Paediatric vulvovaginitis

What is paediatric vulvovaginitis?

Paediatric vulvovaginitis is inflammation of the vulva and/or vagina in young girls who have not yet reached puberty.

What are the different types of paediatric vulvovaginitis?

Nonspecific vulvovaginitis

The most common type, caused by a combination of factors.

Yeast vulvovaginitis

Yeast infections - eg, thrush - are rare in younger girls and not usually the cause of vulvovaginitis in this age group.

What does paediatric vulvovaginitis look like?

The external genital area can often look red and sometimes slightly swollen. There can be a discharge which may be yellow or green.

What causes paediatric vulvovaginitis?

Before girls reach puberty, the levels of oestrogen in the genital area are low. This causes the skin and vaginal lining to be quite thin and easily irritated by bacteria from the anus, as it is close to the vagina.. The area is also less acidic before puberty, so bacteria can grow more easily. Irritants can include products such a soap and bubble bath, and also urine and faeces if the area is not wiped properly after toileting.

Rare causes for similar symptoms are a foreign body inside the vagina, and sexual abuse.

What are the symptoms of paediatric vulvovaginitis?

Symptoms include soreness, itching, hurting to pass urine and sometimes a vaginal discharge.

Similar symptoms including vulval pain and itching, particularly at night, may also be caused by threadworms.

How is paediatric vulvovaginitis diagnosed?

A doctor can diagnose it by listening to the symptoms and performing an external examination. Sometimes a swab is taken to check for bacterial infections.

How is paediatric vulvovaginitis treated?

Vulvovaginitis can usually be treated at home with the following measures:

• Warm baths to soothe itching.

• Loose-fitting cotton underwear.

• Not wearing pants in bed.

• Avoiding bubble bath and soap on the genital area, especially perfumed.

• After bathing, patting the area dry with a soft towel.

• Nappy rash creams such as Bepanthen® may soothe the discomfort and protect the skin.

• Good toilet hygiene - part the legs while passing urine and wipe front to back.

• Rinse with warm water after passing urine or opening bowels.

• Antifungal creams, such as Canesten®, are not usually helpful in this age group.

When to see a doctor

• If there is any bleeding.

• The above measures are not helping.

• You are worried about other causes.

How to prevent paediatric vulvovaginitis

• Wear loose-fitting cotton underwear.

• Avoid tight clothing - eg, tight jeans.

• Wipe from front to back.

• Consider rinsing after wiping.

• Avoid bubble bath and soap - wash with warm water.

• Pass urine with the legs parted.

• Avoid wearing pants in bed.

Can paediatric vulvovaginitis cause long-term problems?

No, the symptoms usually resolve as girls reach puberty.