Vulval Conditions in Children and Adolescents

Vulvovaginitis

Vulvovaginitis is a type of inflammation of the vulva and vagina. The main symptoms of vulvovaginitis are redness, soreness and itchiness of the skin between the outside lips of the vagina (labia majora). This may also be accompanied by discharge from the vagina and a burning sensation when urinating. 

Most often, vulvovaginitis does not need medical help and will get better at home within a few weeks after making a few simple changes. 

You can help your child manage the symptoms of vulvovaginitis by: 

• teaching them good hygiene practices such as wiping from front to back, urinating with their knees apart and keeping the area clean and dry 

• advising them to avoid using perfumed soaps or taking bubble baths

• encouraging them to have a healthy diet with plenty of fibre

• buying them cotton underwear and loose-fitting clothes and nightwear 

• giving them cool compresses to help soothe the area 

• checking to see if they have threadworms, as threadworms can cause or worsen vulvovaginitis

Seek medical help for vulvovaginitis if:

• the symptoms do not improve or are causing distress to your child

• your child notices blood in their discharge

• they have a thick, white discharge, as this may be a sign of thrush

• they have pain when passing urine or develop a fever. This can be a sign of a urinary tract infection (UTI)

Thrush 

Vaginal thrush is a fungal infection caused by an overgrowth of a fungus (candida albicans) that is usually present in the vagina. Vaginal thrush is more common in girls that have gone through puberty, but it can also affect prepubescent girls. 

The main symptoms of vaginal thrush include: 

• redness, swelling or itching of the vulva 

• a thick, white discharge that may look like cottage cheese

• pain or burning when urinating 

If your child has any of these symptoms, it’s important to seek medical help to determine if they have thrush and to rule out any other issues. Vaginal thrush can usually be easily treated with antifungal medication and the symptoms should get better within a few days of treatment. 

Vulvodynia

Vulvodynia is pain in the vulva that’s not usually accompanied by any obvious changes to the way the vulva looks. It may feel like throbbing, burning, stabbing or general soreness and can be present all the time, come and go, or happen when the vulva is touched, for example, when inserting a tampon. Often, there’s no identifiable cause of vulvodynia, and treatment usually focuses on pain management. If your child has pain in their vulva that does not resolve by itself, it’s important to see a medical expert who will determine the best way to help. 

Abnormal vaginal discharge

Normal vaginal discharge before puberty is usually fairly minimal and should be clear or white and without odour. During and after puberty, there will be an increase in discharge, but it should still be clear or white with very little smell. If your child has yellow or green discharge with a bad smell, a thick, white discharge that looks like cottage cheese or discharge accompanied by itching or irritation, you should seek medical advice as it may be a sign of infection. 

Urinary tract infection (UTI)

Pain in the vulva that’s accompanied by pain or burning when urinating may be a sign of a urinary tract infection (UTI). UTIs are common in children and sometimes resolve on their own or may need to be treated with antibiotics.

Lichen sclerosus

Lichen sclerosus is a rare skin condition that can affect the vulva and anus (but not the vagina). The main symptoms of vulval lichen sclerosus are itching, white patches of skin on the vulva, thinning of skin that can lead to tearing and sometimes red/purple skin that can look like bruises. Itching and soreness from lichen sclerosus can affect your child’s sleep and lead to problems with going to the toilet. 

Lichen sclerosus is thought to be an autoimmune response and is not caused by an infection or poor hygiene, and is not contagious. There is no cure for lichen sclerosus, but symptoms can be managed with steroid creams and can improve as a child reaches puberty. It’s important to seek help if you think your child has lichen sclerosus, as treatment is needed to keep the symptoms under control and to prevent complications from occurring as your child grows. 

Labial adhesions

Labial adhesion, sometimes called labial fusion, is where the inner lips around the opening of the vagina (labia minora) become stuck together. As a girl ages, their body produces more oestrogen, and the lips will naturally separate, with no long-term side effects. Occasionally, the fusion can cause urine to become trapped and lead to problems with urine leakage or recurrent UTIs. In cases where the labial adhesion is causing other problems or does not resolve on its own, it may be treated with oestrogen creams or, more rarely, surgery. 

Vaginal foreign body 

A vaginal foreign body is an item that has been left in the vagina for an extended time, which can lead to infection. This may be a tampon that has been forgotten about, toilet tissue that has become trapped or items that have been inserted into the vagina by a child out of curiosity. Vaginal foreign bodies need medical attention as they can lead to infection and a more serious condition called toxic shock syndrome (TSS).

Our specialists will begin by talking to you and your child about their specific symptoms and will likely need to carry out a physical examination. Often, a physical exam will be enough to diagnose a vulval condition, but other diagnostic tests may sometimes be needed.

Other diagnostic tests may include:

• urinalysis to check the urine for signs of infection and other issues
• urine sample collection for laboratory testing
• vaginal swabs
• sexual health screening
• blood tests
• ultrasound
• CT or MRI scans
• biopsy (in rare cases)

Some vulval problems in children do not require treatment or will resolve themselves as your child grows, but others will require treatment, depending on the specific diagnosis. This may include medication such as antibiotics, antifungals or steroids and in rare cases, surgery.  

It’s important to get any vulval issues that you are unsure about checked to make sure they are correctly diagnosed and treated where necessary

At Welbeck, London’s leading paediatric gynaecologists use the latest innovations in healthcare to accurately diagnose and treat a wide range of conditions in state-of-the-art facilities. Your child will receive the best possible care in a welcoming and supportive environment where you both feel listened to. 

With access to colleagues across other specialities, our consultants are also able to refer within the Welbeck ecosystem if needed to ensure your child receives the best possible treatment as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your child’s health is of utmost importance to us, so we strive to offer same-day and next-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance for your child, their treatment at Welbeck can begin once your provider has confirmed authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.

Are vulval conditions in children usually serious? 

Many vulval conditions in children are not serious, and some can resolve without treatment. However, it’s important to get anything you are concerned about checked by a paediatrician to make sure any issue is correctly diagnosed and treated where necessary, so that complications can be avoided in later life. 

Will a vulval condition affect my child going into adulthood? 

Most vulval conditions in childhood do not have an impact on future fertility or sex life, but it’s important to get an accurate diagnosis for any issues, as some conditions, such as lichen sclerosus, can have a lasting impact if left unmanaged. 

Is it normal for a child to experience redness or itching on their vulva? 

Vulvovaginitis (the most common cause of redness or itching in the vulva of children) is quite a common condition. There are many steps that you can take to help prevent or ease the symptoms of vulvovaginitis in your child, as detailed above. If your child’s symptoms do not improve, it’s important to seek medical help in case there is an underlying issue that requires treatment. 

When should I be worried about my child’s vaginal discharge? 

Normal vaginal discharge before puberty is usually minimal and should be clear or white and without odour. If your child has yellow or green discharge with a bad smell, a thick white discharge or discharge accompanied by itching or irritation you should seek medical advice as it may be a sign of infection.