- Vulvovaginitis is the most common gynecological disorder in childhood; its causes include physical and chemical irritants and a variety of infectious agents.
- Group A β-hemolytic Streptococcus and Hemophilus influenza can be self-inoculated from nose and mouth to the vulvar region.
- Candidal vaginitis is rare in prepubertal children and should raise suspicion of diabetes mellitus or depressed immune function.
- Enterobius vermicularis (pinworms) can be a source of irritant vaginitis.
- A prepubertal child with Gardnerella vaginitis should be evaluated for potential sexual abuse.
Vulvovaginitis, or inflammation of the vulvar and vaginal tissues, is the most common gynecological disorder of children.1 This inflammation may be caused by physical, chemical, or infectious irritants.2 In recent studies, only one-third of girls who presented with vulvovaginitis were found to have bacterial causes.2 The majority of cases were found to be due to nonspecific or irritant vulvitis (Table 96–1). The differential diagnosis of childhood vaginitis varies with age and the symptoms may include vaginal discharge with or without vaginal bleeding, itching, or dysuria.3
Table 96-1. Causes of Nonspecific Vulvovaginitis in Children |Favorite Table|Download (.pdf)
Table 96-1. Causes of Nonspecific Vulvovaginitis in Children
Poor hygiene, including inadequate front-to-back wiping
Small labia minora, with a short distance from anus to vagina
Vulvovaginal epithelium that is thin and not well estrogenized, making the area more prone to irritation
Foreign body including toilet paper, small toys, pieces of cloth
Chemical irritants including soap, shampoo, bath oils, deodorant soaps, bubble baths
Eczema and seborrhea
Chronic disease or immunodeficiency
Historical considerations include an overview of nutritional and hygienic practices such as the use of irritating soaps or constrictive clothing, underlying medical disorders (immunocompromised state), and the potential for sexual abuse. (A comprehensive discussion on sexually transmitted infections is covered in Chapter 97.) History should include an assessment for the presence of pruritis and odor, the character and amount of discharge, and the patient's menstrual and sexual history.
The pathogenesis of vulvovaginitis may be associated with an alteration of the vaginal flora with an overgrowth of fecal aerobic bacteria or an overabundance of anaerobic bacteria found in the vaginal flora. Vaginal cultures may reveal organisms considered to be normal vaginal flora such as diptheroids, enterococci, and lactobacillus. The presence of Escherichia coli is often found on vaginal culture, which suggests contamination with bowel flora.3
Treatment recommendation includes proper hygiene measures (Table 96–2). Sometimes, a child may become part of a “scratch and itch” cycle where discharge and inflammation has led to pruritis with subsequent scratching that leads to bacterial superinfection. In these cases, antibiotics such as amoxicillin, amoxicillin/clavulinic acid, or cephalosporin for 7 to 10 days may be helpful.3
Table 96-2. Treatment of Nonspecific Vulvovaginitis