Both adults and children are susceptible to fungal and infectious diseases. One of the most common ailments that mainly affects the female body is candidiasis (thrush). This disease is so common that it is diagnosed in almost every adult woman. Infantile thrush is no less common.
The nature of the disease and its causative agent are the same in both adults and children. The candida fungus (Candida albicans), which causes thrush, is constantly present in the human body (on the mucous membranes, genitals and occasionally internal organs), being part of the microflora, without causing harm and without showing any symptoms. Therefore, the disease is provoked not so much by the fungus itself, but by the state of the body and external factors that contribute to the growth of the fungus and the development of infection.
Children's vulvovaginal candidiasis most often affects adolescents (mainly girls) and newborns of both sexes.
There are two forms of the disease:
- a form with pronounced symptoms according to the standard clinical picture;
- asymptomatic form, which is detected only as a result of laboratory tests.
There are also such types of thrush in children (vulvar candidiasis in girls), as oral candidiasis (develops in the mouth of newborns) and genital candidiasis (mainly in preschoolers and adolescents). In any case, the child must be shown to a specialist, since the infection indicates a decrease in immunity, which can lead to even more complex and unpleasant consequences.
In gynecology, vulvitis is an inflammation of the mucous membranes of a woman’s external genitalia.
The inflammatory process covers the labia, clitoris, external urethral opening, anal area and surrounding tissues (pubis, inner thighs, etc.). At first glance, such a pathology should bypass children of the younger age group and affect only adult women of reproductive age. However, statistics show that acute vulvitis in girls of childhood and adolescence is the most common reason for visiting a pediatric gynecologist. In some cases, doctors even diagnose vulvitis in newborn girls.
To notice and provide medical assistance in time for the development of vulvitis is the most important task of responsible parents . Advanced acute vulvitis in a child can involve the vaginal mucous membranes in the inflammatory process, which leads to aggravation of the little patient’s condition and provokes the development of vulvovaginitis. In addition, the acute process gradually turns into a chronic form, which inevitably affects the sexual, reproductive and menstrual function of an adult representative of the fair sex. This inflammation is dangerous due to the formation of synechiae (adhesions) of the labia minora, erosion of the cervix and uterine body, as well as the addition of cystitis and urethritis.
Diagnosis of vulvitis
In most cases, when the above complaints appear, mother and girl turn to pediatricians.
The diagnosis of vulvitis can be made by a local pediatrician, but further observation and treatment should be carried out by a pediatric gynecologist in order to avoid complications!
Diagnosis is based on examination of the little patient, study of her life history and onset of the disease, and laboratory examination.
The main research method that allows us to identify the causative agent of inflammation is microscopic examination and bacteriological culture of vaginal secretions for flora and sensitivity to antibiotics.
If there is a suspicion that the nature of vulvitis is specific, then the scraping is examined using the polymerase chain reaction method. In addition, it is mandatory to undergo a general blood test, urine test, urine culture for flora and many other tests that the pediatric gynecologist will prescribe for you.
Causes of vulvitis in girls
The high incidence of inflammation of the mucous membranes of the genital organs in girls is associated primarily with the physiological characteristics of newborns and children of a younger age group. At birth, the reproductive tract and membranes of the genital organs are sterile. Only after a week, opportunistic microorganisms master this nutrient medium, forming a prototype of normal female microflora. However, unlike the genitals of an adult woman, the child’s vagina does not have a sufficient number of microorganisms, which explains the inferiority of the protective reaction. The fact is that it is the vaginal microflora that provides the acidic environment of the genital membranes. A high level of acidic components causes the death of dangerous pathogenic flora, effectively protecting a woman from infectious and viral pathogens.
Thus, initially the girl’s genitals are defenseless against aggressive bacterial factors. Only by adolescence, the pH environment of the mucous membranes transforms from neutral (pH 7.0) to moderately acidic (pH 4.0-4.5).
The second important provoking factor of childhood vulvitis in girls is the imperfection of the child’s immune system, namely the deficiency of immunoglobulins, phagocytes and components of the compliment system. It is important to monitor the state of the child’s immunity, because hypovitaminosis, taking antibacterial drugs and the presence of endocrine disorders in the girl, such as diabetes, are considered risk factors that increase the likelihood of developing inflammation.
The immediate cause of vulvitis in a child is infection. The following bacterial pathogens are considered the most dangerous in this regard:
- Nonspecific infections . This group of pathogens is also called opportunistic pathogens, since they normally live on the patient’s mucous membranes and are part of the healthy, complete microflora of the genital organs. This group includes all opportunistic aerobic and anaerobic flora and yeast fungi. To activate them, favorable conditions are necessary, in the form of weakened immunity. The situation is aggravated by failure to maintain personal hygiene, ignorance of the correct washing technique, wearing synthetic underwear, injury to the genitals, etc.
