November 6, 2017
ARTICLE:

Itchy girls bits (vulvovaginitis)

By Dr Megan Yap - Paediatrician

So a really good mate of mine (who I haven’t caught up with for aaages – sorry Vick!!) texted me and suggested that I blog about thrush in little girls and then also about kids who find it hard to gain weight.  The former, not a bad suggestion considering we’ll soon be back in the warmer months, meaning it will probably be a bit more of a common complaint, the latter also great as I struggle with that with my youngest as well.

So this week, instead of talking about “thrush” itself (which is actually a fungal infection of the skin) however, I will tell you all about “Vulvovaginitis.”   Just for your information, “-itis” at the end of a medical word means “inflammation of.”

So, vulvovaginitis = inflammation of the vulva (the opening to the vagina) and the vagina itself

(… and similarly,

  • tonsillitis = inflammation of the tonsils
  • laryngitis = inflammation of the larynx (the voice box)
  • pharyngitis = inflammation of the pharynx (the back of the throat)
  • gastritis = inflammation of the stomach
  • colitis = inflammation of the colon (intestine)           … and so on)

Occasional episodes of itching around the vulval (genital) area can be common in young girls. Irritation to the skin can cause pain.  Parents often attribute these symptoms to a ‘thrush’ infection. However ‘thrush’ is very uncommon in young (premenstrual) girls/women.  There are a quite a number of CAUSES of genital itching in girls.

  • The lining of the vagina and vulva can be quite thin in young girls and this can lead to it being easily irritated.
    • One example of this is “sand-box” vaginitis – ie a toddler/preschooler spends all day playing in the sandpit at kindy, gets sand in their undies and THIS causes a physical friction and irritation – REALLY common.
  • Moisture / dampness around the vulva. This is made worse by tight clothing and obesity; leaving wet swimming togs on for prolonged periods of time (especially common in summer)
  • Irritants (soap residue, bubble baths, antiseptics etc).
  • Threadworms – children with threadworms often scratch a lot at night.  If you use a torch to look at your child’s bottom (anus) and genital area when they go to bed, if your child is infected you will SEE little worms wriggling around down there (yep – it is really gross!!)  – they look like short pieces of cotton thread.  REMIND me to blog about threadworms as a different topic one day – ANOTHER really common problem!!
  • Actual thrush – as above, uncommon in pre-pubertal girls (but not impossible); associated with redness, itch and a “cottage cheese” like discharge – treated fairly easily with an antifungal cream

So what to do about it?

Firstly don’t worry, this is a common problem and a normal part of growing up for many girls.

Try avoiding the triggers:

  • Wear loose cotton underwear and avoid tight trousers/jeans etc; don’t let them sit around in wet togs/sweaty exercise clothes for ages
  • Don’t use a lot of soap in the bath/shower and make sure it is well rinsed from the vulva. Avoid bubble baths and antiseptics in the bath. **Usually just plain water is enough for cleaning and hygeine!!**
  • Similarly if they are playing in a sand pit all day – a thorough rinse at bath time at the end of the day very important, maybe even directing them to other play areas whilst it heals up

Treating the discomfort: 

  • Vinegar baths (add 1/2 cup white vinegar to a shallow bath and soak for 10 to 15 minutes). Do this daily for a few days and see if it helps
  • Soothing creams (eg soft paraffin, nappy rash creams) may help settle the soreness, waterproof and protect the skin from the discharge which can be irritating.

What if it IS thrush?

Then you can use an antifungal cream.  In little girls, there is usually no need to insert the cream (unlike for adults and pubescent girls) – just apply externally.  Some common creams that are used are:

  • Clotrimazole (Canesten; Clonea)
  • Nystatin (Nilstat)
  • Miconazole (Daktarin)

If the area is REALLY red and irritated, you can use a weak 1% hydrocortisone cream together with the antifungal cream to settle the inflammation a bit faster – but stop this as soon as the redness goes away, and continue with antifungal cream 3 times a day for at least a week after the symptoms resolve (or the infection will come back).

What if it is threadworm?

I will blog about this separately another week – go and see your friendly local pharmacist.  Use a worming tablet (or chocolate square) at night before bed, then in the morning wash ALL the sheets, pajamas, undies, pillow cases etc in HOT water and hang in the sun to dry.  You can IRON them with a hot iron if you can be bothered.  Re-treat in 2 weeks.

Important points:

  • Mild vulvovaginitis is a very common problem in young girls.
  • Don’t use soap, perfumed body washes/creams on the area
  • It may recur now and then but will improve as your child gets older.
  • In most mild cases, no treatment or tests are necessary.
  • If your child’s symptoms are persistent, if there is a bloody/foul smelling discharge or you are worried for any other reason – go and see your doctor!

 

Until next time,

Keep well,

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

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