Vulvovaginitis Toddler

Overview

What is vulvovaginitis in toddlers?

Vulvovaginitis in toddlers is the swelling or inflammation of their vagina and vulva. Your child’s vulva is the area between their legs surrounding the opening of their vagina. Vulvovaginitis in toddlers, or pediatric vulvovaginitis, is a common problem that affects young girls.

Before puberty, your child isn’t making estrogen, which means the skin around their vulva is thin. In addition, your child lacks pubic hair and fatty labia, the lips of the vulva. This means they don’t have as much protection from possible irritation. Irritating products such as bubble baths, soaps, detergents and clothing can cause vulvovaginitis.

Without estrogen, mucus hasn’t had a chance to build up in your child’s vagina. Thick vaginal mucus protects against infection. Also, there’s a shorter distance between your child’s vagina and anus. This makes it easier for germs to spread from their anus (where there are lots of germs and poop) to their vagina.

Many young girls are still learning proper bathroom habits. This includes wiping from front to back to keep bacteria from their anus from tracking up their vagina or urethra. The urethra is where they pee, the connection to their bladder.

How common is vulvovaginitis in toddlers?

Vulvovaginitis is the most common gynecological problem in young girls. The condition makes up about 62% of gynecological problems seen by pediatricians.

Symptoms and Causes

What are the symptoms of vulvovaginitis in toddlers?

Vulvovaginitis in toddlers may cause many uncomfortable symptoms in their vaginal area. These symptoms may include:

  • Redness.
  • Itching.
  • Pain, soreness or swelling.
  • Vaginal discharge. (You may see stains on your child’s underpants.)
  • Vaginal bleeding.
  • Burning or stinging sensation, which may occur when they’re peeing (urinating).

What causes vulvovaginitis in toddlers?

Your child lacks estrogen in their body before puberty. Without estrogen, the skin around their vulva is thin. Your child also doesn’t yet have pubic hair and fatty labia. Thicker skin, pubic hair and fatty labia provide protection from irritation. Irritants cause up to 75% of all vulvovaginitis cases in toddlers. Irritants may include:

  • Tight-fitting clothes and underwear.
  • Harsh soaps and bubble baths.
  • Scented lotions.
  • Laundry detergents and fabric softeners.

Poor hygiene and bacterial infections can also team up to cause pediatric vulvovaginitis. During puberty, estrogen thickens your child’s vaginal mucus, which reduces the chance of infection. Before puberty, your child doesn’t have this protection. Also, there’s not as much space between your child’s vagina and anus, which makes it easier for bacteria to spread.

Your child may still be learning how to properly wipe themselves. If they don’t wipe carefully, urine can collect in their vagina and give bacteria a place to grow. If your child doesn’t wipe from front to back, fecal bacteria can transfer from their anus to their vagina as well. Bacteria can also spread by not washing their hands, picking their nose or sucking their thumb, and then touching their genital area.

Other causes of vulvovaginitis in toddlers may include:

  • Pinworms: Pinworms are parasitic worms that live in your child’s intestine and rectum. They lay eggs around your child’s anus while they’re sleeping.
  • Foreign objects: Children place objects inside their vaginas as they’re exploring their bodies. Toilet paper is the most common foreign object found. But small items and toys are also often the culprit.
  • Labial adhesions: Labial adhesions occur when the inner lips of your child’s vulva stick together. This may occur due to low estrogen in their body.
  • Lichen sclerosus: Lichen sclerosus is an inflammatory skin disorder that affects the genital and anal areas. Experts believe the condition is an autoimmune disease.
  • Candida (yeast) infection: Vaginal yeast infections in young girls are rare, but they can occur.
  • Sexual abuse: Sexually transmitted infections (STIs) can cause vulvovaginitis. If your child has an STI or has repeated cases of vulvovaginitis, careful evaluation for sexual abuse will take place.

Diagnosis and Tests

How is vulvovaginitis in toddlers diagnosed?

Your child’s healthcare provider will ask about their medical history, including any recent infections. They’ll ask about your child’s symptoms, including when they started and what makes them better or worse. Their provider will ask about their toileting habits and hygiene. They’ll also ask you about any potential irritants that could cause the infection.

Your child’s healthcare provider will perform a physical examination. They’ll look at your child’s external vaginal area. Your child may feel uncomfortable, but you’ll stay in the room with them and the exam won’t hurt. If your child’s healthcare provider suspects a bacterial infection or sees discharge, they’ll collect a sample for testing. They’ll collect the sample using a wet swab smaller than the size of a Q-Tip. They’ll send the sample to a laboratory to test for bacteria.

Management and Treatment

How is vulvovaginitis in toddlers treated?

