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What is vulvovaginitis?
If your daughter complains of a sore bottom or is scratching her genital area, she may have vulvovaginitis, an inflammation of the vulva and vagina. It's the most common gynecologic problem in young girls (particularly school-age girls), though it can occur at any age.
While you may associate vaginal infections with sexual activity, young girls who have not yet reached puberty are especially susceptible to vulvovaginitis for reasons that have nothing to do with sex. Because your daughter doesn't yet have pubic hair or fatty labia for protection, clothing, chemicals, soaps, and medications can easily irritate the delicate skin of her vulva. Even a foreign object lodged there – something as simple as a piece of toilet paper – can cause inflammation.
Unlike an adult woman (or even a newborn or teenager), your growing daughter has no estrogen to defend her vaginal tract, and the pH of her vagina is high, creating a fertile environment for bacteria to grow. Or she may not have perfected that front-to-back wiping move just yet.
In any case, while being sore and possibly smelly in her private parts can be upsetting, the condition is not serious. Even frequent vulvovaginitis will not affect your daughter's future reproductive life. And while there are some stubborn cases, getting rid of it may be as simple as banishing the bubbles from her bath.
What are the symptoms of vulvovaginitis?
Before she complains of any pain, you may notice your daughter scratching or rubbing her crotch, or sitting or walking in a way that tells you she's uncomfortable. Soon, though, she will probably let you know that she's hurting, because in most cases the vulva becomes extremely irritated – so sore that it may keep her from sleeping. When you check it out, her genital area will be red and perhaps swollen.
Often, though not always, you'll notice a vaginal discharge, most likely on your daughter's underpants. The discharge, which can be light or heavy, is usually yellow or green, but it may be brownish. Regardless of color, it will probably have an unpleasant smell. In very rare cases, the discharge may be bloody.
Your daughter may say that it stings when she pees. This is the result of urine touching her irritated skin – though it's often mistaken for a sign of a urinary tract infection.
If your daughter has any of these symptoms, make an appointment with her doctor.
What causes vulvovaginitis?
There are many kinds of vulvovaginitis, and many explanations for it, ranging from sitting around in a wet bathing suit to a parasitic infection. Serious causes, like tumors, are extremely rare; it's far more likely that your daughter's tights are too tight. Here are some possibilities:
Bacterial imbalance A healthy vagina is alive with bacteria. Vulvovaginitis can result when the normal balance of the various bacteria is upset. A lab culture of your daughter's discharge may show too much of a particular bacteria that, in smaller amounts, wouldn't be troublesome.
The exact reason for the overgrowth isn't always known, although sometimes the balance is thrown off by antibiotics, or by the introduction of a new bacterium – from touching the genitals with contaminated hands, for example. (Frequent masturbation is also considered a culprit.)
Sometimes vulvovaginitis can be caused by a secondary infection. That is, if your child had strep throat recently, the strep bacteria may have made its way to her vagina and caused symptoms there. In vulvovaginitis caused by strep, the vulva is especially bright red and usually painful.
Hygiene It's anatomical: The distance between the vagina and anus is not that great, and neither are the wiping skills of many young girls. If this area is not kept clean, E. coli and other bacteria from her gastrointestinal tract can easily make their way to the vaginal opening.
Pee position Like most young girls, your daughter probably pees with her knees together. This increases the possibility that urine will go up her vagina and cause an infection.
Pinworms Also known as threadworms, these parasites are common in children. Pinworms usually lay their eggs around the anus. If your daughter has pinworms, they – and the itching and irritation they cause – may have spread to her vulva and vagina.
Foreign objects Pieces of toilet paper or other objects can get stuck in your daughter's vagina, causing odor and discharge, even bleeding.
External irritants Sometimes all it takes is a hot day and clothes that are tight-fitting or not breathable (such as a leotard, tight jeans, or nylon underpants) to inflame sensitive skin. Bubble baths and harsh soaps can also cause redness and itching.
