Vaginitis in Children and Teens

Vaginitis refers to inflammation or infection of the vagina, but it can also affect the vulva, the area outside the vagina (vulvovaginitis).

Vaginitis in teen girls most commonly occurs when the normal balance of yeast and bacteria in the vagina becomes disrupted for some reason, by direct chemical irritation or if a teen is sexually active. STDs can cause vaginitis. In addition, cases of vulvar irritation and inflammation may be linked to the increased popularity of waxing pubic hair.

Vulvovaginitis in girls who haven't gone through puberty yet often has different causes. At this age, because of a lack of estrogen, which doesn't increase until puberty, the skin in and around the vagina can be thin, delicate and easily irritated. These younger girls may develop symptoms of vaginitis because they don't wipe once they become potty trained, wipe improperly (back-to-front instead of front-to-back), wipe too vigorously or take bubble baths, etc.

The most common symptoms of vaginitis can include:

• Vaginal itching, soreness or irritation
• Vaginal discharge
• Redness and swelling of the vulva
• Burning with urination (dysuria)
• Frequency (urinating more frequently)
• Bleeding (secondary to severe inflammation)

Keep in mind that some vaginal discharge can be normal in teens, who may have a white, odorless discharge called "physiological leukorrhea." You wouldn't expect them to have other symptoms if they just had leukorrhea.

Common causes of vaginitis can include:

• Prepubertal vaginitis: Often non-infectious and caused by poor hygiene techniques or irritation (bubble baths, harsh soaps, wet clothing, etc.). A retained piece of toilet paper can also lead to irritation and discharge.
• Yeast infections: Caused by Candida albicans. Yeast infections are more common if your child has recently taken an oral antibiotic. In addition to other symptoms of vaginitis, these children might have a thick, white vaginal discharge that is usually odorless. Keep in mind that vaginal yeast infections are much less common before girls go through puberty; they become more common in the later teen years.
• Bacterial vaginosis: Caused by an imbalance in the bacteria that normally live in the vagina, which can produce a fishy vaginal odor and a thin, whitish-gray vaginal discharge.
• Trichomoniasis: An STD that is caused by the Trichomonas vaginalis parasitic protozoa, which causes vaginal itching and a frothy, green vaginal discharge that has a bad odor.
• Chlamydia infections: An STD caused by Chlamydia trachomatis, which can range from being asymptomatic to having a burning sensation when urinating and/or a vaginal discharge.

Unfortunately, finding the specific cause of vaginitis or even that a child has vaginitis can sometimes be difficult. Some may not be fully aware that their symptoms are caused by vaginitis and complain more of urinary symptoms when urine hits the inflamed skin. Other girls might be afraid they will be suspected of being sexually active or are just embarrassed to talk about these symptoms.

A variety of tests can be done on vaginal discharge secretions to help doctors tell the difference between various types of vaginitis, although they may not be available to pediatricians unless they specifically take care of a lot of teenagers. For example, when a yeast infection is causing vaginitis, your pediatrician might be able to see budding yeast and pseudohyphae when looking at a potassium hydroxide wet mount of vaginal secretions under a microscope. A wet mount might also help to identify the clue cells of bacterial vaginosis or the parasites swimming around.

For quick relief of vulvovaginitis, it can sometimes help to:

• Take a warm sitz bath, either with or without baking soda
• Apply ice packs, as tolerated, to the area
• Apply a low-potency, topical steroid cream to the areas of irritation

Other treatments for vaginitis depend on the specific cause.

For example, in prepubertal children, vulvovaginitis is usually treated with improved hygiene and applying a topical barrier cream, such as Vaseline or Aquaphor several times a day. Antibiotics might be prescribed, usually, Augmentin or Clindamycin, if symptoms persist and a bacterial infection is suspected.

If a pubertal teen has a vaginal yeast infection, then she will likely need a one- to three-day course of a topical antifungal medication, such as miconazole or clotrimazole cream. They will typically need to be used in the vagina; however, oral medications, like fluconazole, are available if you don't think your younger teen will tolerate that treatment.

Bacterial vaginosis can be treated with oral metronidazole or with intravaginal metronidazole or clindamycin.

Lastly, trichomoniasis is typically treated with oral metronidazole and chlamydia with an antibiotic like azithromycin.

In addition to avoiding bubble baths and practicing proper hygiene (wiping from front-to-back after urinating), you may help your child prevent vaginitis by teaching her to:

• Urinate with her knees spread wide apart
• Change out of wet clothing as soon as possible, including sweaty work-out clothes
• Avoid tight clothing
• Wear loose-fitting, cotton underwear
• Avoid scented products
• Use non-irritating, mild soaps and rinse them off well after bathing or showering
• Avoid getting shampoo in the vulval area
• Wash and dry the vulval area gently when she showers or takes a bath
• Avoid douching, feminine sprays and scented tampons

It may also help to wash your child's underwear with a dye- and perfume-free detergent and avoid fabric softeners.

Vaginitis is a common problem, so it is important to learn more about it to hopefully prevent your child's first episode or at least know what to do if she has it. In addition to recognizing the symptoms and causes of vaginitis, it can help to know that:

• Teens should have some time to be interviewed alone without a parent or guardian so that they can be asked if they are sexually active.
• Sexual partners of teens with trichomoniasis and chlamydia should be treated, too, and they should all be tested for HIV.
• Lichen sclerosis is often misdiagnosed as vaginitis.
• Labial adhesions can be a complication of vaginitis, especially recurrent vaginitis in younger children.
• Although pinworms can cause vaginitis, it is thought to be a self-limiting infection that doesn't need to be treated, unlike perianal pinworms.
• You can prepare a sitz bath for your child by mixing two tablespoons of baking soda in 4 to 5 inches of water in the bathtub.

Pediatric gynecologists are available in many areas to help care for children and younger teens with chronic or recurrent vaginitis and other gynecological problems. Otherwise, for extra help or a second opinion, ask your pediatrician for a referral to an adult gynecologist who has some experience taking care of children.