Vulvitis in girls: causes, symptoms and methods of treating adult disease in children

Fisenko Karina Olegovna

Specialty: Adult gynecologist, gynecologist-endocrinologist Work experience: more than 25 years Cost of appointment: 1600 rubles Cost of online appointment: 1200 rubles

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• Clinical picture of the disease
• The main causes of inflammation of the external genitalia and vagina in children
• Types of vulvovaginitis in girls
• Diagnosis of the disease
• Treatment of the disease

Diagnosis of vulvitis

The diagnosis of vulvitis is made based on examination of the patient’s external genitalia. For an accurate diagnosis, the gynecologist uses a hand-held magnifying glass, conducts vaginal-abdominal and rectal examinations, takes a smear for cytology, and examines peripheral lymph nodes.

To identify the causes of the inflammatory process, additional diagnostics are required:

• Analysis of urine;
• vulvoscopy;
• HIV test, RW;
• general blood analysis;
• cultural sowing;
• bacterioscopy of smears;
• tests for helminths (feces or blood).

Clinical picture of the disease

Vulvovaginitis in girls is accompanied by complaints of severe itching, pain, burning and discomfort in the external genitalia and perineum. Additionally, pathological vaginal discharge of a reddish, yellow or green color, leucorrhoea or curdled discharge may appear. The girl’s genitals were hyperemic and very red, and a rash and scratches appeared on the skin.

The baby constantly pulls her hands to the crotch area and scratches. Vulvovaginitis may not seriously affect the general health, except for the deterioration of the child’s mental state - tearfulness, irritability, anxiety, etc. As the disease progresses, when the inflammatory process affects other organs, additional symptoms may appear - difficulty urinating, pain in the lower abdomen, fever, etc.

Signs of vulvitis

In gynecology, a distinction is made between chronic and acute forms of the disease. The photo of a patient with vulvitis clearly shows hyperemia, redness and modified mucous membrane.

Signs of acute vulvitis:

• swelling of the clitoris;
• itching and burning of the vulva;
• redness of the labia;
• enlargement of sebaceous glands;
• the appearance of ulcers and erosions;
• painful urination;
• roughness of the labia minora;
• bloody or serous-purulent discharge;
• damage to the inguinal folds (in rare cases);
• blisters with fluid (herpetic vulvitis);
• enlarged lymph nodes in the groin, sometimes an increase in temperature may be recorded;
• curdled, yellow-green or white discharge of a watery nature (if the cause of vulvitis is E. coli, staphylococcus).

Manifestations of chronic vulvitis:

• swelling of the vulva;
• itching and discharge;
• epithelial defects;
• hyperemia on the vulva;
• redness of mucous membranes;
• hypertrophy of the sebaceous glands.

The main causes of inflammation of the external genitalia and vagina in children

Inflammation can occur for many reasons, the most common cause of vulvovaginitis is:

• Allergic reaction. The cause of the pathology is the abuse of certain foods (strong allergens are chocolate, citrus fruits, foods high in dyes, honey). Allergies can also be caused by medications, household chemicals, and synthetic underwear.
• Long-term treatment with antibiotics. It is no secret that antibiotics destroy not only pathogenic bacteria, but also beneficial microflora, which “populate” the vagina in large quantities. In this case, it is important, along with antibiotics, to take drugs to restore the microflora.
• Visiting public or private baths, saunas, swimming pools, swimming in polluted bodies of water. This is the most common cause of infection in young children. In addition, the child may be allergic to chlorine, which is used to disinfect pool water.
• Foreign body in the vagina. In learning about their bodies, babies often try to insert small objects into natural openings - the nose, ears, mouth and, sometimes, the vagina.
• Viral and infectious diseases. Vulvovaginitis can appear against the background of acute respiratory viral infections, influenza, measles, rubella, chicken pox and other diseases. In this case, specific treatment is not required; the disease that caused the pathology is treated.
• Worm infestation.
• General decrease in immunity and endocrine disorders.

An important role is played by the features of the anatomical and morphological structure of the vagina in pre-pubertal girls - the neutral environment of the vagina, the thinness of the mucous membrane, the proximity of the anus to the entrance to the vagina, which also contributes to the development of inflammation.

Prevention of vulvitis

Girls should be taught to properly care for their genitals from birth. Regular washing with non-alkaline compounds, clean linen and proper hygiene of the child after using the toilet can prevent inflammatory and serious infectious diseases of the reproductive system.

