Vaginitis in infants and young children commonly occurs in girls aged 2 to 9 and is a frequent condition among female infants and toddlers. Since vaginitis is often accompanied by vulvitis, it is generally referred to as vulvovaginitis in infants and young children.

bubble_chart Etiology

(1) Poor local hygiene of the vulva: The mother and caregivers of the child do not pay attention to the cleanliness of the child's vulva. Improper handling after defecation or using contaminated paper to wipe the anus allows intestinal bacteria to invade the vagina, causing vaginitis. In a study of 438 cases of infant vulvovaginitis by HuHiman, it was found that 68% were caused by the aforementioned disease causes, with 80% of cultures showing the presence of Escherichia coli.

(2) Foreign objects: Objects such as peanuts, beans, hairpins, pins, small stones, etc., inserted into the vagina can cause injury to the vaginal epithelium, leading to secondary infections.

(3) Pinworm-induced vulvovaginitis: This condition is not common under normal circumstances. It is caused by intestinal pinworms transmitted to the vagina through feces; or improper handling of feces, where pinworm eggs are transmitted to the vulva of young girls through the hands, clothes, or toys of the mother or caregivers, causing inflammation.

(4) Secondary vulvovaginitis: After upper respiratory tract or urinary tract infections in young girls, bacteria can be directly transmitted to the vagina through dust, causing infection.

(5) Specific vaginitis: Trichomonas or fungal vaginitis is rare in infants and young children. The reason may be that the vaginal pH in infants and young children is alkaline, which is not suitable for fungal growth. Trichomonas feeds on glycogen, and the amount of glycogen in the vagina at this age is very low, making it unsuitable for Trichomonas growth. Hemophilic vaginitis is extremely rare in infants and young children.

The main symptoms are itching of the vulva and increased vaginal discharge. Infants and young children, unable to accurately describe their symptoms, often scratch the vulva with their fingers, which can further spread the infection through the fingers and the scratched areas. The vulva, urethral orifice, and vaginal opening exhibit congested mucous membranes and edema, accompanied by purulent discharge. However, it is possible for parents to overlook these symptoms during the acute phase, or due to mild symptoms, leading to labial adhesion after the acute phase. When adhesion occurs, small holes may remain above or below, through which urine may leak. Vaginal foreign bodies can cause an excessive amount of vaginal discharge, which may be bloody, purulent, and foul-smelling. Vaginitis caused by pinworms results in intense itching around the vulva and anus, with a large amount of thin, yellow, purulent discharge from the vagina.

bubble_chart Diagnosis

Due to the anatomical characteristics of infants and young children and their inability to cooperate with the doctor, diagnosis can be somewhat challenging. However, physical examination is the primary basis for diagnosis, so doctors need to be highly patient and meticulous in inquiring about the medical history from the child's mother and caregivers. During the examination, the technique should be gentle and agile. Sometimes, to obtain satisfactory results, it is necessary to distract the child, such as by talking to the child while examining to relax the abdominal wall. In some cases, the child may need to be examined under general anesthesia. Several common examination methods include:

(2) Vaginal speculum examination: The best instrument for this is the Kelly air bladder speculum. A bronchoscope or nasal speculum can also be used as a vaginal speculum. For older girls, a specially designed small vaginal duckbill speculum can be used. Through these specula, the condition of the vagina and cervix can be clearly observed, including the vaginal epithelium and secretions, and the presence of any foreign objects. A small cotton swab can be used to collect vaginal secretions for a Gram stain smear, and the secretions can also be cultured for drug sensitivity testing, which helps identify the pathogenic bacteria.

(3) Rectal-abdominal bimanual examination: Use the left middle and index fingers to separate the bilateral labia majora, and insert the right index finger (or the little finger if the index finger is too large for younger children) into the child's anus and abdomen, while the other hand cooperates to palpate for any foreign objects in the vagina, the size of the uterus, and the pelvic condition. The rectal examination can also assist in collecting vaginal secretions. The method involves the rectal finger pressing forward on the posterior vaginal wall, while the other hand holds a sterilized glass tube to aspirate the vaginal secretions while pressing the rectum.

bubble_chart Treatment Measures

Pay attention to keeping the vulva clean. The vulva can be treated with a 1:10,000 potassium permanganate sitz bath. Any foreign objects in the vagina must be removed as soon as possible. For labial adhesions, a small curved forceps can be gently inserted along the upper or lower opening to separate them. This separation procedure is easy to perform and does not require anesthesia. The vagina can be irrigated with a 0.5-1% lactic acid solution through a rubber catheter inserted into the vagina, and sulfonamide or antibiotic emulsions can be injected through the catheter once a day for a course of 5-7 days. Topical application of estrogen ointment can promote the resolution of inflammation. Apply an ointment containing 0.1mg of diethylstilbestrol deep into the vagina with a small cotton swab once a day for 2 weeks, then every 3-4 days for a total treatment period of 4-6 weeks. Oral diethylstilbestrol is also effective. Take 0.1mg of diethylstilbestrol once a day, then twice a week after two weeks, and continue for 4-6 weeks. Prolonged use may cause the development of secondary sexual characteristics. For the treatment of pinworm-induced vaginitis in infants and young children, Pyrvinium Pamoate can be used. The dose is 5mg per kilogram, taken once in the evening; if there is a recurrence, it can be taken again after 2-3 weeks. This drug has low dermatitis medicamentosa, and a few children may experience nausea, vomiting, abdominal pain, or diarrhea after taking it. This medication can turn stools red and may stain clothing. Pyrvinium Pamoate is highly effective in killing pinworms and is the drug of choice for treating pinworm infections.