Vulvitis
Prepubertal girls have a relative lack of estrogen and are thus prone to vulvitis. It is characterised by an inflamed, irritated vaginal orifice, often with a foul itchy discharge.
There can be pain or discomfort on micturition. It can be caused by:
• poor hygiene
• threadworms
• excessive inappropriate washing
• atopic or seborrheic eczema
• specific infections, e.g. streptococcal infection
• rarely candida, only after a course of antibiotics
• sexual abuse
A full history and investigations often provide a few clues to the etiology of the condition. Threadworms are fairly common as a cause of vulval itching, especially at night. Any specific conditions should be treated appropriately and the child and parent should be given advice on appropriate bathing and clothing.
Vulvovaginitis
A girl who has a discharge associated with the vulvitis has vulvovaginitis. The commonest causes vary with the age of the child. Infectious vaginitis is more common in sexually active adolescents and fungal infections are also more common owing to the more acid pH at this age. Children can also acquire infections such as Chlamydia trachomatis, gonorrhea and trichomonas via the birth passage or from sexual abuse. Non-specific vulvovaginitis is most common between the ages of 2 and 6 years, especially in the overweight girl. This has several causes, including:
• infection such as Staphylococcus aureus, Hemophilus influenzae, Gardnerella vaginalis
• sexually transmitted disease
• foreign body (rare)
• non-specific
Child sexual abuse should be borne in mind and excluded if possible. Specific infections are treated and general advice given as for vulvitis.
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