Vulvitis & Vulvovaginitis (Prepubescent)

See also fused labia and paediatric recurrent UTI (dysuria overlap).

Vaginal discharge — what’s normal

Most newborn girls have some normal mucoid white discharge, usually resolving by 3 months. From 3 months until puberty, discharge is normally minimal.

Mild vulvovaginitis

A very common problem — itch, discharge, redness, sometimes dysuria.

Causes: thin prepubescent vaginal mucosa; moisture (synthetic underwear, tight clothing, wet swimwear, obesity, urine trapping in the vagina); irritants (soap residue, bubble baths, antiseptics).

Investigations: none needed for mild cases; consider urine MC+S if urinary symptoms.

Management:

• Explanation and reassurance.
• Avoid the causal factors above.
• Vinegar baths may help (½ cup white vinegar in a shallow bath, soak).
• Soothing creams (soft paraffin, nappy-rash cream) short-term.
• Educate about spreading the legs on the toilet to avoid vaginal urine trapping.

Moderate/persistent vulvovaginitis

• Perianal/vulval itch as the main symptom → consider threadworms.
• Profuse or offensive discharge → take an introital swab (not vaginal). Sometimes a single overgrown organism (Group A strep, Haemophilus, Gardnerella) is found and responds to antibiotics — e.g. cephalexin 25 mg/kg BD for 10 days.
• Candida infection is unusual between age 2 and puberty — if found, consider an underlying cause (immunosuppression, recent antibiotics, diabetes).
• Blood-stained, offensive or persistent discharge → consider a foreign body; refer to paediatric gynaecology.
• Consider skin disease elsewhere (eczema, psoriasis) as a contributing cause.
• Always consider the possibility of sexual abuse.