The basis of prevention is compliance with three simple rules:

• underwear made from natural materials;
• healthy lifestyle;
• hygiene.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Types of vulvovaginitis in girls

• Specific infectious vulvovaginitis occurs when contaminated with pathogenic microflora - Trichomonas, chlamydia, gonococci, etc.
• Nonspecific infectious vulvovaginitis is caused by excessive growth of opportunistic microflora - staphylococci, streptococci, etc.
• Primary vulvovaginitis can be caused by infection due to the penetration of a foreign body, as a result of helminthic infestation, or infection with nonspecific microorganisms.
• Secondary inflammation occurs against the background of other diseases - endocrine disorders, pathologies of the genitourinary system, viral diseases, atopic dermatitis, etc.

Vulvovaginitis varies depending on the pathological agent that caused the inflammation. Among the pathogens are Trichomonas, chlamydia, Koch's bacillus, as well as viruses, fungi, etc.

The most common pathologies:

• Trichomonas vulvovaginitis. Caused by Trichomonas. It can be transmitted to a newborn girl from the mother during childbirth, as well as in girls over 12 years of age. It is characterized by foamy discharge with an unpleasant odor, severe itching and swelling of the mucous membranes.
• Mycotic vulvovaginitis. The cause is yeast-like fungi. Diagnosed in newborns and girls over 12 years of age. It is characterized by severe itching and the appearance of white, curd-like discharge.
• Viral vulvovaginitis. The cause of inflammation is viral infections - measles, rubella, ARVI, characterized by mild redness and swelling of the mucous membranes.

In terms of duration, the disease can be acute (lasting up to 3–4 weeks), subacute (lasting from 1 to 3 months) and chronic, lasting from 3 months or more.

Causes of inflammation

The causes of vulvitis in girls are most often the same. The problem occurs as a result of pathogenic bacteria entering the body. These can be mycotic organisms, viruses, chlamydia, diphtheria, tuberculosis, anaerobic microorganisms, etc.

Most often, such infections can be transmitted through household means - due to violations of hygiene rules, when using shared objects and linen. In newborn babies, inflammation occurs as they move through the mother's birth canal.

Also, in girls, pathology can occur when foreign objects enter the genital tract. These can be plants, insects, sand, and other things that the body comes into contact with outdoors.

Pathology often occurs due to problems with the immune and endocrine systems, the presence of worms in the body, and also as a result of the use of antibacterial drugs.

Treatment of the disease

Therapeutic therapy is prescribed based on the results of the examination, depending on the cause of the inflammation and is aimed at eliminating the inflammatory process, reducing itching and relieving swelling. The following drugs are used for this.

• Local antiseptics for the sanitation of the external genitalia and vagina.
• Bacterial preparations based on bacterial culture results.
• Antibiotics locally and systemically.
• Antihistamines and anti-inflammatory drugs.
• Antiviral or antimycotic agents.

When the first symptoms of the disease appear, you should immediately consult a pediatric gynecologist. With a long course of the disease without the necessary therapy, vulvovaginitis is fraught with various complications - narrowing of the vagina, necrosis of the walls of the vagina and cervix. In addition, inflammation can affect the organs of the urinary system or internal genital organs - the uterus and appendages.

For any gynecological pathologies in children, contact medical specialists. Pediatric gynecologists will conduct the appointment as tactfully and carefully as possible, without pain or discomfort for the child. You can sign up for a consultation by calling the numbers listed on the website.

Consequences of vulvitis

The acute form of vulvitis in children is accompanied by nervous excitability and sleep disturbances. If diagnosis and treatment are not timely, the disease develops into a relapsing chronic form.

As a result of vulvitis suffered by a girl at an early age, genital deformities develop and fusion of the labia minora (synechia) occurs. Untreated chronic inflammation can subsequently cause anorgasmia, miscarriages, and infertility.

If you experience similar symptoms, consult your doctor

. It is easier to prevent a disease than to deal with the consequences.

Prevention of inflammation of the labia

To prevent vulvitis, it is necessary, first of all, to maintain intimate hygiene. It is recommended to use products designed specifically for caring for intimate areas. Ginocomfort washing gels for intimate hygiene, which were developed by specialists of the pharmaceutical company VERTEX, taking into account the characteristics of the microflora of the genital organs, are well suited for this purpose. They do not dry out the mucous membrane and do not disturb the acid-base balance. These products have a package of necessary documents and quality certificates.

Other measures to prevent inflammatory processes in the labia area include the following:

• Proper drying of the genitals after hygiene procedures. It should be carried out with a clean towel or napkin in the direction from front to back or with gentle blotting movements.
• Careful selection of underwear. It is optimal if it is underwear made of natural and soft material that will not squeeze or rub the perineum.
• General maintenance of immunity, which will allow the body to independently fight infection and suppress the proliferation of pathogens.

Vulvovaginitis: drugs

Local and oral agents are used for treatment.

