Pediatric vulvovaginitis

What is pediatric vulvovaginitis?

• Nonspecific Vulvovaginitis - In childhood, the infection usually begins in the vulva, with secondary spread to the vagina. In adolescence, particularly after the onset of sexual intercourse, vaginal involvement is primary. Vulvovaginal candidiasis (yeast infection) is very rare in children unless the child is immunocompromised or on antibiotics.

Young girls are particularly susceptible to vulvovaginitis. Because the genital area is close to the rectum, bacteria (and sometimes parasites –like pinworms) spreads easily. In addition, children can spread bacterial respiratory infections from their nose and mouth to the vulva. Infection with sexually transmitted pathogens suggests sexual abuse.

In addition, vulvar skin is thin and sensitive to trauma from scratching, rubbing from tight-fitting clothing, or exposure to irritants like harsh soaps or bubble baths.

• Yeast vulvovaginitis - Everyone has a fungus called candida, which is typically found in the intestines, mouth, skin and the tissues around the genital areas. When, candida grows out of control, it causes a yeast infection. Candida flourishes in warm, dark areas, such as the vagina or armpit.

What are the different types of pediatric vulvovaginitis?

• Nonspecific vulvovaginitis - Vulvovaginitis is an inflammation of the vulva and vaginal tissues. This is common problem in prepubertal girls. It is typically not caused by a specific pathogen and is not treated with antibiotics.  It can also be caused by infection, irritation, a foreign body, allergy, or systemic disease
• Yeast vulvovaginitis - Pediatric yeast infection is a general term that describes when a naturally occurring fungus grows in excess and causes irritation.
  • Toddler (1 to 3 years) yeast infection – This infection creates a rash in the armpit, diaper area, mouth and neck.
  • Vaginal yeast infection – This is the most common type of yeast infection. Approximately 75 percent of all women will have at least one during her lifetime. Yeast infections are uncommon in normal prepubertal girls, so treatment is usually avoided in these girls.

What are the signs and symptoms of pediatric vulvovaginitis?

Nonspecific vulvovaginitis:

• Abnormal odor
• Burning sensation during urination
• Discharge
• Discomfort, pain, or itching
• Vulvar irritation
• Vulvar redness

Yeast vulvovaginitis:

• Itching and irritation
• Pain during urination
• Pain during intercourse
• Rashes
• Vaginal swelling
• White, thick coating on tongue

What are the causes of pediatric vulvovaginitis?

The prepubertal vulva and vagina is easily irritated by urine, sweat, stool, soaps, and perfumed products. This can cause discharge which further irritates the skin of the vulva.