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Vaginal Inflammation and Irritation: Treating Vulvovaginitis

Vulvovaginitis, or inflammation and irritation of the genital area, may occur in females of any age – including newborns, toddlers, and children, but it most commonly occurs in girls who have not yet started puberty.

What causes vulvovaginitis?

There are several potential causes of vulvovaginitis. Young girls are more susceptible to vulvovaginitis because they have less estrogen, which makes the vulvar skin thinner and sensitive.

Common causes include allergic reactions, infections (bacterial, fungal, pinworms), poor hygiene, and other skin conditions. Yeast is actually an uncommon cause of vulvovaginitis in girls who are toilet trained.

Sometimes, several causes may be present at once.

What are the symptoms?

Girls experiencing vulvovaginitis may have redness of the vulva, vulvar and/or vaginal itching, vaginal discharge or bleeding, and stinging or burning sensations. Some experience painful urination.

How is vulvovaginitis diagnosed?

Your child’s provider will ask you questions about her symptoms, any prior episodes, and any prior treatments. Then they will perform an exam of the external genitalia. Typically an internal exam is not necessary. They may perform a genital culture – this is done by gently touching the genitalia and vagina with a very small swab. This is sent to the lab to see if any specific bacteria or yeast grow. Rarely an ultrasound or biopsy is needed. In some cases, your provider may suggest an exam under anesthesia to evaluate further.

How is it treated?

Fortunately, the symptoms may improve without treatment. They also improve at puberty.

You can reduce the risk of vulvovaginitis by having your daughter wear white cotton underwear. She may sleep without underwear. Wear loose clothing, avoiding clothes that cause extra rubbing or pressure. She should use mild, unscented soap. Soak daily in clean, warm water. Avoid scrubbing the vulva. Rinse soap completely off and gently pat the vulva dry. Do not use bubble bath.

Avoid all irritants like soaps, lotions, detergents or fabric softeners with colors and fragrance.

Girls should urinate with legs spaced wide apart and wipe from front to back after using the toilet. It is important to treat constipation and diarrhea – as these conditions may make vulvovaginitis worse.

If treatment is necessary, your provider may suggest topical ointments and or an antibiotic. You may try petroleum jelly or a diaper ointment on the vulva if the area is irritated, red, or itchy. Symptoms should improve within 1-2 weeks of using the self-care tips above.

If your daughter’s symptoms do not improve or if she has recurrent symptoms, it’s best to see a pediatric gynecologist. You can request an appointment with Nationwide Children’s Pediatric Gynecology experts online or by calling (614) 722-2250. No referral is needed.

Katherine McCracken, MD
Kate McCracken, MD, is a distinguished member of Nationwide Children’s Pediatric and Adolescent Gynecology team. Dr. McCracken’s diverse clinical and research interests include ovarian masses, cysts and tumors; müllerian anomalies; vaginal agenesis; menstrual disorders (dysmenorrhea, heavy menstrual bleeding and irregular menses); pelvic pain; contraception; pediatric vulvovaginitis; vulvar and hymenal abnormalities; polycystic ovarian syndrome; preventative gynecologic care; and gynecologic care for patients with special needs and developmental delays.Dr. McCracken has a long history of academic and clinical research — from her first peer reviewed published work as an undergraduate at Kalamazoo College in Kalamazoo, MI, to her latest publication in the journal Seminars in Pediatric Surgery. As a fellow at Kosair Children’s Gynecology Specialists at Kosair Children’s Hospital in Louisville, KY, Dr. McCracken investigated the use of norethindron acetate for the management of bothersome bleeding associated with the etonogestrel contraceptive implant. Dr. McCracken was also actively involved in research during medical school at Wayne State University School of Medicine in Detroit and during residency at The Ohio State University.

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