Vaginal suppositories and creams (Gynex, Clotrimazole, Lomixin) are indicated as local ones. Doctors also prescribe a course of tablet antibiotics (Pancef, etc.). For candidal etiology, antifungal agents are prescribed: Nystatin, Fluconazole, Itraconazole, Metronidazole.

Upon completion of treatment, doctors recommend taking probiotics (Lactozhinal, etc.) to restore the microflora.

If the cause of the disease is worms, anthelmintic drugs are needed: Aldazole, Pirantel.

Vulvitis - symptoms and treatment

Success in the treatment of vulvovaginitis depends on an accurate diagnosis based on a thorough analysis of the anamnesis, clinical and laboratory data. Only after receiving the results of bacteriological, virological and histological studies confirming the diagnosis can therapy begin.

First of all, an anti-infective drug , taking into account the sensitivity and type of microorganism.

• For candidiasis - antimycotic drugs, such as Diflucan, fluconazole, nystatin, levorin, clotrimazole, ketoconazole, etc.
• For herpes - antiviral drugs: acyclovir, Valtrex, Famvir.
• For STDs - antibacterial drugs depending on the type of pathogen.
• For bacterial vaginosis - local antiseptics, Clindacin.
• For aerobic vulvovaginitis - local antiseptics, antibiotics taking into account culture indicators.

Treatment of patients with prolonged vulvitis is carried out jointly with dermatologists. In such cases, you can prescribe the combined local drug Tetraderm. It includes:

• Mometasone is the most powerful glucocorticosteroid (GCS) safe for local use. Has anti-inflammatory, antipruritic and anti-exudative effect.
• Econazole is a modern effective antifungal component with a bactericidal effect. Reduces the synthesis of ergosterol, which regulates the permeability of the cell wall of microorganisms.
• Gentamicin is a broad-spectrum antibacterial component used for topical treatment of primary and secondary bacterial skin infections.
• Dexpanthenol (vitamin B5) is a regenerating component with a metabolic effect. It has a local anti-inflammatory and immune effect, is included in the metabolism of skin cells and restores the damaged stratum corneum.

"Makmiror complex" is an antimicrobial combination agent containing nifuratel and nystatin. The drug does not suppress the growth of lactobacilli, so after a course of therapy, normal vaginal flora is quickly restored.

Antimicrobial therapy destroys not only pathogenic, but also beneficial microflora. As a result, more virulent infections invade and colonize the vagina, which again manifests itself as pathological vaginal discharge and vulvar irritation. To break this vicious circle, after antimicrobial therapy it is necessary to restore the flora with eubiotics - preparations containing live cultures of beneficial microorganisms. For example, you can use Laktozhinal. This drug helps normalize the pH of the vaginal microflora due to the production of lactic acid. It consists of :

• Lactobacilli LCR 35 - form a protective film, normalize the pH of the vagina, and prevent the attachment of pathogens. As a result, the stability of the microflora is restored until the moment when the biotope is filled with its own lactobacilli.
• Lactose monohydrate is a nutrient medium for lactobacilli LCR 35. Secreted metabolites by LCR 35 enhance the antibacterial effect.

Application:

• 1 drop per day (No. 21) for vulvovaginal candidiasis;
• 2 drops per day (No. 7) for bacterial vaginosis;
• 1 drop per day (No. 14) as an alternative therapy [10].

Eubiotics also include suppositories “Acilact”, “Lactonorm”, “Triozhinal”, etc.

Proteolytic enzymes enhance the effect of antibiotics . They help accelerate proliferative processes in tissues, activate cellular reactions, enhance the phagocytic activity of leukocytes, and reduce relapses of the disease. Proteolytic enzymes are contained in the Wobenzym preparation. It is resistant to gastric juice. This product contains: bromelain, papain, pancreatin, chymotrypsin, amylase, lipase, rutin. Prescribe 3 tablets 3 times a day for 1-2 months [6]. (The drug should be regarded as a dietary supplement, the effectiveness of which has not been fully proven. - Ed.)

, vitamin therapy, immunostimulants, and interferon inducers are also used [7] .

Due to the fact that prolonged itching is associated with excessive production of histamine, it is recommended to prescribe antihistamines : Suprastin, Tavegil, Diazolin, Zodak, etc. [7]. Some patients with prolonged itching do not consult doctors for a long time and try to treat themselves. As a rule, this does not help, and women go to the doctor with an already formed “vicious circle”. Such patients are recommended to be prescribed sedatives that have a calming effect [2].

Local application of estrogens restores vaginal acidity and neutralizes microbiological changes, especially during menopause, when the level of female sex hormones drops. Also helps prevent recurrences of urinary tract infections.

