of the presence or absence of FGM/C (a and b) and part of a well-being exam (c). (a) No FGM/C, 10-years old, from Ivory Coast, ethnic group: Bambara. (b) No FGM/C, 10-years old, from Ivory Coast (Courtesy of Céline Deguette). (c) No FGM/C, 10-years old, from Switzerland (Courtesy of Michal Yaron). (d) No FGM/C, 11-years old, with Somali ethnic background (Courtesy of Birgitta Essén)

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Fig. 3.11
figure 11

Physiological, uncut anatomy of the external female genitalia postpuberty. (a) No FGM/C, 12-years old, from Ivory Coast. During menses. (b) No FGM/C, 23-years old, from Ivory Coast, Ethnic group: Gouro. (Courtesy of Céline Deguette)

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2 Pictures Without FGM/C, with “Ambiguous” Genitals or Mucocolpos

Fig. 3.12
figure 12

“Ambiguous”genitalia, newborn from Switzerland. (Courtesy of Michal Yaron)

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Fig. 3.13
figure 13

Mucocolpos, newborn with an imperforate hymen from Switzerland. (Springer Nature [9])

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3 Pictures Without FGM/C, with Dermatological Conditions, Infections, and Other Lesions

Fig. 3.14
figure 14

Dermatitis of the genitalia and lichenification of the clitoral hood in prepubertal female from Israel. Contact Dermatitis, 5-years old. (Courtesy of Michal Yaron)

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Fig. 3.15
figure 15

Lichen sclerosus. (a, b) Two different 4-year-old girls, (c) 5-year-old, after 7 days of treatment with clobetasol, and (d) after 14 days of treatment with clobetasol. (Courtesy of Michal Yaron)

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Fig. 3.16
figure 16

Psoriasis. Differential diagnosis is Lichen sclerosus, 3-years old. (Courtesy of Michal Yaron)

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Fig. 3.17
figure 17

Herpes Simplex Virus, 3-years old. (Courtesy of Michal Yaron)

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Fig. 3.18
figure 18

Lipschütz ulcer. (a) 12-years old, (b) 14-years old, (c) Same girl as in (b) after 3 days of treatment with lidocaine gel, and calendula “sitz-baths” and cream. (Courtesy of Michal Yaron)

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Fig. 3.19
figure 19

Vulvar hemangioma in the same girl at (a) 6 weeks, (b) 3 months, (c) 12 months. (Courtesy of Michal Yaron)

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4 Pictures Without FGM/C, with Urethral Lesions

Fig. 3.20
figure 20

Parauretheral cyst, 3-years old. (Courtesy of Michal Yaron)

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Fig. 3.21
figure 21

Urethral prolapse, 7-years old, before (a) and after (b) local estrogen treatment. (Courtesy of Michal Yaron)

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5 Pictures Without FGM/C, with Genital Trauma

Fig. 3.22
figure 22

Trauma with toy, 2-years old (a, b). (Courtesy of Michal Yaron)

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