Nonspecific vulvovaginitis is characterized by inflammation of the vulva and vagina without a specific identifiable etiology. It may result from irritants, polymicrobial infections, or poor hygiene, and it is the most common gynecologic problem in premenarchal girls. Multiple factors in prepubertal girls increase the risk of vulvovaginitis. These include:
- Prepubertal anatomy, such as the absence of labial fat pads and pubic hair, which leads to diminished protection of the introitus.
- The proximity of the vagina to the anus and poor hygiene. Prepubertal girls have diminished estrogen concentration and lack lactobacilli, leaving the mucosa susceptible to irritation and microbial infection.
The diagnosis of nonspecific vulvovaginitis is given when microbiological studies show normal flora / negative studies and no other etiology can be identified. The most common cause of vulvovaginitis results from irritation secondary to poor hygiene; however, overly vigorous cleaning or exposure to irritants such as a bubble bath are also common etiologies. Most cases of vaginitis are not caused by sexually transmitted infections (STIs). However, it can be challenging to differentiate between infectious and noninfectious causes. Nonspecific vulvovaginitis is found in 33%-85% of cases of vulvovaginitis in prepubertal girls. Many prepubertal females, especially those with a high body mass index (BMI), may have vaginal reflux (vaginal voiding), a condition where urine is forced into and pools in the vagina during urination. While these patients report wiping themselves dry after urination, the pooled urine leaks out after standing, leading to prolonged genitourinary wetness / irritation and subsequent vulvovaginitis.
While
candidal diaper dermatitis is common in infants and diapered toddlers,
vulvovaginal candidiasis is uncommon in a healthy prepubertal child who is no longer in diapers. However, it may occur in the case of predisposing factors including antibiotic use, diabetes mellitus (see
diabetic vulvitis), an underlying primary skin disease, and immunosuppression.
Pinworm infection affects up to 15% of children in the United States and is a common cause of childhood anal erythema and pruritus. Cases of vaginal pinworm infestation have been reported resulting in discomfort and discharge.
Vulvovaginitis typically presents in prepubertal girls with localized pain, dysuria, pruritus, erythema, or discharge, making it difficult to distinguish from an STI due to
sexual abuse. Bloody, copious, or foul-smelling discharge increases the likelihood of an STI, a nonvenereal pathogen, or vaginal
retained foreign object.
