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
  • 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

  • Inadequate hand washing or perineal cleansing after urination and defecation increases risk (2).
  • Wearing of tight-fitting clothing increases risk
  • Obesity also predisposes to nonspecific vulvovaginitis (4).

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).

-- To view the remaining sections of this topic, please or --

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
  • 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

  • Inadequate hand washing or perineal cleansing after urination and defecation increases risk (2).
  • Wearing of tight-fitting clothing increases risk
  • Obesity also predisposes to nonspecific vulvovaginitis (4).

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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