Vulvitis in girls: causes, symptoms, treatment,complications

Update: October 2018

It is sad to talk about it, but women’s problems
trap a girl from the moment of her birth. Vulvitis in girls
occupy the top line in the list of gynecological diseases and
reach 70%. The most vulnerable category of girls for this
pathology is a girl aged 1 – 9 years. This pathology
requires immediate treatment, as not only delivers a lot
inconvenience and anxiety to the child, but also threatens the development of serious
complications that may affect the future sexual and
reproductive functions.

What a vulvit

Under the vulva refers to the external genital organs, to which
include small and large labia, external opening
the urethra, the clitoris and the eve of the vagina. When
inflammations of the vulva speak of vulvitis. Vulvitis rarely occurs as
independent disease and often combined with inflammatory
process of the vagina, so this pathology is called
vulvovaginitis.

Classification

Depending on the duration of the disease, the vulvitis is divided
on:

  1. acute (last up to 1 month)
  2. subacute (up to 3 months, alternating periods of exacerbation and
    remission)
  3. chronic

Depending on the age category, the following types are distinguished.
diseases:

  • inflammation of the vulva during infancy (from 0 to 12
    months);
  • inflammation of the vulva and vagina during the childhood period (from 1 to 8
    years old)
  • inflammation of the vulva and vagina in prepubertal age (from 8
    years before menarche);
  • inflammation of the vulva and vagina puberty (after
    menarche).

Also, this pathology may be infectious (caused by
pathogenic and conditionally pathogenic microbes) and non-infectious
Genesis (trauma, including the introduction of a foreign body into the vagina,
burn, allergy or metabolic disorders).

Infectious inflammations of the vulva are divided into
nonspecific, which causes opportunistic microflora and
specific.

In addition, vulvitis are divided into primary, when infection
the vulva is caused from outside by the entering microbes and secondary, with
the presence in the girl’s body of other foci of infection (carious teeth,
tonsillitis, otitis media, etc.).

The reasons

The high probability of developing the disease in girls is due to
anatomical and physiological features of the vulva. At the time of birth and
a few hours after it, the child’s vagina remains sterile and
only by the 5th – 7th day of life is the population of opportunistic microflora.
The reaction of the vaginal contents of the girl before the start of sexual
maturation remains alkaline or neutral, as in the microflora
vagina are missing lactobacilli that produce dairy
acid.

The absence of lactic acid in the vaginal contents reduces
local protection against infectious agents, and a reduced amount
sweat and sebaceous glands on the skin of the vulva, incomplete closure of the genital
crevices, tender and vulnerable skin of the external genitalia increase
risk of developing inflammation of the vulva.

Primary non-specific vulvitis

The cause of the primary non-specific vulvitis is
conditionally pathogenic microorganisms that are in small quantities
inhabit the vagina (protozoa and yeast fungi, anaerobes,
Proteus and others).вульвит у девочки

  • Repetition of episodes of non-specific inflammation of the vulva
    characteristic of girls who suffer from chronic somatic
    diseases (pathology of the urinary system, hormonal
    diseases: сахарный диабет, гипотиреоз, болезни крови и т.
    d.).
  • It is noted that the frequency of inflammatory processes of external genital
    organs increases in children who often suffer from diseases of the nasopharynx
    (angina and chronic tonsillitis, rhinitis, ARVI).
  • In addition, non-specific infectious vulvitis may
    provoke worms (in particular pinworms),
  • penetration of foreign bodies into the vagina during the game (sand,
    insects, blades of grass).
  • Factors that weaken the body’s immune defenses are also
    play a role in the development of the disease (antibiotic therapy, lack of
    vitamins, immunodeficiency states).

Allergic Atopic Vulvitis

Separately, it is necessary to identify the causes of allergic vulvitis (or
atopic).

  • some highly allergic food contribute to its development
    products (chocolate, citrus, strawberry)
  • hygiene products with aromatic additives (soap,
    gaskets)
  • synthetic linen
  • in girls of infancy age
    provokes diaper dermatitis
  • excessive hygiene of the mother’s hygiene of the child (frequent and unnecessary
    washing away, the use of ointments, powders and creams), which leads to
    irritation and violation of the integrity of the skin and mucous
    vulva
  • non-compliance with hygiene rules and the use of general hygiene
    accessories (towels, washcloths) contributes to the development
    diseases and in older girls
  • if a teenage girl is having sex, it’s not excluded
    sexual way of infection

Specific pathogens are gonococci and
trichomonas, chlamydia and ureaplasmas, tuberculosis and diphtheria
bacillus, genital herpes virus and human papillomavirus infection,
mushrooms and pathogens of childhood infections (measles, scarlet fever and chickenpox
smallpox).

У новорожденных девочек воспаление vulva может быть обусловлено
contamination of the child during the passage in labor through infected
maternal birth canal or transplacental infection.

