II. Pathophysiology
- Low levels of Estrogen in the vagina
- Poor peri-vaginal hygiene in toddlers
III. Symptoms
- Streaking in underwear or diaper
- Small amount of Vaginal Bleeding may be present
- Vulvar Pruritus
IV. Signs
- Perform with child in open frog leg position
- Vaginal erythema
- White Vaginal Discharge
- Vulvar excoriations may be present
V. Labs
- Culture of peri-vaginal and peri-anal skin
- Consider in suspected Bacterial Infection (Streptococcus, Shigella)
VI. Differential Diagnosis
- See Vaginitis
- See Vaginal Discharge
- Child Sexual Abuse
- Vaginal Foreign Body (e.g. rolled up toilet paper)
- Associated with foul smelling copious discharge
- May irrigate with warm saline via IV catheter tip (without needle)
-
Yeast Vaginitis
- Rare in pre-pubescent girls (even with recent Antibiotic use)
-
Bacterial Infection
- Streptococcal Vulvovaginitis
- Similar to Perianal Streptococcal Dermatitis
- Shigella Vulvovaginitis
- Associated with copious discharge and recent Diarrheal illness
- Streptococcal Vulvovaginitis
VII. Management
- Improve peri-vaginal hygiene
- Apply hypoallergenic topical to the affected area
- Aquaphor
- Vaseline
- Desitin
- Avoid irritants
- Avoid baby powders
- Avoid scented lotions
- Avoid bubble bath
- Avoid tight synthetic pants or underwear
- Avoid sitting in a soapy bath
- Apply soap at the end of the bath
- Rinse well with fresh water
VIII. References
- Claudius and Willner in Herbert (2019) EM:Rap 19(1): 2-4