Clues to help determine the cause of vulvar and vaginal problems affecting girls

The most common vulvar and vaginal problem amongst girls is urinary tract infections, followed by fissures or abrasions, and then yeast infections.

Your child’s vulvar or vaginal problem may present as discharge, pain, itching, burning, redness or discomfort. Figuring out what’s causing it can become a mysterious journey into things you have no idea about, so here are some clues:

1. Write a list of the symptoms you can see – redness, discharge colour and amount, blood, fever, when did it start (that you know of).

2. Add to this list the signs you can observe in your child, without attributing a cause to them. This might include walking funny, sitting strangely, scratching, avoiding going to the toilet, or being distressed from pain.

3. Add to this list the signs and symptoms your child tells you about (if they are able), without attributing a cause to them, including pain on urinating, sore tummy, feeling hot, feeling pain.

     So… which is it?

This list is not exhaustive or the only things that could be wrong, but they are the most common.

     Itching and discharge

Could be a yeast, staph or strep infection. Staph or strep could be caused by a foreign object inside. Often infections are caused by poor wiping habits – faecal matter gets into the vagina and vulva. Itching and skin thickening can also be caused by lichenoid conditions, an often-missed diagnosis in children. It may also be labial adhesions, where the labia start to fuse together. See our article on causes of vaginal discharge in children. 

     Pain on urinating

Generally a UTI, but could also be caused by raw flesh being in contact with acidic urine, with the raw flesh caused by an infection. See our article on how to spot and treat a urinary tract infection in a young girl. 

     Itching worse at night

Pinworms are the usual cause of genital and anal itching that gets worse at night.

     Blood

Trauma to the hymen or vagina caused by rough play, an accident or sexual abuse. See our article on hymenal injuries in children. 

Establishing the cause of your child’s vulvar or vaginal irritation can be difficult at the best of times, so seek the help from your paediatrician, and if necessary, a specialist paediatric gynaecologist. Take your list of observations with you to assist with diagnosis.