Vulvovaginitis

What is vulvovaginitis?

Vulvovaginitis is a common condition affecting girls between the ages of 2 and 7 years old, before starting puberty. It is inflammation of the vagina and vulva.

Mild vulvovaginitis is common and some girls will have vulvovaginitis many times. In most cases vulvovaginitis is not a serious problem and usually no medical treatment is needed.

Vulvovaginitis usually resolves at puberty.

What are the symptoms?

The main symptoms are vaginal discharge and soreness. The discharge can be white, green or yellow and can be smelly. Other symptoms may include redness of the vagina and vulval area, itching and pain when passing urine.

If they have any blood in their discharge, then please inform your doctor as further investigation is needed.

What causes vulvovaginitis?

Vulvovaginitis is usually caused by repeated infections with bugs that are a normal part of the body. They often live in the gut, bowel, nose or mouth. These bugs are easily transferred to the vulva area by young girls as they learn to be responsible for their own hygiene.

Other factors that make young girls who have not yet gone through puberty more prone to infections in this area are:

• a lack of female hormones which make the vagina and vulva thin and less resistant to infection
• the vagina is not acidic like it is after puberty, so bugs can easily grow and cause infection
• the vulva is very close to the bottom so it is easy to spread germs from the bowel to the vulva
• the labia (lips) are flat and undeveloped so they do not help stop infection
• in some girls who have eczema or sensitive skin, the skin around the genitalia can also become irritated, which may cause vulvovaginitis
• products such as soaps, bubble baths and perfumes
• moisture or dampness around the genitalia may make girls more likely to develop vulvovaginitis. This can be made worse by tight clothing, being overweight or regular swimming
• threadworms can cause itching or irritation. This is usually worse at night.

It is very unlikely that the symptoms are caused by thrush in girls before going through puberty.

Are any tests necessary?

Sometimes the doctor may take a swab from your child’s discharge on the outside of their vagina. This should not hurt.

If there is pain while passing wee, a wee sample may be sent to check for an infection. If any infection shows up on either of these tests, it may be treated with antibiotics.

Are there any other treatments?

There is no single treatment, and the condition will go away as puberty begins. Here are some helpful tips to improve the symptoms:

• teach your child to wipe from the front to the back when they have been to the toilet
• make sure their bottom is completely clean after they have gone to the toilet
• avoid all soaps, shower gels and bubble baths. Your doctor will be able to prescribe you a moisturiser to be used as a soap substitute such as Dermol
• avoid wet wipes
• avoid fabric conditioners and biological washing powders
• dress your child in cotton underwear and avoid tight fitting clothing
• avoid wearing knickers at night
• use a barrier cream or ointment on the skin at least 2 times a day. Your doctor may prescribe your child some cream such as hydromol, dermol, aveeno or balneum. If there is pain when they are weeing, you can apply a barrier cream before they go to the toilet
• constipation can make the problem worse, so try and avoid your child getting it by having a healthy diet. If it is a problem, you might want to get it treated by your GP

If you are worried about your child, they are not improving, or you are concerned something more serious may be occurring please let your doctor know.

Will there be any long-term problems?

The infections associated with vulvovaginitis are different from those that adult women get, and do not cause any problems with periods or fertility. There is no association with pelvic inflammatory  disease or tubal damage.