From the Guidelines
Vulvovaginitis in children should be treated with improved hygiene measures and symptomatic relief, with topical treatments such as antibiotics or antifungals considered only if symptoms persist or a specific infection is suspected, as evidenced by the latest guidelines 1. The symptoms of vulvovaginitis in children can include itching, redness, and discharge, and are often caused by poor hygiene, irritants, or infections. Treatment options should prioritize non-pharmacological approaches, including:
- Improved hygiene measures, such as front-to-back wiping after toileting, daily bathing with mild soap and water, wearing cotton underwear, and avoiding tight clothing
- Symptomatic relief with warm sitz baths 2-3 times daily
- Topical barrier creams like petroleum jelly or zinc oxide applied to the vulvar area If symptoms persist, a pediatrician may consider prescribing:
- Topical antibiotics, such as 2% clindamycin cream, for suspected bacterial infections
- Antifungal creams, such as clotrimazole 1%, for suspected candidal infections, with dosing regimens including 5 g intravaginally daily for 7-14 days, as recommended in the 2021 Centers for Disease Control and Prevention treatment guidelines 1 It is essential to note that systemic antibiotics are rarely needed unless there is significant bacterial infection extending beyond the vulvar area, and parents should be advised that recurrence is common, with persistent symptoms warranting medical evaluation to rule out foreign bodies, pinworms, or other conditions.
From the Research
Symptoms of Vulvovaginitis
- Vulvar itching, burning, and irritation are common symptoms of vulvovaginitis in children 2, 3
- Other symptoms may include discharge, pain, and dysuria 3, 4
- The symptoms can be non-specific and may mimic more serious conditions such as infection, labial adhesion, lichen sclerosis, pinworms, and foreign body 3
Treatment Options
- Hygiene measures, bioyoghurt, and avoidance of chemical irritants are generally useful in treating vulvovaginitis in children 2
- Weight control, if necessary, and prevention of voiding dysfunction are also effective 2
- Specific treatment is generally considered in case of a detected pathogen microorganism 2
- Probiotics, nanotechnology, and petroleum jelly are other important treatment options used in vulvovaginitis 2
- Local antibiotic treatment may be a good alternative to systemic treatment, decreasing the use of oral antibiotics in young people and related risks of bacterial resistances 5
- Topical medication based on netilmicin, associated with Benzalkonium-Chloride, has shown clinical and microbiological effectiveness in first-line treatment of bacterial vulvovaginitis in children 5
Diagnosis and Evaluation
- A comprehensive evaluation is required in all steps of diagnosis, differential diagnosis, and treatment of vulvovaginitis in children 2
- Vaginal cultures and other investigations such as swabs, midstream urine, biopsy, ultrasound, and examination under anaesthesia may be necessary 6, 4
- Clinicians must always be alert to the possibility of sexual abuse in children and conduct a sensitive and thorough history in addition to the examination 6