| Young girls sometimes complain of burning or pain when they urinate (dysuria), and although this can sometimes be a sign of a urinary tract infection, it is more commonly caused by irritation of the skin in and around the vaginal area (vulvovaginitis) or at the opening of the urethra (urethritis). This irritation can also cause vaginal itching and frequent urination (frequency).
Before puberty, the skin around the vaginal area can be very sensitive, and it can easily become red and inflamed when it comes in contact with common irritants, such as soap or shampoo. Bubble baths are also a common irritant that can cause itching in the vaginal area.
Another cause of vulvovaginitis is poor toilet hygiene, which is usually secondary to not wiping or wiping incorrectly after urinating. You should make sure that your daughter is wiping after urinating and that she wipes from front to back (anterior to posterior direction). Young girls may need supervision with this.
Treatments for vulvovaginitis include:
- wearing loose fitting, cotton underpants
- wearing loose fitting clothing
- taking sitz baths (warm water baths) in clear water 2-4 times a day
- use a bland ointment on the skin that is irritated
- use an over the counter 1/2% or 1% hydrocortisone cream 3-4 times a day to help relieve burning and itching (do not use stronger steroid creams in the vaginal area, unless specifically instructed to do so by your physician)
- for severe itching, oral diphenhydramine (Benadryl) can be used.
- rarely, an antibiotic will need to be prescribed to help clear up persistent cases, especially if the irritation is thought to be from a bacterial infection.
- very rarely, an estrogen cream may be applied topically each night to the skin around the vaginal area to thicken and strengthen the skin and make it more resistant to irritation. Warning, this should be done only under the direct supervision of your physician and only for a short time (2-4 weeks).
Prevention of vulvovaginitis:
- Toilet Hygiene
- supervise your child and make sure that she wipes in a front to back direction after urinating
- teach your child to urinate with her knees spread apart, so that the urine does not collect on the skin around or in the vagina.
- Bathing
- Avoid bubble baths.
- Use a nonperfumed, mild soap during baths, use warm water (not hot water) and keep baths brief (less than 10-15 minutes).
- Avoid using soap, or use just a little soap to clean the skin around the vagina before puberty and no scrubbing.
- Rinse the vaginal area well with clear water and a hand held sprayer when a bath is finished.
- Avoid washing her hair in the bath (shampoo the hair over a sink instead), or if you do, do it at the end of the bath and be sure to rinse off any shampoo that may have collected in the vaginal area with a hand held sprayer.
- Dry the vaginal area by gently patting with a towel (no rubbing) and consider using a hair dryer on a cool setting for 10-15 seconds to finish drying or just air dry it with her legs spread apart.
- Skin Protection
- Use a bland ointment, or diaper rash cream to protect the skin around the vaginal area.
- Clothing
- Wear loose fitting, cotton underpants and change them frequently. Also wear loose fitting clothing (such as skirts, loose pants or shorts), and consider allowing her to sleep without underpants.
- Avoid prolonged wearing of tight clothing, especially wet swim suits, gymnastics outfits, ballet leotards, tight fitting blue jeans, and/or nylon tights. Also avoid sleeper pajamas.
Children with vulvovaginitis should have redness and irritation of the skin around the vaginal area, if she doesn't, then she may have another problem causing her symptoms. You should see your doctor if your child has burning and pain with urination and a fever, if she has had urinary tract infections in the past, if she has a green, foul smelling or bloody vaginal discharge, if she also has rectal itching (pinworms), if there is blood in the urine, if she may have a vaginal foreign body (such as toilet paper), or if she is not quickly improving with the treatments described above.
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