Prepubertal Vulvovaginitis

Abstract

Vulvar and vaginal irritation/redness and vaginal discharge are common referrals to the pediatric and adolescent gynecologist. In nearly 75% of cases the etiology of the pre-pubertal patient’s signs and symptoms is non-specific and resolves with proper vulvar hygiene. Infections, ulcerations, labial adhesions, foreign bodies, constipation, voiding dysfunction, and trauma are other causes of vulvar and vaginal complaints. Gathering a detailed history and performing a thorough physical exam help to determine the etiology and best treatment. Staphylococcal aureus and Streptococcus pyogenes infections are frequently isolated on vaginal cultures and treated with organism specific antibiotics. Ulcerations are usually from a self-limiting viral infection (EBV, CMV, influenza) and heal with supportive cares—acetaminophen and sitz baths. Labial adhesions recede with topical estrogen cream in up to 89% of cases and rarely need surgical separation. When vulvovaginitis persists despite hygiene measures and no evidence of infectious etiology assessment and treatment of constipation and voiding dysfunction can provide relief of symptoms. This review contains 1 table and 28 references.  Key words: Vulvovaginitis, vulvar hygiene, vagina hygiene, vaginal infection, labial adhesions, vulvar trauma, genital ulcer, vaginal foreign body, constipation, pre-pubertal voiding dysfunction