Vaginal use of estriol preparations reduces vaginal dryness, itching and dyspareunia (pain during sexual intercourse), and significantly improves cytological data. Estriol is a natural estrogen. He is the safest. Has no effect on the endometrium and mammary glands. Estriol contains drugs such as “Ovestin” (cream and suppositories), “Orniona” (cream), etc. For the treatment of vulvar dystrophy, estriol is used in a single dose for 2-3 weeks daily, then a maintenance dose is recommended 1-2 times a week. Moreover, only a small part of a single dose is applied directly to the vulva, and the rest must be inserted into the vagina.

It is important to understand that local estrogen deficiency is possible not only in postmenopausal women, but also in young patients with regular menstruation, therefore, with dyspareunia and recurrent vulvovaginitis, it is important to pay attention to the cytological conclusion, the results of colposcopy and keep in mind possible estrogen deficiency.

Local use of glucocorticosteroids is especially indicated for autoimmune inflammatory dermatosis. Corticosteroids have an anti-inflammatory effect and an antihyperplastic effect on the proliferating superficial layers of the skin. They have antiallergic, local analgesic, antipruritic effects. Because of the risk of scar tissue, corticosteroids are not used long-term, but may be prescribed for a short period to quickly relieve severe itching and pain in the vulva. Corticosteroids are especially effective in cases of severe inflammatory reaction and mainly in patients with lichen sclerosus [5].

Local application of androgens. It is a promising method for the treatment of vulvitis against the background of lichen sclerosus. 2% testosterone propionate in a small amount should be rubbed into the skin 2-3 times a day for 6-8 weeks. Maintenance course - 1 time every other day. However, the drug may cause side effects, the patient must be warned about this. Long-term use of testosterone can lead to clitoromegaly (abnormal enlargement of the outer part of the clitoris), increased sexual desire and facial hair growth [5].

The following surgical treatments are used: cryodestruction, radiofrequency and laser coagulation, vulvectomy. However, due to frequent postoperative complications and relapses, unsatisfactory cosmetic and functional results, these methods are abandoned in favor of less traumatic ones.

Photodynamic therapy is a high-tech method for treating vulvar dystrophy [11]. PDT is an organ-preserving treatment method. A photosensitizer is first introduced into the patient's body, which subsequently accumulates in pathological tissues (malignant, inflammatory, infected with viruses). Further, under the influence of radiation of a certain wavelength, these altered tissues are destroyed. In this case, there is minimal damage to healthy tissue, an antiviral effect, rapid tissue healing and good cosmetic results.

If the result is not satisfactory, the procedure can be repeated. At the end of treatment, the doctor can see a good cosmetic effect, an improvement in the cytological and morphological picture. The woman herself, as a rule, notes a decrease in itching, burning, soreness, dryness, increased tissue elasticity, and an improved quality of sexual life.

When performing photodynamic therapy, the patient must:

• During the day, observe the light regime - avoid exposure to direct sunlight.
• Treat the external genitalia with an antiseptic solution after each act of urination.
• If pain occurs, apply a local anesthetic (for example, Acriol Pro) to the vulvar tissue.
• Apply Tetraderm cream in a thin layer to the vulva from the second day until the tissue is completely epithelized.
• Apply Orniona cream daily at night for a long time.
• See a specialist [11].

Preventive actions

The basis for the prevention of vulvitis and other genitourinary diseases in girls is teaching children the rules of intimate safety and hygiene. Parents of children need to monitor:

• daily washing before bed and after defecation with warm, clean water using soap or other products no more than 3-4 times a week;
• timely change of diapers;
• wearing loose, non-tight clothing and underwear made from natural fabrics;
• providing girls with personal care products: towel, soap, washcloth;
• wearing panties or swimwear on the beach.

Adolescent girls also need to be told in a timely manner about the dangers of unprotected sexual relations.

If your daughter has symptoms of vulvitis, the pediatric gynecologists of the SM-Doctor clinic will conduct the most delicate examination and prescribe the necessary diagnostic procedures and treatment measures. Remember, the lack of timely treatment can cause the process to become chronic and cause ascending infection of the vagina, uterus, and bladder.

Depending on the nature of the pathology, the following are used:

• medications that act on infectious agents;
• painkillers and anti-inflammatory ointments that relieve swelling, burning and itching;
• sitz baths with medicinal ingredients;
• hygienic washing with antiseptic solutions;
• physiotherapeutic techniques.

In the case of allergic vulvitis, a thorough analysis of the child’s environment is carried out, possible allergens are identified and eliminated: diapers, clothes, detergents, food. To relieve symptoms and relieve itching, general and local antihistamines are prescribed.