Most of the time, you can treat your toddler’s vulvovaginitis with home remedies. Natural remedies for toddler vulvovaginitis caused by irritants include:

  • Soaking in a warm bath with no soap.
  • Avoiding irritating products such as bubble baths and scented soaps.
  • Wiping front to back after peeing or pooping.
  • Teaching your child to pee leaning forward with their legs spread open.
  • Wearing loose-fitting clothes.
  • Sleeping without underwear.

To help relieve symptoms, you can apply an emollient such as zinc oxide (Aquaphor®) or a steroid cream. But you should use steroid creams sparingly and discuss their use with your child’s healthcare provider.

If your child has a bacterial infection, your child’s healthcare provider will prescribe an antibiotic such as penicillin. Pediatric vulvovaginitis treatment for other causes include:

  • Pinworm: Your child’s healthcare provider will prescribe an anti-worm medication such as mebendazole (Vermox®). You should treat everyone in your house and wash all bedding and clothing.
  • Foreign object: Your child’s healthcare provider can usually flush a foreign object such as toilet paper from their vagina with sterile saline. Otherwise, they may refer you to a pediatric gynecologist.
  • Labial adhesions: Up to 80% of labial adhesions clear up on their own. If needed, your child’s healthcare provider may recommend a topical estrogen cream.
  • Lichen sclerosus: The goal of treatment for lichen sclerosus is symptom relief. Your child’s healthcare provider may recommend strong topical steroids or other medications.
  • Candida (yeast) infection: Your child’s healthcare provider may recommend a topical antifungal medication to treat a yeast infection.
  • Sexual abuse: Your child’s healthcare provider will prescribe antibiotics to treat a sexually transmitted infection. If an STI is the cause of vulvovaginitis, they’ll report suspected sexual abuse to authorities.

Prevention

How can I prevent vulvovaginitis in my toddler?

Vulvovaginitis is a common diagnosis in toddlers. Steps you can take to prevent vulvovaginitis in your toddler include:

  • Dress your toddler in cotton underwear and loose-fitting clothing.
  • Use mild, unscented soaps or just water to clean your toddler’s vulva.
  • Dry your toddler’s vaginal area thoroughly.
  • Avoid using products that may irritate your toddler’s vaginal area. This includes products such as bubble baths, soaps, shampoos, detergents and fabric softeners.
  • Don’t let your toddler sit in a wet, tight bathing suit for a long time.
  • Have your toddler sleep in a nightgown without a diaper or underwear.

Teaching your child about proper hygiene should treat and prevent future occurrences. If your toddler is toilet trained, make sure they’re:

  • Spreading their legs widely while urinating.
  • Leaning forward while urinating. (It may help to seat them backward on the toilet.)
  • Wiping from front to back after peeing and pooping.
  • Washing their hands before and after peeing and pooping.

A note from Cleveland Clinic

Redness, soreness, itchiness and even vaginal discharge can be scary for a parent to see in their toddler. But vulvovaginitis is a common condition in young girls. It’s usually not serious and is most likely caused by an irritant. Try eliminating potential culprits, such as scented soaps or bubble baths. And make sure you’re teaching your child proper hygiene. If your child’s symptoms persist, call their healthcare provider. They’ll be able to confirm the diagnosis and determine the correct treatment. With proper treatment, your toddler will be feeling better in no time.

Last reviewed by a Cleveland Clinic medical professional on 03/14/2022.

References

  • Brander, EPA, McQuillan, SK. Prepubertal vulvovaginitis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028267/) CMAJ. 2018;190(26):E800. Accessed 3/14/2022.
  • Cemek F, Odabaş D, Şenel Ü, et al. Personal Hygiene and Vulvovaginitis in Prepubertal Children. (https://pubmed.ncbi.nlm.nih.gov/26187769/) J Pediatr Adolesc Gynecol. 2016;29(3):223-227. Accessed 3/14/2022.
  • Loveless M, Myint O. Vulvovaginitis- presentation of more common problems in pediatric and adolescent gynecology. (https://pubmed.ncbi.nlm.nih.gov/28927766/) Best Pract Res Clin Obstet Gynaecol. 2018;48:14-27. Accessed 3/14/2022.
  • North American Society for Pediatric and Adolescent Gynecology. Pre-pubertal Vulvovaginitis. (https://www.naspag.org/assets/docs/prepubertal_vulvovaginitis_2.pdf) Accessed 3/14/2022.
  • Zuckerman A, Romano M. Clinical Recommendation: Vulvovaginitis. (https://pubmed.ncbi.nlm.nih.gov/27969009/) J Pediatr Adolesc Gynecol. 2016;29(6):673-679. Accessed 3/14/2022.

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