Vulvovaginitis

Question 1

What is vulvovaginitis?

Answer 1

Vulvovaginitis refers to inflammation and irritation of the vulva and vagina. It is a common condition often affecting girls between the ages of 3 and 10 years.

Question 2

Causes of vulvovaginitis?

Answer 2

This irritation is caused by sensitive and thin skin and mucosa around the vulva and vagina in young girls. The vagina is more prone to colonisation and infection with bacteria spread from faeces. It can be exacerbated by:

Wet nappies
Use of chemicals or soaps in cleaning the area
Tight clothing that traps moisture or sweat in the area
Poor toilet hygiene
Constipation
Threadworms
Pressure on the area, for example horse riding
Heavily chlorinated pools

Vulvovaginitis improves and is much less common after puberty, as oestrogen helps keep the skin and vaginal mucosa healthy and resistant to infection.

Question 3

Presentation of vulvovaginitis?

Answer 3

Vulvovaginitis is a common presentation in young girls before puberty. It presents with:

Soreness
Itching
Erythema around the labia
Vaginal discharge
Dysuria (burning or stinging on urination)
Constipation

A urine dipstick may show leukocytes but no nitrites. This will often result in misdiagnosis as a urinary tract infection.

Question 4

Management of vulvovaginitis?

Answer 4

Often patients have already been treated for urinary tract infections and thrush, usually with little improvement in symptoms. It is unusual for girls to develop thrush before puberty.

Generally no medical treatment is required and management focuses on simple measures to improve symptoms:

Avoid washing with soap and chemicals
Avoid perfumed or antiseptic products
Good toilet hygiene, wipe from front to back
Keeping the area dry
Emollients, such as sudacrem can sooth the area
Loose cotton clothing
Treating constipation and worms where applicable
Avoiding activities that exacerbate the problem

In severe cases an experienced paediatrician may recommend oestrogen cream to improve symptoms.