48. Gynecology Concerns for Children and Adolescents with Genitourinary Perineal Vascular Anomalies: A Retrospective Analysis

Background

We investigated the prevalence, management, and outcomes of genitourinary-perineal vascular anomalies (GUP-VAs), focusing on gynecologic concerns in pediatric patients with vulvar anatomy. We compared infantile hemangiomas (IHs) and vascular malformations (VMs) regarding symptom prevalence, functional impairment, treatment approaches, and outcomes. We hypothesized that VMs are associated with more significant gynecologic symptoms, functional impairment, and a higher likelihood of reproductive health counseling. The study aims to further understand gynecologic and developmental needs to improve clinical outcomes and personalized care.

Methods

Following IRB approval, we conducted a retrospective chart review of 119 patients treated for GUP-VAs at Seattle Children's between 1998 and 2024. Patients aged 0-21 years with vulvar anatomy and a GUP vascular anomaly diagnosis were included. Data on demographics, anatomic location, symptoms, functional impairments, treatment modalities, and gynecologic concerns were analyzed. Statistical comparisons between IHs and VMs were conducted using Mann-Whitney U tests for continuous variables and Fisher's exact test for categorical variables, focusing on symptoms, impairments, and treatment outcomes.

Results

Of the 119 patients, 98 (82.4%) had IHs and 21 (17.6%) had VMs. VMs were significantly associated with symptoms of mass (p < 0.001), dyspareunia (p = 0.030), and functional impairments such as pain (p = 0.001) and emotional concerns (p = 0.005). Observation (p = 0.003) and pharmacotherapy (p = 0.004) were more common for IHs, while more invasive treatments like sclerotherapy (p < 0.001) and excision (p = 0.057) were used more frequently for VMs. Post-treatment, patients with VMs showed significant improvements in pain (p = 0.043) and emotional well-being (p = 0.030). Gynecologic issues, such as menstrual irregularities, were prevalent in venolymphatic (100%) and lymphatic malformations (50%), while 50% of patients with lymphatic malformations reported sexual dysfunction. Contraceptive and pregnancy counseling were more common in patients with VMs, particularly those with Klippel-Trenaunay syndrome (66.7%).

Conclusions

VMs in the GUP region are associated with more severe symptoms and greater functional impairments compared to IHs. These findings highlight the physical and emotional impact of VMs and the importance of addressing gynecologic and reproductive health in this population. Treatment outcomes showed significant improvements in pain and emotional well-being, emphasizing the need for early diagnosis and multidisciplinary management to optimize patient outcomes.