Clinical picture

Acute vulvitis develops when the damaged mucosa
(diaper rash or mechanical stress, thermal or chemical
burns) or due to wetting of the external genital organs
infected urine, as well as when there is a foreign body in
vagina, infectious agents fall. It should be noted that
воспаление vulva и/или влагалища неинфекционной этиологии
there is a short time, as in the near future occurs
microbial colonization of primary non-infectious foci
process.

The main symptoms of vulvitis include itching and burning of large and
labia minora, discharge from the mucous-purulent vagina, in
severe cases of purulent discharge. The symptoms described
significantly worsen the general condition of the child, the girl becomes
crying and irritable, her sleep and appetite are disturbed. AT
in case of severe course, body temperature rises
abdominal pain, and palpation of regional lymph nodes (inguinal).

To put the correct diagnosis allows inspection of external genital
organs. When острого воспаления vulva явно видны покраснение
and swelling of the labia majora and labia, which may spread
on the crotch and even the inner thighs.

Constant discharge of purulent discharge from the vagina leads to
мацерации (ткани vulva размягчаются, разрыхляются и набухают)
mucous that aggravates a condition of the girl. Pathogomic
Sign are whites, which have characteristic manifestations for
each type of pathogen, and help to conduct a differential
diagnostics.

Так, в случае трихомонадного воспаления vulva возникают зуд,
отечность vulva и влагалища, а также жидкие и пенистые желтого
highlight colors. The candida nature of the disease indicates
значительный зуд vulva, ее покраснение и творожистые или
tiny white discharge tightly welded to the mucous membrane. AT
случае воспалительного процесса vulva, обусловленного кишечной
stick appear viscous discharge yellow-green color, with
unpleasant smell (smell of feces). ATыраженное воспаление,
significant itching and burning leads to appearance on the vulva
petechial hemorrhages and ulcerations. Child seeks
comb the affected area, which provokes the formation of ulcers
significant size and the appearance of bloody-purulent discharge.

In the absence of treatment and long-existing acute process
it turns into a chronic stage, which is characterized only by
abnormal white in a small amount and weakening
subjective symptoms.

Diagnostics

  1. Diagnostics заболевания начинается со сбора анамнеза и
    complaints
  2. The somatic condition of the child and the factors
    which create a background for the activation of opportunistic microflora and
    development of vulvitis / vulvovaginitis (obesity and exudative diathesis,
    metabolic disorders, allergies to food and non-food agents,
    неправильная или несоблюдение гигиены и т. d.).
  3. A gynecological examination is conducted during which
    swelling and hyperemia of the external genital organs, their maceration
    and ulceration, whites of purulent, cheesy, frothy or
    bloody type with an unpleasant smell.
  4. Rectoabdominal examination allows palpation
    foreign bodies in the vagina.
  5. AT обязательном порядке проводится вагиноскопия (осмотр стенок
    vagina through undamaged chaff), if necessary during
    procedures from the vagina removed foreign bodies.
  6. Since the disease is often combined with inflammation
    urinary tract, urine test shown (general analysis, urine
    by Nechyporenko and urine for bacteriological seeding).
  7. A complete blood count, feces for helminth eggs and
    Ultrasound of the pelvic organs.
  8. To establish the type of pathogen, smears are taken on
    vaginal microflora and urethra and bacteriological culture
    vaginal secretion for sensitivity to antibiotics.
  9. При подозрении на воспаление vulva специфической этиологии
    PCR and sexual serological testing
    infections.
  10. The definition of blood sugar is also shown.

If there are indications, narrow consultations are appointed.
specialists: pediatric allergist, endocrinologist, gastroenterologist
and others.

Treatment

Treatment вульвита у девочек включает ряд определенных мероприятий
and depends on the etiological factor that led to the emergence of
diseases:

Mode and diet

ATсем девочкам с острым процессом показан постельный режим, а в
severe cases hospitalization. ATременно меняют рацион питания,
increasing the amount of alkalizing foods (fresh, boiled and
steamed vegetables, milk, mineral water). Proportion of acid
foods and spices should be reduced (fried meat, strong
broth from meat and fish, seasonings and smoked meat, pickled and
pickled foods, lemons, tomatoes).

With atopic vulvitis, a hypoallergenic diet is prescribed,
which excludes use of highly allergenic products
(seafood, eggs and citrus fruits, products with chocolate and honey,
walnuts, strawberries).

Local treatment

Local therapy aims to eliminate swelling and redness
external genitalia, eliminating itching and burning and lies in
disinfectants that are prescribed in the form of
lotions, irrigation and sedentary baths.

