Symptoms and Causes of Vulvovaginitis in Children

Table of ContentsView AllTable of ContentsCausesSymptomsDiagnosisTreatmentPreventionFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Causes

Symptoms

Diagnosis

Treatment

Prevention

Frequently Asked Questions

Vaginitisrefers to inflammation or infection of thevagina, but it can also affect thevulva, the area outside the vagina (vulvovaginitis).

Vulvovaginitis is one of the most common causes of visits to primary care for people with vaginas.Because of a lack of estrogen, which doesn’t increase until puberty, the skin in and around the vagina can be thin, delicate, and easily irritated.

In addition to the fragility of the skin, people with vaginas are predisposed to vulvovaginitis because of a lack of protective pubic hair, the closer proximity of the vagina and anus, and a lack of labial fat pads that help to protect the entry of the vagina.

People with vaginas need to be taught from a young age to wipe front-to-back when going to the bathroom, not back-to-front, to avoid spreading bacteria into the urethra and vagina. Avoiding other sources of irritation can also help prevent vulvovaginitis in people with vaginas.

Infectious Vulvovaginitis

Approximately 25% of vulvovaginitis cases in children are from an infectious cause.

Yeast infectionsare fungal infections that can be problematic especially for infants with vaginas and for adolescents with vaginas. Babies can getyeast diaper rashes.Vaginal yeast infectionscan be uncomfortable and are more common in people with vaginas who have started their periods.

Yeast infections in a prepubescent person with a vagina are rare, but they may occur if they have had to take antibiotics, have diabetes, or if they have a problem with their immune system. For that reason, recurring yeast infections in prepubescent people with vaginas can be a sign of another health issue.

Bacterial infectionscausing vulvovaginitis in children most frequently come from bacteria in the gastrointestinal or respiratory tract,and they may present with pain, redness, and a discharge that is milky, watery, or may smell “fishy.“Some bacteria, such as the bacteria that cause chlamydia, are sexually transmitted.

Viral infectionslikeherpes simplex virus (HSV)andhuman papilloma virus (HPV)andprotozoalparasitic infectionsliketrichomoniasisthat cause vulvovaginitis are less common in younger children, as they are generally sexually transmitted.

Nonspecific Vulvovaginitis

Most cases of prepubertal vulvovaginitis are from nonspecific causes and can be addressed without the need for medication.Because most cases of vulvovaginitis are from irritants or hygiene issues, the prevention tips below are generally adequate to handle the problem.

Common causes of nonspecific vulvovaginitis in kids and adolescents include:

If a foul odor is noted without an infection found, it may be that you have a foreign object or substance in your vagina, such as toilet paper.

Lastly, in a review of pediatric patients with a recurring vaginal discharge, 5% were later identified as having been sexually abused.

The most common symptoms of vulvovaginitis can include:

Some children may not yet have the language to express their symptoms, so it can sometimes be difficult to differentiate between bladder issues, bowel issues, and vulvovaginitis.

Keep in mind that some vaginal discharge can be expected after puberty. Some adolescents and people with vaginas have more discharge than others, but they may not have the other symptoms above.

For many cases of vulvovaginitis in children, a single cause may not be identified. The good news is that it often gets better without treatment anyway.

For both in-office andat-home testing, ruling out a vulvovaginal infection often starts with a pH test of vaginal fluid. That’s because yeast infections tend to cause a lower-than-normal pH, whereas bacterial infections and trichomoniasis tend to cause a higher-than-normal pH.

Diagnosing the cause of vulvovaginitis may require a culture of vaginal fluid and occasionally a skin biopsy to diagnose skin disorders. If bleeding is present, your healthcare provider may order a pelvic ultrasound.

Other diagnoses that present similarly may need to be ruled out, including skin disorders likeeczema,psoriasis, orlichen sclerosus. Pinworms can also cause similar symptoms.

To treat vulvovaginitis, you first need to rule out infections.

If abacterial infectionis suspected, your healthcare provider might prescribe an antibiotic like oral metronidazole or oral or topical clindamycin.

If a pubertal teen has a vaginal yeast infection, they may need an oral medication like fluconazole. Topical antifungal medication, such as miconazole or clotrimazole cream, are also available if you think your teen will adhere to treatment.

Lastly, trichomoniasis is typically treated with oral metronidazole or tinidazole. If infections do not respond to these treatments, more treatment is available and testing for drug resistance my be needed.

