Vulvovaginitis refers to inflammation and irritation of the vulva and vagina. It is a common condition affecting girls between 3 and 10 years old. The skin and mucosa in this area are sensitive and thin in young girls. The vagina is more prone to colonisation and infection with bacteria spread from faeces.
Vulvovaginitis can be exacerbated by:
- Poor toilet hygiene (e.g., wiping back to front)
- Use of chemicals or soaps in cleaning the area
- Tight clothing that traps moisture or sweat in the area
- Constipation
- Threadworms
- Pressure on the area (e.g., horse riding)
- Heavily chlorinated pools
Vulvovaginitis is uncommon after puberty, as oestrogen helps keep the skin and vaginal mucosa healthy.
Presentation
Vulvovaginitis is a common presentation in young girls before puberty. It presents with:
- Soreness
- Itching
- Erythema around the labia
- Vaginal discharge
- Dysuria (burning or stinging on urination)
A urine dipstick may show leukocytes but no nitrites. It is often misdiagnosed as a urinary tract infection.
Management
Patients may have already been given treatment for a suspected urinary tract infection and thrush, usually with little improvement in symptoms. It is unusual for girls to develop thrush before puberty.
Management focuses on measures to improve symptoms:
- Avoid washing with soap and chemicals
- Avoid perfumed or antiseptic products
- Good toilet hygiene (wiping from front to back)
- Keeping the area dry (pat dry after washing)
- Emollients and barrier creams may help soothe the area
- Loose cotton clothing
- Avoid underwear for sleeping at night
- Treating constipation and worms
- Avoiding activities that exacerbate the problem
A specialist may consider a short course of oestrogen cream in resistance cases.
A foreign body in the vagina, which may present with foul-smelling or bloody discharge, or sexual abuse, requires referral and further management.
Last updated March 2025
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