Vulvovaginitis In Prepubertal Children
Vulvovaginitis occurs in up to 75% of females before their first menstrual period and is one of the most common reasons prepubertal girls have to visit a pediatrician or pediatric gynecologist. By definition, vulvovaginitis means inflammation of the vulva and vagina. Signs of this may include vaginal discharge, odor or bleeding. Presenting symptoms may include external irritation and discomfort. Poor hygiene or topical irritants are the main source of problems, which may introduce common bacteria, such as E. coli, Streptococcus or Staphylococcus. Fortunately, this condition improves with education about proper hygiene measures. Children are particularly prone to vulvovaginitis for several reasons: non-estrogenic state, proximity of the vagina to the anus, and common evidence of poor perineal hygiene. Additional history is important to determine the potential source of the problem. For instance, history of bubble bath use, type of detergents, cleansing soaps or chlorine exposure from swimming pools may provide clues as to whether particular chemical irritants might be associated with symptom timing. Many young girls may begin potty training in the toddler years. During this time of transition for children, education may be necessary: wiping front to back, washing hands often and learning when to tell caregivers when they need help during this process. It is not uncommon for children to struggle with constipation or bladder dysfunction during this time. Subsequently, a history of chronic constipation or frequent urinary tract infections is important, as these problems may contribute to functional leakage of stool in the perineal area or urinary dribbling episodes due to infection and bladder irritation. Furthermore, some young girls have difficulty with vaginal voiding. This occurs when urine exiting the urethra, trickles backward into the vagina during voiding episodes. The sensation of urinary leakage is common with this problem, as the urine that finds its way into the vagina then leaks out immediately once the child stands up, after sitting down to void. Regardless, chronic irritation in the perineal area from either urine or stool may cause chronic redness and discomfort. In the absence of these problems, the possibility of foreign objects should be considered, especially when symptoms have been recurrent and unresponsive to treatment. An unfortunate reality is that 1 in 4 girls may be a victim of sexual abuse. Therefore, inquiring about these concerns is important to rule out this possibility. If concerns are ongoing, it is appropriate to talk to your doctor about perineal care modifications or treatments that may alleviate chronic symptoms. And as always, if you have any questions about your daughter, don't hesitate to contact the Pediatric Gynecology Clinic at Texas Children's Hospital.