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Vaginitis is defined as disorders of the vagina caused by infection, inflammation, or changes in the normal flora. Similarly, vulvitis is inflammation of the vulva, which is the external genitalia that surround the opening of the vagina and includes the labia majora, labia minora, vestibule of the vagina, bulb of the vestibule, and glands of Bartholin. Often, these two conditions occur together and are termed vulvovaginitis. Girls, adolescent girls, and young women may present for medical attention reporting vaginal discharge, odor, pruritus, and/or discomfort. Approximately 75% of women experience vaginitis over the course of their lifetime, with most of the first episodes occurring during adolescence.1
The three most common microbial causes of vaginitis or vulvovaginitis are bacterial vaginosis, candidiasis, and trichomonas. This article focuses on these and other common causes of vaginitis. A confidential history with the patient, separate from her family, is an important part of any evaluation for vulvovaginal symptoms.
Vulvovaginitis in the Prepubertal Girl
Prepubertal girls have un-estrogenized vaginal mucosa, which predisposes them to nonspecific vaginitis. Girls may complain of burning, itching, or general discomfort; or they may be brought in by parents because they are scratching or rubbing their vulvar area. An external examination should be performed with the patient's comfort in mind. Asking patients to “let your knees fall open like a butterfly” will facilitate examination of the vulva, and by having the patient assume the knee-chest position (either supine or prone), the introitus can be easily seen to look for signs of trauma or abnormal discharge. A prepubertal girl with nonspecific vaginitis should have a normal-appearing vulva with red, thin, un-estrogenized vaginal mucosa, minimal discharge, and some degree of erythema (or it may appear completely normal).
Common etiologies of vulvovaginitis in the prepubescent girl include physical, chemical, or infectious irritants (Table 1). Physical irritants include foreign bodies, most often small pieces of toilet paper with other items including coins, bottle caps, or small toys that may have been inserted by the child. Removal of the foreign body with irrigation of the area typically allows for healing. Chemical irritants include soaps, poor hygiene, or tight-fitting clothing. Treatment includes sitz baths several times a day and avoidance of bubble baths, soap, and shampoo in the bathtub.
Infectious etiologies of...