Overview of Vulvovaginal Conditions in Prepubertal Children

Introduction:

The terms vulva and vagina refer to the lower female genital tract, and vulvovaginitis or vulvovaginal conditions indicate any inflammation or infection to that area of the body.

Vulvovaginitis is a common gynecological condition seen in girls of prepubertal age. The primary causes may be poor personal hygiene, hormonal imbalance, etc. It subsides once the child reaches puberty. Every child in the prepubertal age may encounter mild infection, and recurrent infections are seen in those children who lack personal hygiene. However, it is generally not a severe condition and gets resolved independently or by following simple home care remedies.

What Is Vulvovaginitis?

Vulvovaginitis is an inflammatory condition of the vulva or the vagina due to physiologic, anatomic, or other predisposing factors such as infection, trauma, etc. In addition, the factors may be due to alteration in the hormonal levels, poor hygiene, or the use of substances such as soaps and creams that may cause irritation, resulting in inflammation.

How Common Is Vulvovaginitis?

Vulvovaginitis is a common gynecological problem seen in almost 62 % of children of prepubertal age.

What Causes Vulvovaginitis?

• The commonest reason for vulvovaginal conditions is poor hygiene.

• Local irritation is caused due to improper washing methods. Generally, it is advised to wash or wipe from front to back after each bowel movement or urination. The opposite way could result in accidental deposition of fecal residues in the urethra and urine retention, causing irritation.

• Using hygiene products such as soaps, shampoo, and harsh chemicals may result in local irritation to the sensitive areas resulting in urethritis.

• Vaginal discharge is common in prepubertal children. This discharge may cause irritation upon drying and when in contact with the skin surface for a prolonged duration.

• Sex hormones begin their secretion by the prepubertal age (seven years onwards). This may increase bacterial growth in the vagina, creating an acidic medium.

• Presence of skin disorders or any other systemic illness.

• Wearing tight undergarments or outfits. It may cause reduced air circulation and friction between the legs, causing irritation and redness in that area.

• Trauma or any injury to the genitals, presence of any masses or cysts in the ovary.

• Urethral prolapse is a condition where the urethra gets pushed into the vaginal canal.

• Candidal infections are a common cause of vaginal candidiasis due to poor hygiene.

• If sexual abuse is suspected, there may be chances for sexually transmitted infections such as Trichomonas infection, herpes simplex, and gonorrhea.

What Are the Signs and Symptoms?

The common symptoms seen in any vulvovaginal conditions are:

• Vaginal discharge with or without odor: 60% to 90%.

• Redness and inflammation: 82%.

• Soreness: 74%.

• Pruritus (itching): 45% to 58%.

• Dysuria (difficulty in urination) 19%.

• Vaginal bleeding: Five to 10%.

Why Are Prepubertal Children at Increased Risks?

• Hormonal Imbalance: Low estrogen levels may lead to thinning of the mucous membrane of the vagina.

• Less Pubic Hair and Fewer Labial: Children of prepubertal age may have fewer pubic hairs and fewer labial fat pads, both of which serve as defense mechanisms against infections.

How Are They Diagnosed?

The vulvovaginal conditions are often diagnosed by careful history taking. First, the doctor physically examines the affected part of the external genitalia. The adjacent structures are also examined during this examination to identify whether the infection has spread to other regions.

The diagnostic tests followed for establishing vulvovaginitis are:

• Skin Biopsy: It may be indicated to identify the exact cause of the condition. Skin biopsy is an investigative procedure where a small portion of the affected part is examined under a microscope for detailed information.

• Swab Test: A sterile cotton swab is inserted into the vagina, and a sample of the vaginal discharge is taken. This is then mounted on a slide and examined further. This test also provides more accurate information regarding the source of infection.

• Patch Test: They are performed to identify contact allergies due to creams, soaps, and other fragmented hygiene products.

• Test for Sexually Transmitted Infections: If the doctor suspects any sexual abuse in the child, they should perform tests for sexually transmitted diseases.

How Are Vulvovaginal Conditions Treated?

Vulvovaginitis and other vulvovaginal conditions are not serious problems. Although they may cause discomfort in the child, they resolve independently without any medical treatment. However, simple home care remedies can improve the condition of the child.

• Educate the children on how to wash or wipe their private parts soon after urination and each bowel movement. Front-to-back motions are indicated to avoid residual feces or urine.

• Always use loose or comfortable undergarments to avoid friction between the thighs. Encourage the children to wear cotton underwear rather than nylon or polyester fabrics.

• Avoid bubble baths or prolonged contact with soaps, detergents, etc.

• Use soaps or other hygiene products that are chemical-free and gentle on the skin.

• Maintain good personal hygiene.

• Always towel dry the private parts after bathing and bowel movements. Staying moisture-free helps get rid of bacterial infections.

• In case of redness and irritation, lubricating and soothing creams such as petroleum jelly, soft paraffin, and nappy rash cream can be used.

When Should One Seek the Help of a Doctor?

• If the condition worsens despite all the home remedies and if it persists for more than two to three weeks.

• Fever.

• If the vaginal discharge is foul-smelling

• Difficulty in urination.

• Vaginal bleeding.

Can This Condition Be Prevented?

Vulvovaginitis can be prevented by maintaining personal hygiene. If they are due to underlying health conditions, treating the illness may avoid such infections.

Conclusion:

Although vulvovaginitis is not a serious condition to worry about, it may create unnecessary stress and discomfort for the child. Parents may also be worried about the health of their children. It is ubiquitous, and almost all children will encounter this condition during their lifetime. For parents, their main goal is to render healthy and proper hygienic instructions to their children and instruct them to follow them throughout their lives. Maintaining personal hygiene itself resolves almost all problems. Parents are also advised to teach their children in the prepubertal stage about changes in their bodies. Creating such awareness among children may help them protect themselves from sexual abuse.