From medicinal herbs infusions are widely used (1 table
spoon per liter of boiling water) of chamomile and sage, succession and
calendula, celandine and eucalyptus, St. John’s wort, oak bark and nettle.
The liquid in the bath should be warm, the duration of the procedure
makes 10 – 15 minutes (3 times a day).

From medical antiseptics for local therapy apply water
solution of furacillin, potassium permanganate (pale pink),
chlorhexidine, chinosol, miramistina. Effective lubrication
areas of the affected skin with oily solution chlorophyllipt,
Sangivyritin (1% ointment), ointments with antibiotics (antibiotics for children
appointed only in severe cases). The following ointments are applied.
при вульвите: мазь тетрациклиновая (старше 8 years old), эритромициновая,
oletetrinovaya.

Systemic etiotropic therapy

In identifying the causative agent of the disease and its sensitivity to
antibiotics are prescribed appropriate drugs
for ingestion.

In candidal inflammation, antimycotic therapy is indicated.
means (fluconazole, levorin, itraconazole), topically used
treatment of affected areas with sodium tetraborate (borax) in
glycerol, clotrimazole, dekaminova and other antifungal
ointments. Pre-vulva treated with 4% soda solution.

When выявления трихомонад назначается метронидазол,
ornidazole or tinidazole (the dose is adjusted for age
girls) for 7 – 10 days. Long-term current recurrent
Trichomonas vulvitis apply the vaccine Solkotrihovak (3 injections
on 0B5 ml in 2 weeks, and then in 12 months repeated
administer 0.5 ml once).

When a gonococcus smear is detected in a smear, a venereologist will treat
drugs of choice are cephalosporin antibiotics
(ceftriaxone). Mycoplasma and chlamydial vulvitis treat
broad-spectrum antibiotics (josamycin, sumamed,
doxycycline).

Hygiene

Special attention should be paid to intimate hygiene. AT легких
cases of inflammation, hygiene procedures will help to cope with
disease without the use of drugs.

  • You should wash the crotch after each use of the toilet.
    (remember the direction of movement: front to back).
  • Change of pants twice a day, and diapers and diapers in children
    infancy immediately after contamination.
  • Wash clothes thoroughly (preferably hypoallergenic powder) and
    rinse further.
  • Use of soap in older girls is not allowed
    more than once a day (soap should be pH-neutral).
  • Refuse from aromatic powders, oils and other means of
    infants.
  • ATыбирать белье для девочек из натурального хлопка и белого
    colors (does not contain dyes).
  • The child must have personal hygiene items (towels,
    washcloths).

Normalization of the general condition

In the treatment of this disease is mandatory
desensitizing agents are prescribed that reduce swelling
tissues, relieve itching and inflammation (suprastin, diazolin, drugs
calcium).

When аллергического вульвита антигистаминные препараты
include in the composition of ointments for local therapy.

Reception shown:

  • sedatives (valerian, motherwort)
  • enzymes (hilak-forte, wobenzym, baktisubtil) to normalize
    bowel work
  • витаминов (А, Е, С и группы AT)
  • immunomodulators (immunal, sodium nucleinate)
  • interferon inducers (cycloferon, neovir)

If the disease is recurrent in nature, local
the use of estrogen (estriol, folliculin), which accelerate
reparative processes and increase the concentration of glycogen in
epithelium of mucous membranes.

After the removal of acute events change the diet, in which
must be present dairy products, which is necessary for
restoration of the biocenosis of the vagina and intestines.

When prescribing antibiotic therapy is additionally recommended
taking antifungal drugs.

Remediation of chronic infection foci

Therapy of the inflammatory process of the external genital organs should
conducted with the simultaneous elimination of the source of infection (therapy
ОРATИ, заболевания почек, санация кариозных зубов).

Separately, it should be said about vulvitis due to worms
and a foreign body in the vagina. Treatment вульвовагинита на фоне
enterobiasis (pinworms) must begin with the appointment
anthelmintic drugs (pyrantel, piperazine).

When вульвовагинита, обусловленного инородным телом во
the vagina must be removed and then flushed
vagina through a special catheter with antiseptic solutions.
Removal of a foreign body is performed with vaginoscopy or through
the rectum, pushing it towards the entrance to the vagina, and then
gripping the clamp.

Complications

Refusal of treatment leads to the development of the following complications:

  • synechia of small prisoners lips (deposits of fibrin on the mucosa of small
    labia leads to their sticking together and fusion, which requires
    surgical treatment);
  • vaginal atresia (gluing mucosa of the labia minora and
    vagina, and then their fusion);
  • cystitis – the transition of inflammation to the urea, which is accompanied
    pain, dysuria, and burning sensation;
  • the formation of scars on the site of former ulcers in the future lead to
    problems in sexual life;
  • Imbibition – external genitals become bluish color
    (in a chronic process), and pigmentation can persist
    for a long time or for life, which leads to the development of complexes
    and problems in sexual life.

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