Pediatric vulvovaginitis

What is pediatric vulvovaginitis?

• Nonspecific Vulvovaginitis - In childhood, the infection usually begins in the vulva, with secondary spread to the vagina. In adolescence, particularly after the onset of sexual intercourse, vaginal involvement is primary. Vulvovaginal candidiasis (yeast infection) is very rare in children unless the child is immunocompromised or on antibiotics.

Young girls are particularly susceptible to vulvovaginitis. Because the genital area is close to the rectum, bacteria (and sometimes parasites –like pinworms) spreads easily. In addition, children can spread bacterial respiratory infections from their nose and mouth to the vulva. Infection with sexually transmitted pathogens suggests sexual abuse.

In addition, vulvar skin is thin and sensitive to trauma from scratching, rubbing from tight-fitting clothing, or exposure to irritants like harsh soaps or bubble baths.

• Yeast vulvovaginitis - Everyone has a fungus called candida, which is typically found in the intestines, mouth, skin and the tissues around the genital areas. When, candida grows out of control, it causes a yeast infection. Candida flourishes in warm, dark areas, such as the vagina or armpit.

What are the different types of pediatric vulvovaginitis?

• Nonspecific vulvovaginitis - Vulvovaginitis is an inflammation of the vulva and vaginal tissues. This is common problem in prepubertal girls. It is typically not caused by a specific pathogen and is not treated with antibiotics.  It can also be caused by infection, irritation, a foreign body, allergy, or systemic disease

• Yeast vulvovaginitis - Pediatric yeast infection is a general term that describes when a naturally occurring fungus grows in excess and causes irritation.

  • Toddler (1 to 3 years) yeast infection – This infection creates a rash in the armpit, diaper area, mouth and neck.

  • Vaginal yeast infection – This is the most common type of yeast infection. Approximately 75 percent of all women will have at least one during her lifetime. Yeast infections are uncommon in normal prepubertal girls, so treatment is usually avoided in these girls.

What are the signs and symptoms of pediatric vulvovaginitis?

Nonspecific vulvovaginitis:

• Abnormal odor

• Burning sensation during urination

• Discharge

• Discomfort, pain, or itching

• Vulvar irritation

• Vulvar redness

Yeast vulvovaginitis:

• Itching and irritation

• Pain during urination

• Pain during intercourse

• Rashes

• Vaginal swelling

• White, thick coating on tongue

How is pediatric vulvovaginitis diagnosed?

If your daughter has symptoms of vulvovaginitis, her doctor will first ask about her symptoms as well as about:

• Bathroom habits and hygiene

• Recent respiratory infections

• Use of soaps and bubble baths

Her doctor will then examine the vulvar area and may swab the area to test for bacterial and other infections. If the doctor suspects a foreign body is present, he or she will conduct a pelvic exam and remove it.

What are the causes of pediatric vulvovaginitis?

The prepubertal vulva and vagina is easily irritated by urine, sweat, stool, soaps, and perfumed products. This can cause discharge which further irritates the skin of the vulva.

How is pediatric vulvovaginitis treated?

Improved hygiene and vulvar care

• Making sure your daughter wipes from front to back after using the bathroom

• Using toilet paper without perfumes or dyes

• Avoiding the use of harsh or perfumed soaps and bubble baths, which can irritate the vulva

• Patting the vulvar area dry after bathing, or allowing it to air dry

• Avoiding tight-fitting, non-breathable clothing and underwear

• Washing clothes in a mild detergent with no rinse or dryer additives

• Discouraging the child from touching the area when sick

• Taking “sitz baths” in lukewarm water to soothe inflammation

• Barrier emollients such as Vaseline®, Aquaphor® ointment, Desitin®, or coconut oil can be applied to the vulva to decrease the itching

In some cases, the doctor may prescribe a low-dose topical steroid to reduce itching and inflammation. If these methods don’t work, and vulvovaginitis is caused by infection, her doctor may prescribe antibiotics (or an anthelmintic in the case of pinworm infection).