Overview 

Vaginitis is a condition referring to any form of irritation, inflammation or infection that may occur surrounding the vagina or vulva.¹ Commonly this condition can be found in women of all ages. However, it can also occur in children, particularly prepubescent girls between the ages of one to ten years old.² Research shows that 62% of pediatric gynaecological care is regularly directed towards treating vaginitis in children, therefore highlighting the prevalence of the condition in younger children.² It is important to address vaginitis if it occurs in children in a timely and appropriate manner, as not treating the condition could lead to further health issues, which can further irritate the vagina and vulva.⁶ 

Vaginitis is the common term for multiple issues impacting the vagina and vulva. Some other forms of vaginitis include bacterial vaginosis and vulvovaginal candidiasis,² Predominantly, vaginitis occurs due to infectious and non-infectious reasons. Roughly about 25% of vaginitis cases in children occur due to infectious reasons, while 75% can be due to hygiene or lifestyle habits.² Therefore with simple lifestyle and hygiene changes, vaginitis could be promptly dealt with. 

Types and Causes of Vaginitis in Children

As vaginitis is the generic term given for irritation or infection of the vagina and vulva, there are several forms of vaginitis that can occur in children. 

Bacterial vaginosis could be a form of vaginitis that a child may have. Symptoms of bacterial vaginosis consist of foul odour in vaginal discharge, which is typically greyish in colour, and an increase in vaginal pH than usual.³ Girls typically in the later stages of puberty are more susceptible to bacterial vaginosis than young girls.⁵ If you suspect that your child may have bacterial vaginosis, then it is important to visit their primary care doctor for initial advice and possible treatments.⁷ If a child is diagnosed with bacterial vaginosis, it can be typically treated with antibiotics or medicated creams and gels.⁷

Vulvovaginal candidiasis, also referred to as a yeast infection, is also a form of vaginitis which can occur in children. The symptoms typically manifest as itching, swelling and pain in the vaginal area, in addition to vaginal discharge described as cottage cheese-like in colour and consistency.³ However, yeast infections are typically rare for young girls unless they have other conditions that may suppress their immune system such as diabetes.⁴ Yeast infections are more likely to occur in older pubertal girls.⁵ Typically, the treatment for yeast infections includes antifungal medications.⁵

The risk of vaginitis may be further exacerbated in prepubertal girls due to the close proximity of their vagina and anus, which could lead to the greater transfer of bacteria as the faecal matter could contaminate the vulval and vaginal area.^{2 8} Furthermore, the minimal amount of pubic hair and labial fat may further exacerbate this, as there is less physical protection for the vagina and vulva, leading to more chances of vaginitis occurring.^{2 8}

Foreign bodies which may be trapped around the vulva or inside the vagina may lead to vaginitis.² The most common foreign body that can be found in the vagina tends to be toilet paper.² This can be physically removed from the vagina by using a sterile saline solution at home.² If foreign bodies persist in the vagina, this could further lead to severe inflammation, a foul smell and blood in vaginal discharge. Therefore, it is vital to ensure that there is nothing remaining in the vagina or around the vulva.⁶ 

Symptoms and Clinical Presentation of vaginitis in children 

In order to spot vaginitis in children, you should be aware of the most common symptoms that can occur due to various forms of vaginitis. Although vaginitis could be caused by various conditions such as bacterial vaginosis, yeast infections or foreign bodies, these are the main symptoms children should look out for:

• An increased amount of vaginal discharge and secretions ⁹
• Abnormal vaginal discharge where there are changes in colour, odour and consistency ⁹
• Irritation, redness, soreness or swelling near the vulva or vagina ⁹
• Burning or stinging sensations when passing urine ⁹

If your child notices these symptoms, then a primary care physician may be helpful in confirming the diagnosis and thereby providing the appropriate treatment and healthcare measures. 

Addressing the lifestyle and hygiene-related causes of vaginitis 

Most cases of pubertal vaginitis in girls can be improved by increased hygiene habits and hand washing after using the toilet.² Vaginitis can be prevented and maintained with improved hygiene. Therefore, educating young girls on how to improve their hygiene may be the best form of prevention for vaginitis. Here are some ways in which children can minimise the risk of vaginitis.

Children are recommended to wear looser clothing to allow airflow and not restrict the vulva, which will promote less dampness in the area, minimising the chances of vaginitis and the growth of bacteria.² Wet swimming suits and exercise clothing that hold moisture should be changed out as soon as practically possible.⁶

It is important to minimise the exposure of irritants towards the sensitive areas of vulval skin. This can be achieved by not using any scented items such as soap, strong detergents or washing powders for underwear. This will minimise the chances of getting vaginitis in children. It is also recommended to wear loose or minimal underwear at night to allow for breathability, emphasising the importance of underwear that is not dyed, which can further promote irritation.² 

When cleaning the vulval area during bathing, children should be mindful of not using harsh products. Soaking the area with water is sufficient.² It is also recommended to preferentially have more showers than baths to minimise contamination.⁷  Furthermore, the vulval area should be pat dried afterwards bathing or showering to minimise the levels of moisture in the area, which could lead to vaginitis.²

When using the toilet, it is recommended that children wipe from front to back to avoid any contamination towards the vagina and vulva.² Children should be educated by parents and carers about the appropriate hygiene tips during their time using the toilet. 

Complications and Long-Term Effects of Vaginitis

It is important to treat any forms of vaginitis with the appropriate methods, as symptoms may worsen if they are not addressed. To avoid the chances of getting other reproductive and sexual health issues, it is vital to get the necessary treatment or take the appropriate hygiene and lifestyle steps to treat the condition. If left untreated, vaginitis could lead to other health complications such as cervicitis, pelvic inflammatory disease and adnexitis.⁸  

Special Considerations for Parents

Vaginitis has the capability of impacting a child’s physical and mental health while also burdening parental well-being.⁸ Parents and carers should be mindful of their children’s mental well-being if they are going through issues caused by vaginitis, as studies suggest that vaginitis can have a similar impact on the parent and the child as other health issues can.⁸ As the condition may be considered an embarrassing and stigmatised area of concern for families, it is important to be mindful of negative emotions arising due to the condition. Another study has highlighted that if parent’s negative and shameful emotions are not addressed, resulting in anxiety and depression, they can significantly impact the prognosis of the affected child.⁸ Therefore, if parental anxiety does arise, then parents should be mindful of how they can reach out for help while also being supportive of their children so that the parents are not prolonging the recovery time for their children.⁸

Furthermore, as this may be a difficult time for the child going through the condition, it is important to approach the topic of conversation sensitively, making sure that consent is provided by the child for any form of physical examination by parents or healthcare workers.⁸

Summary 

Vaginitis is a common yet easily treatable condition which can occur in young girls. It is important for parents and carers not to worry if they suspect that their child may have vaginitis, as it is a treatable condition and is common for many girls who are transitioning from childhood to puberty.¹ Parents should also be mindful of how their mental well-being might further worsen the health of their child, so being aware of your emotions and seeking help should be considered if your child’s health issues are distressing you.⁸ As only 25% of vaginitis in children is caused by infections, it is imperative to be aware that the likelihood of the condition in children can be managed if children are educated about the appropriate hygiene routines and habits that can minimise the likelihood of vaginitis.² Changes and improvements to hygiene and lifestyle habits will have the most significant impact on preventing vaginitis in children, therefore, it is important to educate young girls on how they can take care of themselves and how they can take the necessary cautionary steps to minimise the chances of getting vaginitis.