Vulvovaginitis

Assessment

This covers problems in pre pubertal girls.

Vulvovaginitis is a common problem in young, pre pubertal girls – symptoms include:

Redness, sore vulva
Complaining of an itch in the vulval area
Pain and discomfort (of the skin) when passing urine; urine dipstick may show 1+ or 2+ blood which may have come from skin rather than higher up the urinary tract.

Perineal swabs are rarely useful in these girls, unless there is significant vaginal discharge.

White/yellow, non-offensive vaginal discharge is normal in young girls and increases as they become oestrogenised, often with cyclical variation.

If there are systemic symptoms, such as fever, abdominal pain or vomiting, consider other diagnoses and ensure a urine sample is taken to exclude urinary tract infection (UTI). There is a separate information sheet for UTIs.

Red Flags

Candida infection (thrush) is rare in prepubertal girls; a confirmed infection on swab should raise the possibility of other medical conditions (e.g. diabetes, immunosuppression) or Child Sexual Abuse (CSA).

If you have any concerns regarding safeguarding (CSA), please find advice and referral details via the following website:

This covers the following boroughs: Croydon, Kingston, Richmond, Wandsworth, Merton and Sutton.

https://swlondonccg.nhs.uk/about/governance/safeguarding/

Management

There are some simple measures that can help alleviate the symptoms of vulvovaginitis:

Children are commonly infected by threadworms, making the itching worse, especially at night. Mebendazole (Ovex^TM, Vermox^TM) can be bought over the counter and should be used to treat the whole household at the same time. Advice should also be to keep fingernails cut short, wash all bedding, towels and nightclothes on a hot wash (> 60^oC). If symptoms recur after 2 weeks, a second dose of mebendazole can be given.

Threadworm eggs are laid, usually at night, on the outside of the anus, so advising a shower morning and night on the day the medication is taken, will help get rid of any eggs. Children should be discouraged, if at all possible, from scratching the anus and sucking thumbs/biting fingernails as this will propagate re infection.

Girls should be advised to wear cotton pants rather than synthetic fibres and avoid tight clothing.
Perineal hygiene is really important and the message to ‘wipe front to back’ and ensuring the perineum is completely dry after passing urine, should be reinforced. Ask them to show you how they are currently wiping their bottom and correct them if this is not optimal.
Girls should be advised to avoid the use of soaps, bubble baths and anti-bacterial products in the bath or when washing the perineal area. Avoiding biological washing powders may also help.
Ensure any constipation is being adequately managed.

Things to suggest to help:

Using a barrier cream, spread in a thin layer can provide some relief, and can protect the skin from any further irritation.
Some find vinegar baths helpful (add ½ cup of vinegar to a warm, shallow bath) and bathe for 10-15 minutes daily.
Ensure good fluid intake (at least 1500ml daily) to ensure more dilute urine is passed

Referral Information

The steps above will be helpful in most cases. As in ‘Red Flags’, if there are any safeguarding concerns, please follow the safeguarding referral procedures. Safeguarding concerns can also be discussed with your Designated Safeguarding lead or Named or Designated Safeguarding professionals.

If the problem persists despite the above measures, consider referral to General Paediatrics via ERS including clear information on any known safeguarding or social concerns. We are happy to discuss cases via Advice & Guidance on ERS.

Supporting Information

We have developed a leaflet for parents which explain the treatment and can be found here: Vulvovaginitis

Vulvovaginitis

Assessment

Red Flags

Management

Referral Information

Supporting Information

Paediatric referrals (Healthcare Professionals)

Paediatric referrals (Healthcare Professionals)