Vulvovaginitis

Vulvovaginitis refers to inflammation and irritation of the vulva and vagina. It is a common condition often affecting girls between the ages of 3 and 10 years.

This irritation is caused by sensitive and thin skin and mucosa around the vulva and vagina in young girls. The vagina is more prone to colonisation and infection with bacteria spread from faeces. It can be exacerbated by:

  • Wet nappies
  • Use of chemicals or soaps in cleaning the area
  • Tight clothing that traps moisture or sweat in the area
  • Poor toilet hygiene
  • Constipation
  • Threadworms
  • Pressure on the area, for example horse riding
  • Heavily chlorinated pools

Vulvovaginitis improves and is much less common after puberty, as oestrogen helps keep the skin and vaginal mucosa healthy and resistant to infection.

 

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)
  • Constipation

A urine dipstick may show leukocytes but no nitrites. This will often result in misdiagnosis as a urinary tract infection.

 

Management

Often patients have already been treated for urinary tract infections and thrush, usually with little improvement in symptoms. It is unusual for girls to develop thrush before puberty.

Generally no medical treatment is required and management focuses on simple measures to improve symptoms:

  • Avoid washing with soap and chemicals
  • Avoid perfumed or antiseptic products
  • Good toilet hygiene, wipe from front to back
  • Keeping the area dry
  • Emollients, such as sudacrem can sooth the area
  • Loose cotton clothing
  • Treating constipation and worms where applicable
  • Avoiding activities that exacerbate the problem

In severe cases an experienced paediatrician may recommend oestrogen cream to improve symptoms.

 

Last updated January 2020
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