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 Haemophilus influenzae can be self-inoculated from nose and mouth to the vulvar region.
Good hygiene is fundamental to the resolution of many pediatric vulvar conditions.
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.
Vulvovaginitis, or inflammation of the vulva and vagina, is the most common gynecological problem in prepubertal girls and can cause anxiety in both the child and the parent.1,2,3 Symptoms may include vaginal discharge, redness, soreness, itching, dysuria, bleeding, or pain.2,3 Vulvovaginal symptoms may be caused by nonspecific irritants, specific infections, trauma, or dermatologic conditions (Table 103-1).4 Contributing factors for prepubertal girls are poor hygiene, lack of estrogenization, proximity of vagina to anus, and lack of labial fat pads or pubic hair.1,2
++ Table Graphic Jump Location TABLE 103-1Causes of Vulvovaginal Symptoms in Children ||Download (.pdf) TABLE 103-1 Causes of Vulvovaginal Symptoms in Children
Streptococcus pyogens, Haemophilus influenzae,
Staphylococcus aureus, Streptococcus pneumoniae
Sexually transmitted infections
Neisseria gonorrhoeae, Chlamydia trachomatis,
Trichomonas vaginalis, condyloma acuminata
Vulvar dermatologic conditions
Others: trauma, polyps, tumors, systemic illness, psychosomatic vaginal complaints
Evaluation should include a full history, including symptoms (soreness, itching, burning, dysuria, odor, discharge), location, duration, prior treatments, hygiene habits, voiding habits, physical activities, and the potential for sexual abuse (sexual abuse is covered in Chapter 144 and a comprehensive discussion of sexually transmitted infections is covered in Chapter 89).1 Evaluation should also include an external genital examination. Aspects of a complete external genitalia exam are noted in Table 103-2. A vaginal culture should be obtained if significant vaginal discharge is present.5 Positive cultures are more likely in the clinical setting of visible vaginal discharge with moderate to severe inflammation extending beyond the introitus.6
Table Graphic Jump Location TABLE 103-2External Genitalia Examination ||Download (.pdf) TABLE 103-2 External Genitalia Examination
Explain to child, parent/care giver that the examination is not painful, provide opportunity to ask questions
Educate child in appropriate language that only parents/caregivers/health care providers can touch or examine genital/private area
Do not rush examination
Vitals signs and systemic physical examination first followed by genital inspection
Examination should include inspection of external genitalia, visualization of the vagina, and rarely a recto-abdominal examination ...