Vulvovaginitis in the Child and Adolescent
S. Jean Emans MD1
1 Associate Chief, Division of Adolescent/Young Adult Medicine, The Children's Hospital, Assistant Professor of Pediatrics, Harvard Medical School, Boston
Vulvovaginitis is one of the commonest gynecologic complaints seen in pediatric practice. The young child is particularly susceptible to nonspecific infections secondary to poor hygiene but can also have specific infections from respiratory or enteric pathogens or sexually acquired organisms. The adolescent with vaginal discharge usually has a specific vaginal or endocervical infection, often sexually transmitted. In addition, symptoms of dysuria or urinary frequency suggestive of a urinary tract infection in the adolescent may frequently result from vaginitis or Chlamydia trachomatis genital infection. This article brings the pediatrician up to date since the review in Pediatrics in Review 5 years ago.1
CAUSES OF VULVOVAGINITIS IN THE PREPUBERTAL CHILD
In the newborn period, the vagina is well estrogenized from maternal hormones, and the hymen appears redundant, pink, and succulent. As the influence of maternal hormones wanes during the first few weeks of life, the vagina becomes reddened and atrophic, and the hymen appears as a thin membranous crescent (Fig 1). The pH is 6.5 to 7.5. Because of inadequate hygiene, the lack of protective hair and labial fat pads, and the lack of estrogenization, the vulvar skin is susceptible to irritation and is easily traumatized by medications and clothing. For example, if a child sits for a few hours in nylon leotards and tights, transient erythema and discomfort in the vulvar area may result.
