What are the signs my child might have a vulvovaginal problem?
There are many ways children can let us know that something is not right for them. Children might tell you their vulval area is sore or itchy. They might scratch or rub the vulva and seem unable to stop. Another possibility is you notice blood or a change in the vaginal discharge on clothing. Some children might have a new problem with passing urine and bowel motions. Another possibility is they wake up in the middle of the night screaming and afraid, maybe even clutching at their vulva.
All of this is distressing. However, most of the time the cause is something harmless and easily treated. The most common causes are a reaction to something that has been near the vulval skin, chronic dermatitis (eczema) due to a tendency towards itchy skin, or psoriasis. Less commonly, there could be something inside the vagina like toilet tissue. Other possibilities include pinworms, lichen sclerosus (see Lichen sclerosus), or a reaction to a medication.
Could my child have thrush?
The answer is almost always no. Until they start having periods, oestrogen levels are very low in children. Yeast love oestrogen, so they don’t grow well in children. The exceptions to this are children with uncontrolled or undiagnosed diabetes, and children with serious immune problems. Do not buy thrush treatments at the chemist for your child. They probably will not work, and they can cause harm. Yeast creams contain a lot of chemicals that can cause an allergy or irritation to your child’s skin.
There are infections in childhood that look like a yeast infection of the skin. These include a skin infection with group A Streptococcus, or a fungal infection called tinea cruris. Swabs and scrapings of the skin can help make the diagnosis.
My child’s labia look stuck together – is this normal?
Sometimes a child’s labia minora can stick together – this is called labia fusion. It is usually due to the low oestrogen levels of childhood. Most of the time, nothing needs to be done and the labia separate once puberty begins. Rarely, labial fusion causes difficulty with passing urine by blocking urine from leaving the body. In this situation, oestrogen creams placed on the labia minora can help them to separate. However, they might go back together again after stopping the creams. Doctors used to recommend separating the labia with a minor surgical procedure. This is not routinely done anymore. If a doctor tells you to do this, seek out a second opinion from an expert in childhood vulval conditions.
There is one other possible cause of the labial fusion. Lichen sclerosus can cause labia to stick to each other or to the interlabial fold. The skin usually looks pale or white in the affected area. If this seems to be the case, arrange to see a specialist in childhood vulval conditions. If lichen sclerosus is the cause, it is important to make this diagnosis and start treatment with corticosteroid ointments.
My child complains about pain ‘down there’ but the doctors say everything looks normal. What could be happening?
It is important to do a thorough investigation to see if there are any reversible causes for the pain. This might include a general examination and examination of the vulva area, blood tests, stool tests, swabs, and sometimes a procedure in the operating room to look inside the vagina and bladder. Sometimes all of this is negative. That usually means than the problem is overactive pain nerves and pelvic floor muscles. The same thing can happen to adults. Often children with this problem have other pain issues like headaches, chronic abdominal pain, or back pain. Constipation and urinary problems are also common. Treatment with a tablet for nerve pain is helpful for most children in this situation. Older children may also find benefit from pelvic floor physiotherapy. Many large hospitals have teams of health care workers who look after children affected by chronic pain. If your child has pain and has tried a lot of treatments without getting better, it may be worth getting a referral from your local doctor to one of these teams.
I am waiting to see a specialist to find out the cause of my child’s vulval problems. What can I do in the meantime?
Good skin care practices are similar in adults and children (see Vulval care advice sheet). The goal of vulval skin care is to get rid of anything that could be causing an allergic rection or irritating the skin.
In the bath
• Do not use soap, shampoo, conditioner or bubble bath. Instead use a non-scented bath oil or a soap substitute like aqueous cream or emulsifying ointment. Wash hair over a basin to avoid contact with hair care products.
• If your child uses the shower, make sure they are not scrubbing the vulval area or using other family members’ products. You may need to supervise their bathing.
Toileting
• Do not use baby wipes.
• If your child is wearing nappies at night, this may be aggravating the problem. Is it possible to reduce or stop using nappies overnight?
• Use hypo-allergenic toilet paper. Avoid repetitive wiping. A squirt bottle to rinse the area may be a gentler way to clean.
• Does your child have trouble with leaking of urine or bowel motions? If so, this is likely aggravating the problem. Talk to your doctor about what to do.
Clothing
• Use cotton underwear. Avoid wearing underwear at night.
• Close fitting nylon or lycra tights and leotards can irritate the skin. These are commonly used in dance and gymnastics. Would it be possible to wear loose fitting clothes for practice sessions? If no other option is available, try to spend as little time as possible in that outfit.
• Swimming costumes are a major source of irritation, especially in a chlorinated pool. Apply Vaseline or another barrier ointment beforehand to protect the skin. Shower immediately after and change into dry loose clothes.
• Are tights part of your child’s school uniform in winter? Will the school allow long socks instead? If needed, your doctor can give you a certificate.
Chemist products
• Don’t use antifungal creams or other over-the-counter medications.
• Avoid perfumed moisturisers on the vulva.
• It is OK to try nappy rash cream. Once you see your doctor, ask them what barrier ointment or oil to use.
• If itch is a problem and haven’t had medical advice yet, you can apply 1% hydrocortisone ointment (not cream). Be prepared for your chemist to caution you about steroid ointment, but don’t be scared by what they say. Be sure to follow through with a visit to your doctor, so you can find out the cause of the problem and start a directed treatment.