Prepubertal Vulvovaginitis: Causes, Treatment and Prevention
Jul 30, 2024
Vulvovaginitis is a group of symptoms affecting the female genitals and can include itching, irritation, redness and/or pain of the vulva (skin on the outside of the female genitals) or vaginal discharge. Prepubertal is the time frame before puberty when hormones activate in the body and cause changes throughout the body. Puberty especially affects the genital area, causing changes to the mucosa (the type of skin lining the vagina) and changes and growth of the labia (lips around the vagina/skin folds of the vulva) in addition to pubic hair growth.
Young girls before puberty have smaller labia, a smaller distance between the urethra (where urine comes out) and anus and the vagina, which increases the risk of vaginal infection. The vaginal mucosa is also redder in color, compared to pink after puberty, which can sometimes be concerning to families if they are worried about infection, but this is normal.
What Causes Prepubertal Vulvovaginitis?
Because this is a group of symptoms, rather than a particular disease, there are many different causes. The most common causes are non-infectious or infectious vulvovaginitis, which is mainly due to poor genital hygiene. Old skin cells that are not cleaned off with regular bathing or wiping from back to front can increase the risk. As young children become more independent, they may lack the skills to clean themselves effectively, leading to poor hygiene. Sometimes contact with substances such as scented soaps or bath bombs can cause irritation. Other causes are a foreign object in the vagina (the most common is toilet paper), skin disorders (lichen sclerosus, eczema) or pinworms.
How Is Prepubertal Vaginitis Evaluated and Treated?
The provider will start with a history including symptoms and hygiene habits. It can be helpful to have the child demonstrate how she wipes. Next an external genital exam is recommended. This can be performed with the child in a butterfly or frog-leg position, sometimes in the parent/guardian’s lap for comfort. The provider will examine the skin for any redness, rashes or skin changes. The provider will then apply gentle traction to the labia to be able to see the urethra and vaginal opening to inspect for discharge or other concerns.
Most prepubertal vaginal infections are from bacteria, so if your daughter is struggling with vaginal discharge, your provider may recommend a genital culture, a tiny swab of the lower part of the vagina to test for bacteria. Very rarely an infection can be a sexually transmitted infection, which is concerning for sexual abuse, so your provider may recommend testing for this to rule it out. If an infection is found, antibiotics will be prescribed. Yeast is uncommon after the child is no longer wearing diapers but before entering puberty.
If an infection is found or your clinician suspects a vaginal foreign object, skin disorder or pinworms are causing the symptoms, they will recommend a treatment specific to the condition.
Some irritation or itching, occasional redness or discharge that goes away on its own may be normal. Warning signs that should be evaluated right away include bright red or bloody discharge or green discharge. If the symptoms are not going away on their own with good hygiene, this would be a reason to have your child evaluated.
What Can You Do to Prevent Prepubertal Vulvovaginitis?
Helping your child to have good hygiene habits is a great start. Here are some tips that are recommended for everyone, but especially girls struggling with these symptoms:
Work on wiping front to back. Avoid going back and forth several times, may need to discuss getting a new piece of toilet paper or wipe if needed.
Make sure to spread legs wide when voiding.
Taking a bath in plain water for 10-15 minutes can sometimes clean the vulvovaginal area better than a shower.
Use unscented, sensitive skin soaps. Avoid soaps and detergents with scents and bath bombs.
Wear loose, cotton underwear and change daily.
Change out of wet swimsuits or clothes immediately after activities.
Chelsea Kebodeaux, MD is a member of the Pediatric and Adolescent Gynecology physician team as well as the Fertility and Reproductive Health Program physician team at Nationwide Children's Hospital.
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