bubble_chart Overview

Due to physiological characteristics, infantile vulvitis differs from adults in terms of disease causes, manifestations, consequences, and treatment.

bubble_chart Etiology

Within the first 15 days after birth, the vaginal mucus shows a significantly acidic reaction, with a pH of approximately 5.5. After this period, the pH rises and becomes neutral or alkaline. At birth, the vagina remains sterile. In the days before and after delivery, due to the influence of high maternal estrogen levels, the vaginal epithelium resembles that of adults, rich in glycogen, with a vaginal pH of 4.2–4.5. Three days later, the bacterial flora is entirely composed of vaginal bacilli. Around 15 days, the vaginal bacilli dominate. The vaginal epithelium maintains low hormone levels until puberty.

Infants and toddlers wearing open-crotch pants are prone to contamination if hygiene is neglected. If diapers are not changed frequently, the irritation from urine and feces can lead to skin infections, acute pestilence, reduced overall resistance, and local uncleanliness, making infections more likely. A few cases of vulvitis in young children are caused by the presence of foreign objects in the vagina. Improper wiping of the anus after defecation, leading to fecal contamination of the vulva, excessive washing of the vulva with soap or other cleansers, tight underwear, or wearing nylon or synthetic fiber underwear can all contribute to the condition. The pathogenic bacteria are mostly pyogenic, such as staphylococci, streptococci, and large intestine bacilli.

bubble_chart Clinical Manifestations

Older children may complain of vulvar pain, itching, and increased discharge. Infants and young children often cry restlessly due to local discomfort.

The vulva, clitoris, urethral orifice, and vaginal opening show mucosal congestion, edema, and purulent discharge. Parents may notice frequent purulent crusts or watery traces on the underwear of infants and young children, along with redness, edema, or even skin peeling of the vulva. Some children scratch the affected area due to pain and itching, leading to scratches or bleeding, while others experience dysuria, frequent urination, or a burning sensation. However, some cases are overlooked by parents during the acute phase or due to mild symptoms, resulting in labia minora adhesion and a narrowed urine stream only being noticed later, mistakenly diagnosed as genital malformation. Examination reveals adhesion of the labia minora, leaving a small opening at the top or bottom for urine discharge, with the urethral and vaginal openings covered. Upon closer inspection, the adhered area of the labia minora appears thinner and more translucent.

bubble_chart Diagnosis

Pain, itching, and increased discharge in the vulva.

The vulva, clitoris, urethral orifice, and vaginal opening show mucosal congestion, edema, and purulent discharge. Purulent crusts often form on underwear, or there may be traces of watery discharge, with redness and edema of the vulva, and even skin peeling. Local scratching marks, bleeding, and other phenomena may occur. The labia minora may adhere, leading to a narrowing of the urine stream. Examination may reveal that the adhered area of the labia minora is thinner and more translucent.

bubble_chart Treatment Measures

First, special infections should be ruled out by sending secretions for examination to check for trichomonads or fungi. If necessary, cultures can be performed to identify the pathogenic bacteria and administer appropriate antibiotics. Local treatment includes sitz baths with a 1:5000 potassium permanganate solution. Apply Arnebia oil, Coptis Rhizome ointment, or antibiotic-cortisone ointment to the vulva. Maintain vulvar cleanliness and dryness. For more stubborn cases, estradiol can be added to Arnebia oil or the aforementioned ointments for topical application. If adhesions have formed, they can usually be separated by gently pulling downward and outward with fingers after disinfection. For more stubborn adhesions, a curved mosquito forceps can be inserted through a small opening and then moved vertically backward to separate the translucent area. After separation, apply Arnebia oil or sterile Vaseline ointment to prevent re-adhesion. Perform sitz baths with potassium permanganate solution once or twice daily, followed by application of Arnebia oil until the epithelium returns to normal.

bubble_chart Prevention

Parents and caregivers should pay attention to the cleanliness of infants' and young children's external genitalia and promote related awareness. Infants' and young children's outer pants should have closed crotches, and children should be taught to wipe their anus from front to back after each bowel movement to avoid fecal contamination of the external genitalia. Underwear should be made of cotton and preferably loose-fitting. If there are family members or children in kindergarten with reproductive system infections, attention should be paid to the isolation of utensils. When infants and young children suffer from acute pestilence, hygiene of the external genitalia should be maintained.