Today’s post discusses something many young girls experience at least once before puberty: vulvovaginitis. With this, they may complain of pain or discomfort around their private parts. While many things can cause these symptoms, vulvovaginitis is one of the most common. This post will describe what it is, how to prevent it, and reasons to seek medical care.
What is vulvovaginitis?
Vulvovaginitis refers to irritation or inflammation around the vulva. For a quick anatomy review, we can think of a female’s external “private parts” as the vulva. It includes the vagina and the urethra (where pee comes out) and the surrounding labia or “lips.” The labia majora includes the skin around the outside. The labia majora provide some protection to the more sensitive areas.
However, those sensitive areas can get irritated. It’s really common among preschool-aged kids. They may be new to using a toilet (and the hygiene involved), or are wearing clothing that causes discomfort. Sometimes, bubble bath can irritate. Today I’m referring to this condition in young girls, especially around pre-school ages. (It’s a different topic for teens and adults).
How would you know if your child has vulvovaginitis?
Some children may describe outright pain. Sometimes it’s just discomfort when they pee. (The urine comes in contact with the irritated area). And, sometimes it’s more of a constant discomfort. Many times, girls pull or itch at the area without clearly saying what bothers them.
Often, parents suspect a urinary tract infection (more on that later), and bring their child in for an appointment. The child’s genitalia may look slightly inflamed or swollen. Or, maybe just a tiny spot appears this way. Sometimes, the tissue may look a little raw (depending on the cause). A small amount of oozing or bleeding is possible.
To be clear, if you’re concerned, please take your child to their pediatrician.
What causes vulvovaginitis in young girls? How can it be prevented?
Before puberty, young kids’ genitalia are more sensitive to irritation. There are a few common causes of vulvovaginitis:
- Bubble baths
- Tight fitting clothing (like underwear or jeans)
- Incomplete wiping after using the bathroom
- Synthetic fabrics
So, if a child has been diagnosed, the first step is to eliminate any potential cause. The following tips are both the first step in treatment and ongoing steps for prevention.
Avoid bubble baths.
Any fragrance or chemical that touches the vulva can also irritate it. Young kids need only water to wash their private parts. If they do use soap, they need to rinse well afterwards.
Wear cotton underwear and loose-fitting clothing.
Synthetic fabrics can be very irritating. Tight clothing can cause problems as well. I’ve had several patients diagnosed with vulvovaginitis when they simply grew a bit. Their clothing was just too snug. Imagine the slight pressure and rubbing just from everyday movement. It can take a toll on this sensitive area.
Think about constipation
Vulvovaginitis is really common around toilet-training time, as is constipation. So, even if you’re pretty sure your daughter isn’t constipated, double-check. Her bowel movements should be daily, soft, and easy to pass. Urine can also irritate. It’s worthwhile to make sure she isn’t still damp after using the toilet. Depending on her anatomy and how she sits on the toilet, she may need to shift her position a little before standing up to pull on her underwear. With this position shift, sometimes a few more drops of pee will fall. This can prevent the dampness that leads to more irritation.
If prevention doesn’t work, there are gentle treatments for vulvovaginitis in young girls.
Many times, the above steps of limiting irritation will allow everything to heal. However, some kids may still be uncomfortable. There are a few more things parents can consider.
Add baking soda to the bath.
A generous sprinkle of baking soda can be added to a child’s bath water. It helps calm inflammation. Kids can sit cross-legged in the bath, letting the water move around their sensitive areas. No aggressive or invasive washing is needed. They still need to rinse well afterwards.
Dab Vaseline as needed.
If there is a single spot that is bothersome, a dab of Vaseline (100% white petroleum jelly) can help coat and protect. Depending on the child, she may even be able to apply the Vaseline herself. It can be done a few times a day, if needed. I suggest unscented Vaseline, with no added ingredients, so as not to irritate more. If there is also a lot of itching, discuss other treatments with her pediatrician. There are other options, but instructions may be specific to the individual.
Focus on hydration.
If someone is even a little dehydrated, their urine will be more concentrated. Concentrated pee can sting, even with healthy tissue. And, if it’s not healthy? If the area is raw or inflamed? It may be even more uncomfortable. So, really emphasize drinking enough water.
Help with hygiene.
Stool can also be irritating. Some girls this age wipe themselves after using the restroom. This is often fine! However, if they’ve been diagnosed with vulvovaginitis, it’s a good idea to have a grown-up help wipe until everything is healed. Remember to wipe from front to back. This helps prevent any stool from irritating the area more.
Remember that other things can cause some of the same symptoms of vulvovaginitis in young children.
If you’ve tried all of the above suggestions and symptoms don’t improve within a few days, please seek medical care. Or, if things seem to worsen instead of staying the same or improving: please seek care. Do not wait to seek care if your child has vulvovaginitis symptoms and any of the following:
- Consistent pain with urinating
- Belly pain
- Change in vaginal odor or discharge
- Any concern for abuse (If this is a concern, you may want to call first to ensure she’s seen by the most appropriate clinician).
- Child is under age 2 years old
A quick note on UTIs (urinary tract infections).
Many of the above concerning symptoms can be due to a UTI. UTIs in young children often require treatment to prevent a more serious illness or kidney damage. A urinary tract infection (UTI) is an infection in any of the listed parts, from the kidney down to the urethra.
In children, to diagnose a UTI, we need to run TWO tests on a urine sample.
First is the urinalysis or UA. Many times, these results are back before a child leaves the doctor’s office. It just takes a few minutes. The UA tells us if there are signs of a UTI, but it alone cannot diagnose a UTI.
The second test is a urine culture. If the UA shows those signs of a UTI, we send the urine sample to the lab for a culture. It takes a few days to get results back. This test confirms the presence or absence of a UTI. It tells us if any bacteria are actually in the urine. Because it takes a few days for bacteria to multiply and grow, the lab needs more time for this result.
Why does this matter? It’s related to appropriate antibiotic use. Without both tests, there can be over or under use of medication.
If your child is told they have a UTI based on the quick UA results, ask about a culture. And then: follow up on those results to see if treatment needs to be adjusted. (Please note: there are reasons a clinician may not be able to do both tests, especially these days. I share just because having both lab tests is ideal, and worth a conversation during the appointment).
Summary: Vulvovaginitis in young girls is common and treatable.
Many girls will experience vulvovaginitis, especially in the preschool years. However, it can often be prevented by limiting any kind of irritation to the genitals. Avoiding bubble baths and choosing loose cotton clothing are good first steps. If needed, treatment is available. As always, seek medical care with any concerns. Part of the check up may include an evaluation for a UTI. If a child is under two years old, do not delay an appointment.
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