Adolescents and children experiencing vaginal discharge and irritation present frequently in a pediatric practice. Although there are distinct differences in the epidemiology of vulvovaginitis in the child and adolescent, a standard approach to evaluation can be followed in both the prepubertal and postpubertal child.
In practice, the terms vulvitis, vaginitis, and vulvovaginitis often are used interchangeably by physicians in diagnosing inflammatory conditions of the lower female genital tract. Although the infection or irritation may have been localized at onset, by the time of presentation it may have become generalized. Vulvitis may occur alone or be accompanied by a secondary vaginitis. Conversely, a child may acquire a primary vaginal infection, and the discharge may cause maceration of the vulva and a secondary vulvitis. Presenting symptoms of vulvovaginitis can include genital irritation, pain and inflammation, vaginal discharge, and dysuria. Thus, a variety of presenting complaints are due to vulvovaginitis.
Epidemiology and Pathogenesis
Familiarity with the anatomy and normal developmental changes of the female genital tract is essential to understanding the etiology of and pre-disposing factors for vulvovaginitis.
During the newborn period, the vagina is well-estrogenized from maternal hormones. The desquamation of the estrogen-induced hypertrophic vaginal epithelium, together with mucus from the stimulated cervix, produces the physiologic white discharge seen in the neonate.