OVERVIEW

What is infant vulvovaginitis?

Infant vulvovaginitis refers to vaginitis and vulvitis occurring in female infants and young children. It is caused by thin vulvar skin and mucosa, low estrogen levels, or secondary infections from vaginal foreign bodies, commonly seen in children under 5 years old^[1].

Symptoms may include increased vaginal discharge, often purulent. The irritation from excessive discharge can lead to vulvar itching, causing the child to cry incessantly, become restless, or even scratch the affected area^[1]. Some children may experience frequent urination, urgency, or pain during urination.

Parents should also maintain good hygiene habits.

SYMPTOMS

What are the main symptoms of infantile vulvovaginitis?

The main symptom is increased vaginal discharge, which is purulent. Parents may notice purulent discharge on their child's underwear.

Abnormal vaginal discharge can cause vulvar itching, leading to symptoms such as crying, irritability, or scratching the vulva. Some infants may also have a urinary tract infection, with symptoms like frequent urination, urgency, dysuria, and reluctance to urinate.

What complications can infantile vulvovaginitis cause?

In severe cases, it may lead to vulvar ulcers and labial adhesions. Severe adhesions may cover the urethral opening, causing difficulty in urination.

CAUSES

What are the causes of infantile vulvovaginitis?

Due to the following characteristics of the vulva and vagina in infants and young children, they are prone to vulvovaginitis:

• The vulva of young children is not fully developed and cannot cover the urethral opening and vestibule, making it easy for bacteria to invade.
• The vaginal environment in children differs from that of adults. The vaginal pH ranges from 6.0 to 8.0, and lactobacilli are not the dominant bacteria, resulting in poor vaginal resistance and susceptibility to other bacterial infections^[1].
• Poor hygiene habits in children, such as unclean vulva, contamination by urine or feces, vulvar injuries, or pinworm infections.
• Accidental placement of foreign objects in the vagina, leading to secondary infections.
• Infected adults indirectly transmitting pathogens to infants through hands, clothing, towels, bathtubs, etc., during care.

What are the common pathogens of infantile vulvovaginitis?

Common pathogens include Escherichia coli, Staphylococcus, Streptococcus, Candida albicans, pinworms, and Gardnerella vaginalis.

A small number of children may have sexually transmitted infections, such as Trichomonas vaginalis, gonorrhea, chlamydia, or syphilis.

Is infantile vulvovaginitis contagious?

It can be contagious in cases of sexually transmitted infections, such as Trichomonas vaginalis, gonorrhea, chlamydia, or syphilis.

Pathogens are usually transmitted indirectly through the hands, clothing, towels, or bathtubs of infected adults^[1].

DIAGNOSIS

What tests are generally required for diagnosing infantile vulvovaginitis?

• Pathogen testing: Use a thin cotton swab or pipette to collect vaginal secretions for pathogen testing to identify the infectious agent. If the child has recurrent or persistent infections, bacterial and fungal cultures may also be necessary.
• Digital rectal examination: Perform a digital rectal exam to rule out vaginal foreign bodies or tumors.
• Stool routine test: Check for pinworm eggs to screen for pinworm infection.
• Urine routine test, blood routine test, and urine culture should also be conducted.
• Abdominal ultrasound or CT scan may be performed if necessary.

How is infantile vulvovaginitis diagnosed?

After ruling out external genital malformations, the diagnosis can be confirmed based on symptoms and secretion test results.

Vaginal secretions can be collected for etiological examination to identify the pathogen^[1].

A rectal examination may be required if necessary to exclude vaginal foreign bodies or tumors^[1].

TREATMENT

Which department should be consulted for infantile vulvovaginitis?

Generally, gynecology is recommended. Pediatrics can also be chosen.

How should infantile vulvovaginitis be treated?

• Select appropriate medications based on the pathogens identified in secretion tests, or use a pipette to drip medicated solutions into the vagina.
• Use diluted potassium permanganate or chlorhexidine solutions for sitz baths or external vulvar rinsing.
• Administer deworming treatment for children with pinworm infections.
• If a foreign object is present in the vagina, it should be promptly removed.
• For labial adhesions, estrogen ointment can be applied externally; severe cases may require adhesion separation surgery followed by antibiotic ointment application.

DIET & LIFESTYLE

What should be paid attention to in daily life for infantile vulvovaginitis?

• Maintain vulvar cleanliness and dryness. Change diapers promptly after urination or defecation and clean the area immediately.
• Avoid letting children wear open-crotch pants to prevent vulvar contamination. Also, be cautious to avoid vulvar injuries during play or activities.
• Give daily warm water baths, soaking the child's buttocks in clean water (without soap) for 10–15 minutes. Avoid bubble baths and do not use soap to clean the vulva.
• If the vulva is tender or swollen, cold compresses can help relieve discomfort.
• Use wet wipes instead of toilet paper when wiping the vulva. Applying moisturizers can help protect vulvar skin.

PREVENTION

Can infantile vulvovaginitis be prevented?

Pediatric vulvovaginitis can be prevented by paying attention to the following points in daily life:

• Avoid one-piece pajamas; ensure sleepwear allows air circulation.
• Wear cotton underwear.
• Rinse undergarments thoroughly after washing to avoid residue of irritants. Avoid using fabric softeners on underwear or swimwear.
• Avoid tight leggings, bodysuits, and leg bindings. Opt for skirts or loose pants to promote airflow.
• Monitor children's hygiene habits. Emphasize wiping from front to back after bowel movements and encourage sitting with knees apart to reduce urine backflow into the vagina. If maintaining this posture is difficult due to the child's small size, consider using a smaller removable potty chair or sitting backward on the toilet (facing the tank).
• Avoid letting children sit in wet swimsuits for extended periods after swimming.
• Use dedicated bathtubs and towels for children. Wash and sun-dry underwear separately to avoid cross-infection with adults.
• Bathe regularly but not excessively—2–3 times a week is appropriate.