Vulvovaginitis

Question 1

What is vulvovaginitis?

Answer 1

Vulvovaginitis is an inflammation and soreness of the skin in the vagina or surrounding vulva, common in younger, pre-pubertal girls.

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Question 2

Mild vulvovaginitis = very common and child may have had several episodes

Answer 2

Sometimes local skin infection may be present e.g. Group A streptococcal infection (rarer in younger girls as non-oestrogenised hymen protects the vagina)

Question 3

History:

1. Duration of symptoms
2. Clarify symptoms: itching, burning, dysuria / soreness when passing urine, bleeding etc
3. Hx of trauma?
4. Any other perianal symptoms (nocturnal itching?)

Answer 3

5. Any other household members with symptoms (threadworm?)
6. Any changes to toiletries / laundry products?
7. Any other skin changes e.g. eczema or psoriatic type changes
8. Is the child potty-trained? Do they wipe their own bottom / privates when they go to toilet?
   * in adolescents it’s important to ask about sexual hx and discuss safe sex with signposting

Question 4

Examination:

1. Inspection:
   => vulval, peri-vulval erythema, excoriation or discharge
   => discharge may be assoc. with foreign body
2. Poor perineal / peri-anal hygiene (common cause)
   => peri-anal excoriation or presence of threadworm

Answer 4

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Question 5

Childhood vulvovaginitis most common between 3-10 years old children. What are the symptoms?

Answer 5

1. Inflammation
2. Pruiritis
3. Erythema
4. Soreness
5. Yellow / green vaginal discharge (may stain the pants)

Question 6

Young girls are more prone to vulvovaginitis because they have lower levels of oestrogen so the vagina and vulva are thin and less resistant to infection. Before puberty the vagina is not acidic like after puberty so bacteria can easily grow and cause infection.

Answer 6

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Question 7

How is vulvovaginitis managed?

Answer 7

1. Hygiene advice and symptomatic relief
   => non-biological laundry powders, no soap or bubblebaths

=> supervision with toileting and hygiene - wiping from front to back

=> may need to rinse after toilet then towel dry

2. Girls should not wear pants to sleep in for better airflow and prevent dampness + wear soft, breathable clothes
3. Can continue hobbies i.e. swimming but need to be dry before re-dressing
4. Barrier creams e.g. sudocrem prevents urine passing over inflamed skin
5. Threadworn - treat whole family
6. Hand hygiene and short nails
7. Swabs if there is persistent infection despite good hygiene
8. Safeguarding concerns need to be escalated per local protocol

Question 8

Vulvovaginitis improves at puberty if not before.

Answer 8

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