What is vulvovaginitis?
Inflammation and soreness of the skin in the vagina or surrounding vulva.
It is the most common gynaecological problem in pre-pubertal girls. Young girls are particularly susceptible because of their anatomy and the loss of maternal oestrogen after birth
Mild vulvovaginitis occurs very commonly, can occur more than once and can be managed using simple strategies in most cases.
Who can refer:
Referrals are considered from General Practitioners and other health professionals working with children and young people.
Who to refer:
Most Vulvovaginitis can be managed in Primary Care. See primary care management tab for advice on this.
Recurrent episodes in childhood are common but if there is clinical suspicion of alternative diagnosis, referral to Community Paediatrics (Maple Clinic) is indicated. For example, labial adhesions or lichen sclerosis where there is pallor, erosions, ecchymosis or shiny skin lesions.
Unclear diagnosis and atypical presentation.
Who not to refer:
Urinary tract infection: treat in primary care and refer to Paediatric Renal clinic if indicated.
Child protection concerns: refer urgently via the child protection hub (0131 3120499).
Advice for primary care practitioners:
- Barrier creams (e.g. Vaseline) can be helpful.
- If there is any evidence of threadworms then the whole household should be treated, threadworm infection can occur recurrently in childhood.
- Swabs are mostly not helpful and not usually required.
- Persistent discharge without redness may be indicative of a foreign body.
- Perform urinalysis to ensure no concurrent UTI.
- Constipation is a common co-diagnosis – treatment should be optimised. https://apps.nhslothian.scot/refhelp/guidelines/paediatrics/medical-paediatrics/constipation/
In most cases symptoms will improve as the child grows and produces more oestrogen.
In children who are not in nappies, candida infection is uncommon and antifungal creams are not indicated.
Advice for parents and carers:
- Symptoms often resolve with hygiene measures, but girls can have multiple episodes during childhood.
- Do not use soap or bubble bath for washing.
- Use non-biological laundry powder and no fabric softener.
- Wiping after using the toilet should be front to back.
- Avoid tight clothing and ideally sleep without underwear.
Signpost to patient information leaflet Patient information leaflet
Patient information leaflet available from the British Society for Paediatric and Adolescent Gynaecology (BritSPAG)
