Vulvovaginitis, Prepubescent
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Basics
Description
- Vulvitis is inflammation of the external genitals.
- Vaginitis, often associated with vaginal discharge, is inflammation involving the vaginal mucosa.
- In premenarchal girls, vulvitis is usually primary with secondary extension into the vagina.
- Vulvovaginitis can be classified as either nonspecific or specific
- Systems affected: reproductive, integumentary
Epidemiology
Incidence
Unknown
Prevalence
Most common gynecologic problem in prepubertal girls
Etiology and Pathophysiology
- In the prepubertal child, levels of estrogen are low, leading to thin, immature, and fragile vaginal epithelium.
- Anatomically underdeveloped labia minora, absence of pubic hair, minimal adiposity of the labia majora, and close proximity of the introitus to the anus make contamination more likely (1).
- The prepubertal child also has an alkaline vaginal pH, with an absence of lactobacilli (1).
- Infectious organisms causing vulvovaginitis are typically respiratory, enteric, or rarely sexually transmitted.
- Most cases of pediatric vulvovaginitis are classified as nonspecific vulvovaginitis and do not have an infectious etiology.
- Nonspecific vulvovaginitis causes include:
- Poor perineal hygiene (wiping back to front) (2)
- Nonspecific chemical irritants (bubble baths, scented soaps, laundry detergents)
- Tight-fitting clothing or underwear made of synthetic materials
- Specific vulvovaginitis causes include:
- Bacterial: The most common bacteria are introduced from respiratory and GI tracts.
- The most common respiratory pathogen is Streptococcus pyogenes (3). Vulvitis may occur in the absence of respiratory symptoms.
- Escherichia coli is the most common fecal pathogen.
- Shigella vaginitis is associated with mucopurulent bloody discharge and is not always accompanied by a history of diarrhea.
ALERT
Presence of Neisseria gonorrhea or Chlamydia trachomatis strongly suggests sexual transmission and should prompt consideration of sexual abuse
- Enterobius vermicularis (pinworms)
- Very common in young children and certain populations
- Should be considered in children with vaginal itching and irritation
- Most common symptom is nocturnal perineal itching
- Bacterial: The most common bacteria are introduced from respiratory and GI tracts.
- Recurrent/chronic vulvovaginitis:
- Anatomic abnormalities could include double vagina with fistula, ectopic ureter, and urethral prolapse.
- Systemic inflammatory diseases
- Other conditions, such as lichen sclerosus, vitiligo, psoriasis, and atopic dermatitis are possible.
- Foreign body
- Presents with foul-smelling, bloody, or brown discharge from the vagina
- Should be considered in patients with recurrent vulvovaginitis after other causes are ruled out.
Risk Factors
General Prevention
- Good perineal hygiene (including wiping from front to back)
- Urination with legs spread apart and labia separated
- Avoidance of tight-fitting clothing and nonabsorbent underwear
- Avoidance of irritants such as harsh/perfumed soaps and bubble baths
Commonly Associated Conditions
Urinary tract infections are common in children with vulvovaginitis (4).
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Basics
Description
- Vulvitis is inflammation of the external genitals.
- Vaginitis, often associated with vaginal discharge, is inflammation involving the vaginal mucosa.
- In premenarchal girls, vulvitis is usually primary with secondary extension into the vagina.
- Vulvovaginitis can be classified as either nonspecific or specific
- Systems affected: reproductive, integumentary
Epidemiology
Incidence
Unknown
Prevalence
Most common gynecologic problem in prepubertal girls
Etiology and Pathophysiology
- In the prepubertal child, levels of estrogen are low, leading to thin, immature, and fragile vaginal epithelium.
- Anatomically underdeveloped labia minora, absence of pubic hair, minimal adiposity of the labia majora, and close proximity of the introitus to the anus make contamination more likely (1).
- The prepubertal child also has an alkaline vaginal pH, with an absence of lactobacilli (1).
- Infectious organisms causing vulvovaginitis are typically respiratory, enteric, or rarely sexually transmitted.
- Most cases of pediatric vulvovaginitis are classified as nonspecific vulvovaginitis and do not have an infectious etiology.
- Nonspecific vulvovaginitis causes include:
- Poor perineal hygiene (wiping back to front) (2)
- Nonspecific chemical irritants (bubble baths, scented soaps, laundry detergents)
- Tight-fitting clothing or underwear made of synthetic materials
- Specific vulvovaginitis causes include:
- Bacterial: The most common bacteria are introduced from respiratory and GI tracts.
- The most common respiratory pathogen is Streptococcus pyogenes (3). Vulvitis may occur in the absence of respiratory symptoms.
- Escherichia coli is the most common fecal pathogen.
- Shigella vaginitis is associated with mucopurulent bloody discharge and is not always accompanied by a history of diarrhea.
ALERT
Presence of Neisseria gonorrhea or Chlamydia trachomatis strongly suggests sexual transmission and should prompt consideration of sexual abuse
- Enterobius vermicularis (pinworms)
- Very common in young children and certain populations
- Should be considered in children with vaginal itching and irritation
- Most common symptom is nocturnal perineal itching
- Bacterial: The most common bacteria are introduced from respiratory and GI tracts.
- Recurrent/chronic vulvovaginitis:
- Anatomic abnormalities could include double vagina with fistula, ectopic ureter, and urethral prolapse.
- Systemic inflammatory diseases
- Other conditions, such as lichen sclerosus, vitiligo, psoriasis, and atopic dermatitis are possible.
- Foreign body
- Presents with foul-smelling, bloody, or brown discharge from the vagina
- Should be considered in patients with recurrent vulvovaginitis after other causes are ruled out.
Risk Factors
General Prevention
- Good perineal hygiene (including wiping from front to back)
- Urination with legs spread apart and labia separated
- Avoidance of tight-fitting clothing and nonabsorbent underwear
- Avoidance of irritants such as harsh/perfumed soaps and bubble baths
Commonly Associated Conditions
Urinary tract infections are common in children with vulvovaginitis (4).
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