Personal practiceVulvovaginitis
Section snippets
Definitions
Vulvar inflammation, vulvitis, may precede or accompany vaginitis, which is inflammation of the squamous epithelial tissues lining the vagina. The hallmarks of the former are irritation and redness of the vulva causing itching, pain and dysuria, whereas the major symptom of vaginitis is vaginal discharge. Usually patients suffer from concurrent inflammation of both the vulva and the vaginal tissues, namely, from vulvovaginitis. Vulvovaginitis is common in the pediatric practice. The differences
History
History should include questions about itching, discharge (colour, quantity, odour, consistency and duration), dysuria and redness. Other issues which should be discussed are: Perineal hygiene, exposure to irritants such as bubble baths and soaps, the possibility of a vaginal foreign body, the use of medications, underlying diseases, anal pruritus, recent infections in the child or family, and obviously sexual activity and use of contraception in the adolescent, who should interviewed alone.
Physical examination
The physical examination should look for evidence of chronic illness or dermatological disease and include determination of the pubertal stage. The genitalia should be inspected in the frog-leg supine position, with attention to the vulva, introitus, hymen and anterior vagina, including gentle lateral retraction of the labia as well as gripping of the labia and pulling anteriorly and laterally. Signs of inflammation or injury should be sought as well as the presence of a foreign body. For
Investigations
Vaginal secretions should be obtained for examination under the light microscope and for microbiological investigation in both the prepubertal and adolescent patient. The specimen can be collected with a saline-moistened swab or using a sterile newborn suction catheter carefully inserted 2–3 cm into the vagina. Vaginal fluid should be evaluated microscopically for epithelial cells, white cells, motile trichomonads, clue cells, and for hyphae or spores on a potassium hydroxide wet mount. A
Vulvovaginitis in the prepubescent girl
Vulvovaginitis is the most common gynecological problem in prepubertal girls. Factors that explain the increased susceptibility of children to vulvovaginitis include: The close anatomic proximity of the rectum; lack of labial fat pads and pubic hair; small labia minora; thin and delicate vulvar skin; thin, atrophic, anestrogenic vaginal mucosa; and children's tendency to have poor local hygiene and to explore their bodies. Most cases of vulvovaginitis are of nonspecific etiology. However in
Differential diagnosis & management
Girls suffering from vulvovaginitis should be treated with hygienic measures: Avoiding tightly fitting clothing or other irritants like harsh soaps to the vulva, front-to-back wiping after using the toilet, sitz baths and protective ointments. If symptoms persist vaginal secretions should be investigated and specific antimicrobial treatment prescribed according to microbiological results. Pinworms (Enterobius vermicularis) should be considered in girls whose major symptom is perineal pruritus
Vulvovaginits in the adolescent
Vaginal complaints in the adolescent are common, consisting mostly of vaginal discharge, pruritus and dysuria. The major causes of vaginal discharge in the adolescent are: Physiologic leukorrhea, vaginitis, cervitis and foreign body, mostly a retained tampon. In the case of a foreign body the discharge is usually foul-smelling and bloody. Physiologic leukorrhea, which typically starts before menarche and has a cyclic variation, is a whitish mucoid discharge resulting from the normal estrogen
Acute vaginitis
The three most common types of acute vaginitis are vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis. In the non-sexually active teenager, candidiasis is the major cause of vaginal complaints and inflammation, most cases being caused by Candida albicans. The vaginal discharge is typically white, thick and curdy (“cottage cheese like”), without odour. It is accompanied by pruritus, dysuria and burning. The vaginal pH is lower than 4.5 and microscopic evaluation reveals hyphae or
Cervicitis
The sexually active adolescent presenting with vaginal discharge might be suffering from mucopurulent cervicitis, which is characterized by mucopurulent discharge from an inflamed cervix. It can be caused by Chlamydia trachomatis and Neisseria gonorrhoeae, by herpes simplex or by Trichomonas vaginalis. Additional symptoms include itching, irregular vaginal bleeding and dyspareunia. If there is lower abdominal pain pelvic inflammatory disease (PID) must be considered. In this serious consequence
References (0)
Cited by (3)
Gonococcal vulvovaginitis in prepubertal girls: Sexual abuse or accidental transmission?
2013, Archives de PediatrieVulvovaginitis, prepubescent
2015, The 5-Minute Clinical Consult Standard 2016: Twenty Fourth EditionThe role of cystovaginoscopy and hygienic advice in girls referred for symptoms of vulvovaginitis
2012, Archives of Disease in Childhood