General Medical Information

Nonspecific Vulvovaginitis

Michele D. Wilson

Nonspecific vulvovaginitis is the single greatest cause of prepubertal vulvovaginitis, accounting for between 25% and 93% of all cases in various clinical series. When vaginal cultures are obtained in a patient with nonspecific vulvovaginitis, they will grow organisms considered to be part of normal vaginal flora, i.e., lactobacilli, diphtheroids, S. epidermidis, a-hemolytic streptococci, or gram-negative intestinal organisms, particularly E. coli. Despite normal flora, vulvar irritation develops for several reasons. Frequently, poor perineal hygiene associated with wiping from the rectum anteriorly toward the vagina is the key issue. Tight-fitting clothes, nylon underpants or stockings, and prolonged exposure to wet bathing suits or dance leotards may contribute to the problem. Once inflammation has begun, scratching may follow, which will predispose to bacterial superinfection. Symptoms of nonspecific vulvovaginitis include vaginal discharge, genital pain, pruritus, irritation, and dysuria.

The cornerstone of treatment as well as prevention of subsequent episodes of nonspecific vulvovaginitis is the institution of good perineal hygiene. Proper wiping technique is essential to prevent fecal contamination of the vagina and vulva. The child should wear white cotton underwear and use white toilet paper because the dyes and perfumes used in clothing and toilet paper can be irritants. The child should use a mild, nondeodorant, nonperfumed soap to bathe. After bathing, she or her parent should dry her vulva by patting gently with a towel, but without rubbing. Nylon stockings, ballet leotards, tight-fitting clothes, and prolonged exposure to wet bathing suits or wet clothes should be avoided. The goal is to keep the genital area cool and dry. It is important to discontinue using bubble baths or harsh soaps. In the acute phase of irritation, sitz baths of warm water alone or warm water mixed with baking soda, colloidal oatmeal, or cornstarch are beneficial. Wet compresses of Burow’s solution may provide relief for weeping lesions. For the more recalcitrant condition, antibiotics may be indicated. A 10-day course of one of the following oral antibiotics is recommended: amoxicillin, amoxicillin combined with clavulanate, or a cephalosporin. In persistent cases, it may be necessary to prescribe a course of low-dose antibiotics for as long as 2 months. Topical estrogen cream applied to the vulva for 2 to 3 weeks is efficacious when there is inadequate recovery with improved hygienic measures. Caution must be exercised in prescribing topical estrogens because prolonged use can result in iatrogenic precocious puberty.