From the Guidelines
Prepubertal vulvovaginitis should be managed with improved hygiene measures and targeted treatments based on the cause, with topical antifungals being recommended for candidal infections, as stated in the 2016 update by the Infectious Diseases Society of America 1. Prepubertal vulvovaginitis is inflammation of the vulva and vagina in girls before puberty, commonly presenting with genital discomfort, redness, and discharge. Treatment depends on the cause but typically begins with improved hygiene measures including:
- Front-to-back wiping after toileting
- Wearing cotton underwear
- Avoiding bubble baths and harsh soaps
- Regular bathing with warm water only For non-specific vulvovaginitis, daily sitz baths with warm water for 10-15 minutes and application of a barrier cream like petroleum jelly can provide relief. If bacterial infection is suspected, topical antibiotics such as clindamycin cream applied twice daily for 7 days may be prescribed, although the CDC guidelines from 2002 suggest that treatment of the male sex partner has not been beneficial in preventing the recurrence of bacterial vaginosis 1. For specific infections, targeted treatments are needed:
- Pinworm infections require oral mebendazole 100mg as a single dose repeated after 2 weeks
- Streptococcal infections need oral penicillin V 250-500mg three times daily for 10 days
- Candidal infections require topical antifungals like clotrimazole cream applied twice daily for 7-14 days, as recommended by the Infectious Diseases Society of America in 2016 1 Prepubertal girls are particularly susceptible to vulvovaginitis because they lack protective estrogen effects, have thin vaginal mucosa, minimal labial fat pads, and a vaginal pH that's less acidic than in post-pubertal females, all of which reduce natural defense mechanisms against irritants and pathogens.
From the Research
Definition and Presentation
- Prepubertal vulvovaginitis is a common gynecologic complaint in prepubertal girls, typically presenting with symptoms such as vulvovaginal itching, burning, irritation, discharge, or skin changes 2.
- The condition is also commonly encountered among prepubertal and adolescent females, with vulvovaginal complaints being common in the pediatric and adolescent age group 3.
Diagnosis and Evaluation
- The patient's age, in conjunction with history and associated complaints, will guide evaluation, diagnosis, and treatment of prepubertal vulvovaginitis 3, 2.
- Careful attention to history and associated complaints is necessary to direct evaluation, diagnosis, and treatment 2.
Treatment and Management
- Treatment of prepubertal vulvovaginitis should include counseling on hygiene and voiding techniques, as well as therapy for any specific pathogens identified 3.
- Most cases of prepubertal vulvovaginitis are nonspecific in origin, and treatment includes counseling to patients and parents on hygiene and voiding techniques 2.
- Antibiotic treatment for specific pathogens may be indicated in some cases 3, 2.
- Other less common causes of prepubertal vulvovaginitis, such as foreign bodies and lichen sclerosus, may require alternative treatment approaches 2.