Vulvovaginitis in children

Children with vulvovaginitis should have redness and irritation of the skin around the vaginal area. In most of the cases, the vulva gets infected first and the vagina follows while the opposite is also possible.

Written by
Pantelis A. Tsimaris
Obstetrician – Gynaecologist, Specialized in Children’s Gynaecology, Scientific Partner of the Children – Adolescents Gynaecology of MITERA Children’s Hospital

Most common symptoms include: redness, itching, burning on urination and vaginal discharge. In the majority of incidents the infection is characterized as “non specific” and refers to vulvovaginitis without any specific pathological cause. However, vaginal discharge as well as vulva and vagina redness is common symptoms of infectious vulvovaginitis. Proper hygiene and treatment of the area are enough to solve the problem. Mycotic vulvovaginitis is not common in childhood.

The risk factors associated with vulvovaginitis are mainly anatomic and include: lack of pubic hair (during prepuberty), lack of labial fat pads, thin and delicate vulvar skin as well as atrophic vaginal mucosa. No estrogenization is present during childhood and for that reason many infectious microorganisms can be grown into the vagina that has a neutral pH. Poor hygiene is also a risk factor along with infrequent hand washing, inadequate cleaning of the area especially due to its proximity to the rectum, and the wrong wiping from front to back (anterior to posterior direction). Synthetic underwear, scented soaps and sand are particularly irritating. Finally, in recurrent incidents of vulvovaginitis we should not exclude the existence of a foreign body as well as sexual abuse.

The diagnostic approach starts with a complete review of the child’s history as well as of its parents. Particular questions can elucidate the pathogenetic mechanism. During physical examination of the little patient, the area examined is not limited only to the infected one but also to any areas that can assist the doctor to conclude on a diagnosis. Vaginal discharge is in all cases collected for examination.

As for “non specific” vulvovaginitis, the improvement of the hygiene conditions is often enough to solve the problem. The area should be cleaned with warm water and neutral soaps. Soap should be washed away properly and the whole area should be maintained as dry as possible. This can be done by using a hair dryer on a cool setting. Application of local ointments should waterproof the skin and can assist to quicker relief from symptoms.

All the above-mentioned are not valid in the case of a smelly vaginal discharge that indicates the presence of a particular infectious microorganism. Moreover, in the case that there is no improvement in 48 hours, the patient should definitely be examined by a doctor specialized in Children’s Gynaecology.