Vulvovaginitis is the general term which refers to many types of vaginal/vulva inflammation or infection.
In prepubertal girls non specific vulvovaginitis is responsible for 25-75% of vulvovaginitis
Causal Factors of non specific vulvovaginitis in prepubertal child
- Unoestrogenised thin vaginal mucosa with lack of labial development
- More alkaline pH (pH 7) than post-menarchal girls
- Moisture to area (aggravated by synthetic fibre underwear, tight clothing, wet bathers, obesity, poor hygiene)
- Irritants (e.g. bubble baths, shampoos, soaps, antiseptics)
- Swelling to area
- Vaginal discharge
- Examine the perineum of prepubertal child in “frog leg” position (girl supine with heels together) and always wear gloves
- A nurse chaperone must be in attendance throughout the examination
- Do not perform an internal vaginal examination or take vaginal swabs
- Mild Vulvovaginitis
- No investigations (e.g. swabs) are necessary
- Profuse/offensive discharge take an introital swab
If persistent, offensive or bloody discharge, consider the following:
- Threadworm if pruritus (vulval and/or perianal) is prominent especially at night
- Foreign body if chronic vaginal discharge, intermittent bleeding, offensive odour. Toilet paper commonest foreign body. Refer to paediatric gynaecologist as required.
- Specific Organisms if discharge is profuse/offensive take an introital swab
|Group A Streptococcus
|S. aureus, H. influenzae, Shingella
- May resolve with hygienic measures but culture- negative persistent vaginitis may resolve with 10 days of Amoxycillin/Clavulanic Acid
- Unusual (3%) in > 2 year old prepubertal girls
- Usually if recent antibiotic therapy, immunocompromised or wearing nappies
|Sexually Transmitted Infections
- Typically the result of sexual abuse with some exceptions
- All cases of Neisseria gonorrhoea, Chlamydia trachomatis, HPV, Herpes simplex must be referred to Child Protection Unit for further assessment
- Measles, Chickenpox, Kawasaki disease, Steven-Johnson syndrome, and Chrohn’s disease may be associated with vulvovaginal symptoms
- Dermatological abnormality – unclear aetiology
- Presents with pruritus, discharge and/or bleeding. It usually consists of pale atrophic patches on the labia and perineum. The patches can be confluence and extensive.
- If asymptomatic – no treatment required
- If symptomatic (itchy, uncomfortable and bleeding) – avoid irritants/use barrier cream +/- 1% hydrocortisone (BD for 2 weeks) then review by paediatric gynaecologist/dermatologist
The resolution of non-specific mucoid discharge and/or odour within 2-3 weeks should result from the following:
- Avoid excess moisture and irritants
- Daily warm baths (not hot)
- Add 1/2 cup of white vinegar to a shallow bath and soak for 10-15 minutes
- Pat dry
- Review hygiene with child
- Emphasize wiping from front to back after bowel motions
- May use wet wipes instead of toilet paper if sensitive
- Cool compresses may relieve discomfort
- Soft paraffin or Nappy-Mate® paste (zinc oxide paste) may help with pain and protect the skin
- Laufer MR and Emans SJ (2014) Vulvovaginal complaints in the prepubertal child. UpToDate. Accessed at www.uptodate.com
- Joishy M et al. Do we need to treat vulvovaginitis in prepubertal girls? BMJ 2005;330:186.
- Stricker,T,et al. Vulvovaginitis in prepubertal girls. Arch Dis Child 2003;88:324.
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