General Medical Information

Vulvitis

Wilberto Nieves-Neira
Bhagirath Majmudar
Ira R. Horowitz

Vulvitis is the most common pediatric gynecologic problem and frequently manifests as vulvovaginitis. Prepubertal girls are prone to vulvitis because the anus is physically closer to the vestibule, and the labia lack the fat pads and pubic hair that provide protection after puberty. Poor hygiene habits as well as bizarre genital care practices may contribute to this condition. Most cases of vulvitis have no specific identifiable etiology. Bacteriologic studies of the vaginal flora in asymptomatic children and children evaluated for vulvovaginitis found a similar microbiologic pattern. Anaerobes such as Peptococci, Peptostreptococci, and Bacteroides species have been found to be part of the vaginal flora in asymptomatic girls, but these organisms as well as yeasts such as Candida albicans are significantly more frequent in symptomatic children. When evaluating laboratory culture reports, it is important to obtain a colony count of all organisms identified. A pathophysiologic response to an organism commonly is related to inoculum size, particularly in the case of enteric organisms. A laboratory report of “normal vaginal flora” is inadequate, because it has not been determined what is normal for the prepubertal girl.