Gynecologist about inflammatory diseases of the external genitalia 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

Diagnostics

The pediatrician interviews the child and parents, makes an initial diagnosis and refers to a pediatric gynecologist , who will examine the girl’s genitals and, if necessary, use a colposcope to thoroughly examine the vulva and a vaginoscope to make sure that there are no foreign objects in the vagina.

He also collects anamnesis, takes swabs and gives directions for tests. List of tests for vulvitis:

• bacterial culture of urine and taking a smear;
• fecal analysis to identify possible parasitic diseases;
• blood sugar level;
• taking biomaterial for testing for polymerase chain reaction and enterobiasis;
• general analysis of urine and blood;
• level of immunoglobulin in the blood.

The gynecologist may subsequently refer the child for examination by other specialists (gastroenterologist, endocrinologist, etc.). After receiving test results, treatment is prescribed.

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.

Symptoms

Acute vulvitis in girls occurs in the same way as in adult women. The first sign is pronounced redness of the labia minora and majora, the clitoris and the surrounding soft tissues. There is swelling that can spread to the pubic area, groin and even thighs. The most common complaints are:

• itching and burning in the genital area, intensifying during urination, physical activity, and touching;
• discomfort and slight pain in the perineum;
• discharge of leucorrhoea of ​​various types.

Vulvitis in babies under one year of age can be suspected by obsessive attempts to touch and scratch the affected area; older girls also complain of an unpleasant odor, abdominal pain, and weakness. In some cases, the disease is accompanied by enlarged lymph nodes in the groin, increased temperature, excitability, tearfulness, and decreased appetite.

In the chronic course of the pathology, swelling and redness subside slightly, itching and discomfort increase. The recurrent form of vulvitis often leads to complications such as fusion of the labia minora or vagina, cystitis, and discoloration of the genitals.

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.

Complications and consequences

1. Synechia of the labia minora. During the disease, erosions occur, the labia become deformed, stick together and gradually grow together. If the fusion affects the urethra, urination will become difficult. Surgery may be required in the future.
2. If infection affects the urethra during illness, cystitis and urethritis .
3. Vulvovaginitis . Develops when an infection enters the vagina. A common complication of vulvitis.

Other complications are also possible: erosion, neurogenic and conditional leucorrhoea, and in rare cases, infertility.

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.

Classification and types of disease

The course of vulvitis is divided into:

• acute (lasts less than one month);
• subacute (less than three months);
• chronic (longer than three months).

Based on the nature of its origin, vulvitis is divided into two types:

1. Primary , also called non-specific. It occurs due to violations of hygiene rules, disruptions in the production of hormones, and injuries to the external genital organs.
2. Secondary , or specific. Caused by pathogenic microorganisms.

Vulvitis is also divided into the following categories:

• allergic vulvitis. Is an immune reaction that occurs upon contact with any allergen;
• bacterial vulvitis. Caused by pathogenic bacteria, has a rapid course;
• candidiasis vulvitis. Caused by a yeast-like fungus of the genus Candida, it can occur due to poor nutrition, weakened immunity and after antibiotic therapy;
• atrophic vulvitis. Occurs in diabetes mellitus and is quite rare in children.

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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.

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.

Symptoms

The presence of diaper rash is accompanied by various unpleasant symptoms. Among these are:

• redness of the skin on the labia;
• formation of wounds and weeping ulcers;
• itching, pain;
• Synechiae may form.

At the same time, the girl becomes irritable, capricious, and often cries. It prevents the affected areas from being treated with medications.

At this time, the child’s general health deteriorates significantly and his appetite disappears. In severe cases, a decrease in the body's defenses may occur. The child becomes lethargic and painful.

Stages

There are three stages of diaper rash:

• Stage 1 – the labia become red.
• Stage 2 - ulcerations, wounds, cracks, rashes or blisters filled with purulent contents appear on the skin.
• Stage 3. It is the most neglected and difficult to tolerate by patients. This condition develops if personal hygiene continues to be poor and treatment is not followed. In this case, the upper part of the epidermis peels off. Large and deep erosive areas and cracks appear on the skin. A fungal, viral or bacterial infection often gets inside such wounds.

At the last stage, the girl has problems sleeping, fever appears, and body temperature increases.