Vulvovaginitis in children information for parents and carers

This leaflet aims to provide information on vulvovaginitis, and how to treat it, to parents and carers.

About vulvovaginitis

Vulvovaginitis (pronounced vul-vo-vaj-ee-night-is) is a common condition affecting girls, most commonly between the ages of two and ten years. Vulvovaginitis is an inflammation of the vagina and vulva (external female genital area). Some children will have vulvovaginitis many times, however once puberty has begun it usually occurs less often.

In most cases, vulvovaginitis is not a serious condition and it will usually improve with simple steps that can be followed at home. It is not common for medical treatment or tests to be required in this condition.

Some of the signs and symptoms of vulvovaginitis are also seen in children with a urinary tract infection (UTI) and so your child may have been considered to have had a UTI and had her urine analysed when she actually had vulvovaginitis.

Signs and symptoms of vulvovaginitis

If your child has vulvovaginitis, she may have:

• Redness and soreness of the skin between the labia majora (outside lips of the vagina).
• Discharge from the vagina which can be white, yellow or green.
• Itching in the vaginal area.
• Burning or stinging sensation when urine is passed (they have a wee).

What causes or can trigger vulvovaginitis?

Before puberty, the skin around the vaginal area can be extremely sensitive. The lining of the vagina and vulva is normally thin and therefore more susceptible to irritation and less resistant to infection. Both moisture and dampness around the vulva can also lead to vulvovaginitis. We know this can be made worse by wearing tight‑fitting clothing or being overweight. Irritants such as soap residue, some laundry products, perfumed soaps, and antiseptics can lead to vulvovaginitis.

Another cause of vulvovaginitis is poor toilet hygiene, which is usually caused by the child not wiping, or wiping incorrectly, after going to the toilet.

Threadworms can also cause or worsen vulvovaginitis, as children with this type of worm will itch and therefore irritate the area. If your child’s major symptom is itching, then you may wish to treat them for threadworms.

Care that you can provide at home

In most mild cases of vulvovaginitis, your child can be cared for at home without the need to be reviewed by a doctor. Please reassure your child that she does not need to worry, as vulvovaginitis is a common problem and a normal part of growing up.

Things that will help with treatment of vulvovaginitis/ measures that may prevent it:

• Supervise your child and make sure that she wipes in a front to back direction every time after passing urine/ stool (weeing or pooing).
• Teach your child to pass urine with her knees wide apart as this prevents urine from collecting on the skin, around or in the vagina. If your child cannot sit with her legs apart and her feet flat on the floor, the use of a footstool may be required to aid her in achieving a good position.
• Constipation can make vulvovaginitis worse, so ensure constipation is well managed and that your child has a healthy diet and drinks a lot of fluids.
• Avoid bubble baths and antibacterial products. If your child does use a mild soap in the bath or shower, like a pH neutral soap which is non-perfumed, make sure the soap is well rinsed from the vulva with clean water.
• Avoid washing her hair in the bath if possible (shampoo the hair over a sink instead), or if you do, wash hair at the end of the bath and be sure to rinse off any shampoo that may have collected in the vaginal area with a handheld sprayer.
• Dry the vaginal area by gently patting with a towel (no rubbing) and consider using a hair dryer on a cool setting for 10‑15 seconds to finish drying or just air dry it with her legs spread apart.
• Some people find vinegar baths helpful: add half a cup (~125 ml) of white vinegar to a shallow bath and soak for 10‑15 minutes. Do this daily for a few days and see if it helps. Alternatively, salt baths can be used (two tablespoons of salt in 16 pints/ 9 litres of warm water) for 10 minutes, which can relieve soreness.
• Soothing creams (for example. soft paraffin, Vaseline, Sudocrem, nappy-rash creams) may help settle the soreness and waterproof and protect the skin from the moisture or any discharge, which can be irritating.
• Cool compresses may relieve the discomfort if the area is swollen or tender. If severe pain is present on passing urine, the symptoms may be eased by passing urine in the bathtub.
• If possible, your child should wear cotton underpants and change them daily. Avoid nylon underwear, tights and tight jeans or leggings. Change your child's bathing suit immediately after swimming.
• Avoid pyjamas, especially onesies. Nightdresses allow air to circulate and encourage your child to sleep without underwear.
• Avoid using bleach or fabric softeners when washing clothes. Rinse underwear well to remove all washing powders.
• If your child is overweight, seek advice on how to help her to reduce her weight and then maintain a healthy weight with diet and exercise.

When to see a nurse or doctor

Take your child to be reviewed if:

• The vulvovaginitis is upsetting your child; the doctor may advise having a swab taken from the area for testing.
• Your child has a more severe case of vulvovaginitis, for example blood-stained discharge, or other skin problems. Your doctor may then refer your child to a specialist for further management.
• If your child develops a fever and pain when passing urine, the urine may require testing to exclude a urinary tract infection.

Key points to remember

• Mild vulvovaginitis is a common problem in girls.
• It may recur but does improve as your child becomes older.
• In most mild cases, your child will require no medical treatment or tests.
• Your child must avoid things that make vulvovaginitis worse, such as tight underwear and irritants like soap.

Who should I contact if I have any queries, concerns or questions?

Your nurse specialist is available on 01223 586973 (Monday to Friday 08:00 to 18:00).