Vulvovaginitis

Question 1

What is vulvovaginitis?

Answer 1

Inflammation and irritation of the vulva and vagina.

It’s a common condition affecting girls between the ages of 3-10 years.

Question 2

What is the irritation caused by?

Answer 2

Sensitive and thin skin and mucosa around the vulva and vagina in young girls.

The vagina is more prone to colonisation and infection with bacteria spread from faeces.

Question 3

What can exacerbate vulvovaginitis?

Answer 3

Wet nappies, use of chemicals or soaps in cleaning the area, tight clothing that trap moisture or sweat, poor toilet hygiene, constipation, threadworms, pressure on the area (e.g., horse riding), and heavily chlorinated pools.

Question 4

Does vulvovaginitis improve or worsen as you get older?

Answer 4

It improves and is less common after puberty.

This is because oestrogen helps keep the skin and vaginal mucosa healthy and resistant to infection.

Question 5

How does vulvovaginitis present?

Answer 5

Soreness, itching, erythema around the labia, vaginal discharge, dysuria, and constipation.

Question 6

What investigations are done for vulvovaginitis?

Answer 6

Urine dipstick may show leukocytes but not nitrites.

This often results in misdiagnosis as a UTI.

Question 7

What is the management for vulvovaginitis?

Answer 7

Avoid washing with soap and chemicals, avoid perfumed or antiseptic products, maintain good toilet hygiene (wipe from front to back), keep the area dry, use emollients (e.g., sudacrem) to soothe the area, wear loose cotton clothing, treat constipation and worms, and avoid activities that exacerbate the problem.

In severe cases, oestrogen cream may be needed to improve the symptoms.