Vulvovaginal complaints in the prepubertal child
- Marc R Laufer, MD
Marc R Laufer, MD
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- S Jean Emans, MD
S Jean Emans, MD
- Mary Allen Avery Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Vulvovaginal complaints in prepubertal children may be the result of infection, congenital abnormalities, trauma, or dermatologic conditions. Vaginitis may have a nonspecific etiology or may be due to known pathogens. It is the commonest gynecological problem in prepubertal girls . Symptoms include vaginal discharge, erythema, soreness, pruritus, dysuria, and bleeding. Occasionally, urinary tract or bowel symptoms may be interpreted by a child as vulvar or vaginal complaints.
This topic will discuss common vulvovaginal disorders in this population. The gynecological history and physical examination and techniques for obtaining cultures in these children are reviewed separately. (See "Gynecologic examination of the newborn and child".)
Nonspecific vulvovaginitis is responsible for 25 to 75 percent of vulvovaginitis in prepubertal girls . There are a number of potential factors in children that increase their risk of vulvovaginitis: lack of labial development, unestrogenized thin mucosa, more alkaline pH (pH 7) than postmenarchal girls/women, poor hygiene, bubble baths, shampoos, deodorant soaps, obesity, foreign bodies, and choice of clothing (leotards, tights, and blue jeans).
Chronic masturbatory activity can lead to vulvar irritation with occasional thickening of the clitoral hood. Sexual abuse is another etiology of nonspecific vulvovaginitis. Some girls with nonspecific vulvovaginitis seem to experience recurrences at the time of upper respiratory infections.
Once a specific etiology (listed below) for the symptoms has been excluded, the following recommendation for parents may be of help:
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- NONSPECIFIC VULVOVAGINITIS
- SPECIFIC INFECTIONS
- Respiratory and enteric flora
- Gardnerella vaginalis
- Sexually transmitted diseases
- - Neisseria gonorrhoeae
- - Chlamydia trachomatis
- - Trichomonas vaginalis
- - Condylomata acuminata
- FOREIGN BODY
- POLYPS, SKIN TAGS, OR TUMORS
- SYSTEMIC ILLNESS
- VULVAR ULCERS
- URINARY TRACT PATHOLOGY
- Ectopic ureter
- Urethral prolapse
- CUTANEOUS VULVAR DISEASE
- Lichen sclerosus
- Labial adhesions
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS