Vulvo­vagi­nitis in young girls: redness, itching and discharge

What is vulvovaginitis?

Vulvovaginitis is irritation and inflammation of the outer genitals (the vulva) and the vaginal opening. It is common in girls before puberty and usually settles with good hygiene. At this age there is little estrogen, so the skin in this area is thin and sensitive.

Causes

The most common type is non-specific vulvovaginitis: there is no single germ, and several factors together cause the irritation:

• soap residue, bubble bath, fabric softener, antiseptics,
• tight clothing, a wet swimsuit or a wet diaper,
• not cleaning well after using the toilet, leaving urine and stool on the skin.

Less often, there is another cause:

• pinworms: itching and pain, especially at night,
• bacteria, often group A strep: marked redness and pain,
• a foreign body in the vagina, such as a small piece of toilet paper: bad-smelling, sometimes bloody discharge.

Yeast (Candida) is an uncommon cause before puberty. It can occur after antibiotics or when the immune system is weak.

Rarely, similar symptoms are linked to sexual abuse. The doctor keeps this possibility in mind during the visit.

Symptoms

• itching, burning, discomfort,
• redness and swelling around the vaginal opening,
• discharge stains on the underwear, sometimes tinged with blood,
• burning when peeing.

How it differs from similar conditions

• Urinary tract infection: burning when peeing happens here too, but the germs are in the urine. If needed, the doctor will order a urine test.
• Labial adhesions: the labia are stuck together with a thin line in the middle, usually without redness or discharge.

Treatment and hygiene

In most cases no medicine is needed; good hygiene is enough:

• Do not use soap, bubble bath or antiseptics. Wash the area with warm water and pat it dry gently, without rubbing.
• Let your daughter soak in shallow, warm water with no soap.
• Teach her to wipe from front to back and to keep her legs apart when she pees.
• Choose cotton underwear, and loose pajamas or a nightgown for sleep.
• Change a wet swimsuit or wet diaper promptly.

If bacteria or pinworms are the cause, the doctor will prescribe treatment. For pinworms, everyone in the household is treated.

When to see a doctor

See a doctor if:

• symptoms do not settle with good hygiene, or keep coming back,
• the discharge is heavy, bad-smelling or bloody,
• there is severe redness and pain,
• nighttime itching keeps her awake,
• pain when peeing comes with a fever.

At this age, the inside of the vagina is not examined. If a swab is needed, it is taken only from the outside, at the vaginal opening.