By Guest Blogger, Dr. Tara Vick (CMC Women’s Institute)
It is very surprising to most mothers in my pediatric gynecology practice that the majority of little girls that I see are referred for a vaginal discharge or vulvar irritation. This is called vulvovaginitis. This is the most frequent gynecologic problem in girls before puberty, and although most pediatricians are familiar with recognizing and treating the common causes, some little girls have persistent or recurrent symptoms requiring the help of a pediatric gynecologist. The vagina and skin of the vulva in little girls is obviously much different from that of the adult female. The skin is very thin, delicate, and fragile – much more susceptible to irritation from fragranced products (detergents, toilet paper) and even soap.
Little girls who have an infection or inflammation of the vulva or vagina may complain of their panties being wet or of not being able to stay dry after using the bathroom. They may also complain of stinging or burning when they go to the bathroom. Parents may notice that their daughters are scratching frequently, or pulling at their panties or pants. Parents of nonverbal girls may notice this behavior or irritability with urination or defecation.
Some little girls will have problems with small pieces of toilet paper getting lodged in the vagina. Over time this will usually result in a vaginal discharge that may have a brown or bright red color and a bad odor. This can be resolved with an office procedure to rinse out the tissue with warm sterile water, and teaching the girl better toileting behaviors.
Most commonly, vulvar or vaginal irritation results from exposure to irritating agents in the young girl’s environment: exposure to perfumes in laundry detergent, bubble baths or soaps. Sometimes the girl’s hobbies or activities will predispose to irritation. For example, prolonged periods of time in a wet bathing suit in the summer or wearing tight fitting clothing such as tights and ballet leotards will result in poor air circulation and moisture accumulation. Treatment in this circumstance is sometimes more challenging: first it may be difficult to isolate the specific cause(s), and second it requires great vigilance to remove all factors which can be exacerbating the irritation. Perhaps the hardest requirement of treatment in this situation is patience.
Rarely there are specific skin conditions that affect the genital skin area in little girls. Many of these disorders will improve with the onset of puberty; however the correct diagnosis will lead to great improvement in symptoms.
In summary, vulvovaginitis in little girls is common, and the causes are very different from infections that affect adult women. If your daughter is experiencing these issues, she may require the expertise of a pediatric gynecologist.
For more information, or to schedule an appointment with Dr. Tara Vick, please call 704-355-3149 or visit CMC Women’s Institute online.