Herpes simplex virus infections can bemanagedwith antivirals, but infection is life-long.

For quick relief of vulvovaginitis, it can sometimes help to:

You should also wash your child’s underwear with a dye- and perfume-free detergent, rinse it twice, and avoid fabric softeners and dryer sheets.

A Word From Verywell

Some people with vaginas may be embarrassed or ashamed to discuss issues involving their “privates.” They should be encouraged to discuss any health issues or concerns they have, no matter which body parts are involved. This will set them up for a lifetime of positive health behaviors, including reproductive health.

Some hospitals have specialized pediatric and adolescent gynecology programs that treat recurrent vaginitis and other gynecological problems. Otherwise, for extra help or a second opinion, ask your pediatrician for a referral to an adult gynecologist who has some experience taking care of children and adolescents.

It depends on the cause, but most girls with vulvovaginitis will have redness, itching, vaginal discharge, swelling, and sometimes bleeding.

If the cause is an infection or a skin disorder, certain medications and creams may help. Otherwise, the main way to treat vulvovaginitis in children is to prevent the irritation that causes it.

7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Goje O, Munoz JL.Vulvovaginitis: find the cause to treat it.CCJM. 2017;84(3):215-224. doi:10.3949/ccjm.84a.15163Children’s Hospital Colorado.Vulvovaginitis.Brander EPA, McQuillan SK.Prepubertal vulvovaginitis.CMAJ. 2018;190(26):E800. doi: 10.1503/cmaj.180004North American Society for Pediatric and Adolescent Gynecology.Pre-pubertal vulvovaginitis.Sobel JD.Patient education: vaginal yeast infection (beyond the basics).Boston Children’s Hospital.Vaginitis | symptoms and causes.McGreal S, Wood P.Recurrent vaginal discharge in children.J Pediatr Adolesc Gynecol. 2013;26(4):205-208. doi: 10.1016/j.jpag.2011.12.065Additional ReadingGavin ML.Vaginitis in children.KidsHealth.

7 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Goje O, Munoz JL.Vulvovaginitis: find the cause to treat it.CCJM. 2017;84(3):215-224. doi:10.3949/ccjm.84a.15163Children’s Hospital Colorado.Vulvovaginitis.Brander EPA, McQuillan SK.Prepubertal vulvovaginitis.CMAJ. 2018;190(26):E800. doi: 10.1503/cmaj.180004North American Society for Pediatric and Adolescent Gynecology.Pre-pubertal vulvovaginitis.Sobel JD.Patient education: vaginal yeast infection (beyond the basics).Boston Children’s Hospital.Vaginitis | symptoms and causes.McGreal S, Wood P.Recurrent vaginal discharge in children.J Pediatr Adolesc Gynecol. 2013;26(4):205-208. doi: 10.1016/j.jpag.2011.12.065Additional ReadingGavin ML.Vaginitis in children.KidsHealth.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Goje O, Munoz JL.Vulvovaginitis: find the cause to treat it.CCJM. 2017;84(3):215-224. doi:10.3949/ccjm.84a.15163Children’s Hospital Colorado.Vulvovaginitis.Brander EPA, McQuillan SK.Prepubertal vulvovaginitis.CMAJ. 2018;190(26):E800. doi: 10.1503/cmaj.180004North American Society for Pediatric and Adolescent Gynecology.Pre-pubertal vulvovaginitis.Sobel JD.Patient education: vaginal yeast infection (beyond the basics).Boston Children’s Hospital.Vaginitis | symptoms and causes.McGreal S, Wood P.Recurrent vaginal discharge in children.J Pediatr Adolesc Gynecol. 2013;26(4):205-208. doi: 10.1016/j.jpag.2011.12.065

Goje O, Munoz JL.Vulvovaginitis: find the cause to treat it.CCJM. 2017;84(3):215-224. doi:10.3949/ccjm.84a.15163

Children’s Hospital Colorado.Vulvovaginitis.

Brander EPA, McQuillan SK.Prepubertal vulvovaginitis.CMAJ. 2018;190(26):E800. doi: 10.1503/cmaj.180004

North American Society for Pediatric and Adolescent Gynecology.Pre-pubertal vulvovaginitis.

Sobel JD.Patient education: vaginal yeast infection (beyond the basics).

Boston Children’s Hospital.Vaginitis | symptoms and causes.

Gavin ML.Vaginitis in children.KidsHealth.

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