What is vulvovaginitis?
Vulvovaginitis is an inflammation or irritation of the delicate skin of the vulvar and vaginal area. The vulva is the outside area of the female genitals; the vagina connects the vulva and the uterus. Vulvovaginitis may cause soreness, itchiness, redness and burning. Sometimes children with vulvovaginitis have a slight discharge from the vagina, which will stain the underpants and produce a strong odour.
Parents often first become aware of the problem when their child complains about the redness and soreness of the skin, which is the most common sign of vulvovaginitis.
Vulvovaginitis can have several causes
Most often, vulvovaginitis is caused when the vulvar and vaginal skin become irritated. This irritation can be caused by the use of products that are too strong for the delicate vulvar skin, clothing that rubs, dampness and less commonly, a skin or vaginal infection. Vulvovaginitis can also be caused by sexual abuse. Other skin problems, such as eczema, can also affect the vulvar skin. Vulvovaginitis may result from several of these causes at the same time.
Skin in the vaginal area changes over time
In young children, before puberty, the skin in the vaginal area is thin and delicate. This delicate skin is easily irritated. When they grow and begin to produce their own sex hormones, pubic hair and thickened skin will develop and protect the vaginal area. Normal vulvar skin should not look reddish or raw.
Activities and clothing
Many normal things children do can irritate the skin around the vagina. For example, playing in sandboxes or on slides and teeter-totters, and wearing wet clothes, bathing suits or tight ballet leotards can irritate the skin.
Sometimes chidren wait too long to go to the bathroom
Children who are playing often forget to go to the bathroom until the last minute. Sometimes they do not wipe themselves properly. When this happens, bacteria from the anus can get into the vagina. Dirty underwear can also bring bacteria into contact with the vagina and the surrounding skin. Most children will not wash their vaginal area at bath time. Children need to be helped with bathing so they clean themselves properly.
Other problems: soaps and the weather
- Soaps, bubble baths and perfumes can irritate a child's skin. Strong laundry detergents and fabric softeners can also be a source of irritation.
- Dry winter air can be irritating to the skin.
- Heat and humidity can also irritate the skin, especially if combined with wet bathing suits or tight clothing.
Diagnosing vulvovaginitis
If your child develops skin irritation in the vaginal area, develops an odour in the area or has discharge from the vagina, they should see their health-care provider. Depending on the problem and how severe the symptoms are, the doctor may refer them to a gynaecology clinic.
The gynaecologist will ask questions about your child's health and do a physical examination. The doctor will want to make sure that there is no infection or skin problem that needs treatment. Sometimes, a small vaginal swab will be taken to look for infection. If there has been any bleeding, the doctor may need to examine further.
The doctor will also ask questions and examine your child to make sure that they have not been subject to any sexual abuse. Tell your child what the examination is about, using words they can understand. The goal is to let your child feel comfortable with the examination and make sure they do not have a painful or frightening experience.
After the examination, the doctor will tell you what the best treatment is. Whatever treatment is recommended, there will be some things that you can do to help at home.
Treating vulvovaginitis
The treatment of vulvovaginitis will depend on the cause of the irritation. Usually, the irritation comes from hygiene measures. It may be that your child is not cleaning themselves well enough. It is important to remember that the most common cause of vaginal discharge in children with vulvovaginitis is skin irritation. It is rare to find an infection. If there is an infection, it can be treated with antibiotics or antifungals.
You can help your child by starting some simple habits and routines. Because your child's skin is so delicate, anything you can do to help keep the vaginal area clean, dry and healthy will help. Here are some of the things you can do.
Clean and dry underwear and clothes
Make sure your child changes into clean underwear often, especially if their underwear has gotten dirty. Try to have your child change their underwear more than once a day. White cotton underwear are best. Your child should change out of wet or tight-fitting clothing as soon as possible. Encourage your child to not wear underwear at night.
Do not use pantiliners to contain vaginal discharge as this will actually increase symptoms. It is better to make sure your child changes their underwear often.
Wiping properly after the bathroom
Make sure your child knows how to clean themselves well after using the toilet. This is a particular problem for parents whose children go to daycare or to babysitters, because the parents are not there to help their child. Children should wipe themselves from front to back. Use only white toilet paper. Many children can clean themselves better with alcohol- and perfume-free wet wipes. These wipes are easier on the skin than dry toilet paper. A little packet of wet wipes tucked into your child's things when they go off to daycare may be helpful.
Bathing
If using wet wipes does not solve the problem, have your child take a shallow sitz bath when they get home to make sure that they are nice and clean. A sitz bath is a small tub that can be placed on the toilet and filled with warm water to soak the vulvar region. You can purchase a sitz bath at most drug stores. Do not use soaps, bubble baths or perfumed products on your child. When they have signs of vulvovaginitis, it is a good idea to have your child bathe two to three times a day. Adding non-allergenic skin softeners to the water will help soften and soothe the vulvar skin. You can consider applying a barrier cream such as petroleum jelly or a zinc oxide after bathing to help soothe the skin.
Encourage your childr not to scratch their bottom because scratching can cause more irritation and infection.
After a bath
After the bath, gently blot or pat dry the child's vaginal area. Do not use scratchy towels or rub the skin too hard. You may find it helpful to use a hairdryer on a low, cool setting to dry the area gently. It is all right for the child to run around the house wearing skirts or loose shorts without underwear to let the air reach their bottom.
A good daily hygiene routine
Your child needs to learn how to take care of their vaginal area. It is an important part of their body that needs special cleaning, just as their teeth need special care. If creams have been recommended, your child can learn how to put their own cream on. They can learn to wash their hands before and after and use a hand mirror so that they can put the cream exactly where it is needed. In this way, your child will learn that this is their body and they have a responsibility to care for it.
Vulvovaginitis often comes back
About half the girls who have this problem will have it more than once during their childhood. It usually gets better as girls grow up, and will not cause them any long-term harm.
If the irritation comes back, begin strict hygiene measures again. Your child may need to be seen at the clinic again. Sometimes, if the inflammation comes back it may be caused by something different.
The better your child gets at being clean and dry, the less likely they are to get vulvovaginitis again.
If your child has any pain or bleeding, see your health-care provider.
Other things your child can do to treat and avoid vulvovaginitis
- Take sitz baths twice a day when the skin is irritated.
- Do not use soaps in the vulvar region. It is best to clean with warm water on a soft face cloth. No bubble baths.
- Use gentle detergent on the underwear and do not use fabric softener.
- If the skin is very sore, try using cotton balls with mineral oil after a bowel movement instead of toilet paper.
- Do not wear underwear to bed.
- Do not wear tight clothing such as pantyhose, tight pants or leotards.
- Change out of wet bathing suits or any other wet clothing as soon as possible.
- Girls who are menstruating should not use perfumed tampons or pads.
- Do not use topical medications, or topical antibiotic ointments or feminine hygiene sprays.
- Use petroleum jelly or zinc oxide diaper cream on the area. It can be soothing and is harmless.