Candida (yeast) While yeast infections are a common nuisance for women, they don't usually bother girls who haven't started puberty. Unless she has recently finished a course of antibiotics (which can upset the balance of helpful and harmful bacteria in her system), is still in diapers (or training pants), or has a compromised immune system, your daughter is unlikely to have this fungus, which causes a whitish yellow cottage-cheese-like discharge and a very red, inflamed vulva.
Chronic yeast infections in children may be a sign of diabetes or immunosuppression. If your daughter has frequent candida, talk with her doctor about identifying possible causes.
Abuse Children who are having no sexual contact with adults are generally safe from the sexually transmitted bacteria that cause vulvovaginitis as a result of such diseases as trichomoniasis, chlamydia, and gonorrhea. If your daughter's culture comes back positive for these or other sexually transmitted diseases, she will need to be evaluated for sexual abuse.
Labial adhesion The inner lips of the vagina (the labia minora) become stuck together in about 2 percent of girls up to age 6. Labial adhesion isn't a serious condition, but it can contribute to vulvovaginitis.
A skin condition Lichen sclerosis is an uncommon skin condition in which patchy, white, thin areas of skin appear, often on the genitals. It may cause very sensitive skin and vulvovaginitis.
How is vulvovaginitis evaluated and treated?
First, the doctor will probably talk with you and your daughter about her symptoms and any recent illnesses or medications, about how your daughter bathes and what she likes to wear, and about how she wipes herself.
The doctor will then gently examine your daughter's external genital area. This may be awkward or uncomfortable for your daughter, but it will not hurt or be physically intrusive. If there's a discharge, the doctor may take a sample on a swab.
The doctor will treat your daughter's vulvovaginitis according to its cause. If it turns out to be a bacterial infection, she'll probably get a prescription for antibiotics. The doctor will tell you how you can help ease her immediate pain.
Frequent warm baths (with no soap), cool compresses, Epsom salt soaks, and possibly using wet wipes (choose wipes for sensitive skin) may be helpful. The doctor will probably also recommend wiping front to back and wearing loose cotton clothing to allow air in and keep her vulva dry.
Depending on the diagnosis, the doctor may also recommend a topical antibiotic, antifungal cream, hydrocortisone cream, or an ointment to speed healing and soothe pain.
It's important to keep the sensitive tissue from continual irritation, because irritated tissue is more likely to become infected than normal tissue, and the vaginal area (dark, damp, and warm) is the perfect environment for infection-causing organisms to thrive.
Can vulvovaginitis be prevented?
There are no guarantees, but here are a few things you can do to reduce the odds of your daughter having a repeat bout (some girls are more prone than others) or getting it in the first place.
- Keep her genital area as clean as possible by making sure she wipes herself front to back after using the toilet (it's a good habit for both pooping and peeing).
- Encourage her to pee with her knees apart, which will help prevent urine from going up her vagina. (Having her sit on the toilet backward – facing the toilet cover – will help spread the labia while she urinates.) Teach her to wash her hands well both before and after using the toilet.
- Choose nonscented toilet paper, and don't use perfumed products (such as powders).
- Avoid bubble baths and harsh soaps. In fact, don't leave a bar of soap in the tub while she's in the water. If you wash her hair in the tub, do it at the end of her bath so she's not sitting around in shampoo for a long time. Rinse her well with a handheld sprayer after her bath. If your daughter gets vulvovaginitis often, switch to showers and limit the use of soap in her genital area.
- See that she's completely dry after bathing or showering before she gets dressed. A few seconds of a hairdryer set on low can help dry her between her legs.
Enforce a few clothing rules: No tight jeans, nylon underpants, pajamas with the feet sewn up, or other clothes that limit air circulation. Go for loose cotton. Try to limit her time in leotards, tights, and wet nylon bathing suits. (Have a dry one for her to change into after swimming, if she wants to stay in a bathing suit.) Wash her underwear in a mild detergent, and don't use dryer additives such as fabric softener sheets.