Infantile vulvovaginitis refers to a secondary vulvovaginal infection in infants and young children, primarily caused by low estrogen levels, thin vulvar and vaginal mucosa, or the presence of foreign bodies in the vagina. This condition is most commonly observed in children under the age of 5.
Etiology
Certain anatomical and physiological characteristics in infants and young children increase their susceptibility to vulvovaginal inflammation:
- The vaginal environment in infants differs from that of adults. After 2–3 weeks of birth, maternal estrogen levels decline, and the infant’s own estrogen levels remain low. Vaginal epithelial layers become thin, glycogen content decreases, and vaginal pH rises to 6.0–8.0. Without lactobacilli as the dominant flora, the vaginal resistance to infections is reduced, allowing for colonization by other bacteria.
- The underdeveloped vulva in infants leaves the urethral opening and vaginal vestibule exposed, making it easier for bacteria to invade.
- Poor hygiene practices in infants, such as unclean vulvar areas, contamination with urine or feces, vulvar trauma, or pinworm infestations, can lead to inflammation.
- Secondary infections may occur when foreign objects are accidentally inserted into the vagina.
- The most common pathogens include Escherichia coli, Staphylococcus spp., and Streptococcus spp., although infections may also involve Neisseria gonorrhoeae, Trichomonas vaginalis, or Candida albicans.
Clinical Manifestations
The primary symptom is an increase in vaginal discharge, which is typically purulent. Many cases are identified when caregivers notice purulent discharge staining the child’s underwear and seek medical attention. The large volume of discharge may irritate the vulva, causing pain and pruritus, which leads to crying, irritability, or scratching of the vulva. Some children may experience lower urinary tract infections, characterized by urgency, frequency, or dysuria. Upon examination, the vulva, clitoris, urethral meatus, and vaginal Opening mucosa may appear erythematous and edematous, with purulent discharge sometimes observed flowing from the vaginal opening. In severe cases, vulvar ulcerations may develop, and the labia minora may become adherent. Adhesions of the labia minora may cover the vaginal opening and urethral meatus, leaving slits above and below the adherence for urine to pass through.
Diagnosis
Due to limited verbal communication abilities in infants, detailed history-taking often requires input from caregivers. Diagnosis typically relies on clinical manifestations and physical examination findings. Vaginal secretions can be collected using a thin cotton swab or pipette for microbiological testing to identify the causative pathogens. When necessary, bacterial and fungal cultures can be performed. Rectal examination and ultrasound imaging may be conducted to rule out the presence of vaginal foreign bodies or tumors. In cases involving labial adhesions, differentiation from congenital malformations of the external genitalia should be considered.
Treatment
Efforts are made to maintain cleanliness and dryness of the vulva to reduce friction.
Appropriate oral antimicrobial therapy is selected based on identified pathogens. Antimicrobial solutions can also be administered into the vagina using a pipette.
Symptomatic treatments are implemented. For pinworm infestations, anthelmintic therapy is provided. Foreign bodies in the vagina are removed if detected. In cases of labial adhesions, the application of estrogen cream often resolves the issue, while severe adhesions may require separation followed by the application of antimicrobial ointment.