- Specific infections . This includes pathogens that are not normally present in the microflora of the vagina and external genitalia of a child - chlamydia, ureaplasma, gonorrhea, herpes virus, gonococci, mycobacterium tuberculosis, etc. Infection of children most often occurs through household means due to poor hygiene and the entry of strangers objects in the vagina (insects, toys, sand, etc.). In adolescents, infection can be caused by sexual relations and masturbation. Vulvitis in newborn girls can occur due to infection during contact with the contaminated birth canal of the mother.
- Fungal pathogens . Mycotic vulvitis develops as a response to the death of microflora in response to antibiotics and hypovitaminosis. This form of vulvitis in infants can be a consequence of diaper dermatitis.
- Helminthic infestations . Pinworms and other helminths usually affect children who have frequent contact with animals. This cause is often classified as a nonspecific form of pathology.
- Allergy . A rare form of the disease is atopic or allergic vulvitis, which manifests itself as a hypersensitivity reaction to an allergen. Both food products (citrus fruits, sweets, nuts, etc.) and local hygiene products (soap, balms contained in diapers, sanitary pads) can act as an irritant.
- Anatomical disorders of the structure of the genital organs . If a child has developmental abnormalities of the external genitalia, the risk of inflammation increases sharply. This is especially true in cases where the girl has incorrect localization of the external urethral opening, a gaping genital fissure, the external labia are too open, and the mucous membrane is excessively thinned.
Treatment plan
How to treat vulvar candidiasis (thrush) in children of school age, and not only?
Basically, treatment involves eliminating the pathogen and stopping its reproduction, which will therefore eliminate the symptoms. Only a good specialist can treat the disease correctly and effectively, who can prescribe:
- antifungal drugs and antiseptics (topically);
- antibiotics;
- ointments and medicinal baths;
- therapy to restore and strengthen the immune system;
- therapy to restore the microflora of the reproductive system.
Which course of treatment will be chosen and prescribed depends on the specific case and the reasons that led to vulvovaginal candidiasis in a teenage girl and a smaller child.
Repeated appointment
At the follow-up appointment, the doctor assesses the child’s condition and checks how effectively the chosen regimen works. If no positive dynamics are observed, then repeated diagnostics and selection of new methods for treating thrush in the child are prescribed.
Control reception
The control reception is an important point. The doctor prescribes it to see how the child recovers after a full course of treatment, to see if there are any relapses or suspicions of them. It is also possible to prescribe physiotherapy and rehabilitation (for example, if a long course of antibiotics has been prescribed). A follow-up appointment is usually scheduled after 21–30 days or later.
Treatment result
The disease can be cured, but the timing of treatment is individual and depends on the stage and causes of thrush in young children or teenage girls. All details of treatment are discussed individually at a doctor’s appointment. If there is a suspicion that the parents are infected, then both parents are treated.
Prevention
Thrush in children is a fairly common occurrence, especially under “favorable” conditions for the disease. To protect the child, it is necessary to take preventive measures:
- carry out proper personal hygiene of the child in accordance with age;
- wear the correct underwear;
- normalize nutrition (moderate or limited consumption of sweets, starchy foods and fast foods, more fruits, vegetables, etc.);
- Strengthen your immune system by taking vitamins and exercising.
Compliance with the rules of personal hygiene at home and in public places will also help avoid the occurrence of vulvar candidiasis and other unpleasant diseases in a teenage girl or young child.
Types of vulvitis in children
Depending on the timing and severity of the pathology, three forms of the disease are distinguished:
- acute vulvitis in girls - symptoms persist for up to 1 month;
- subacute vulvitis - duration is up to 3 months;
- chronic vulvitis - all inflammatory conditions whose symptoms persist for more than 3 months.
Chronic and subacute vulvitis in girls of preschool age, caused by nonspecific pathogens, are considered common.
Prevention of vulvovaginitis
To prevent vulvovaginitis in girls, it is important:
- strictly observe hygiene measures, but do not overuse cosmetic soap, especially antibacterial soap,
- change your underwear daily and use underwear made from natural fabrics,
- increase the child’s immunity through hardening, daily walks in the fresh air, sports, balanced and nutritious nutrition.
It is important to remember that vulvovaginitis of any etiology, if untreated or self-treated, can cause serious damage to a girl’s reproductive health.
Symptoms of vulvitis in girls
The first signs of the development of the inflammatory process are severe itching and burning in the groin area. Upon visual inspection of the affected area, parents also note external symptoms of vulvitis in the child in the form of severe redness and swelling of the labia and clitoris. Often inflammation also affects surrounding tissues. Also, upon examination, small ulcerations and erosions may be revealed, which indicate a severe course of the pathology and require immediate consultation with a doctor.
As the disease develops, children in the first years of life experience anxiety, frequent crying, and sleep disturbances. In older children, this condition is easier to diagnose. For example, vulvitis in a three-year-old girl will manifest itself in the fact that the child constantly touches the genitals, rubs the inflamed tissue and complains of pain during urination. Excessive rubbing and scratching of thin, inflamed mucous membranes can lead to injury, which the child’s parents should prevent.
Another characteristic sign of the development of an inflammatory reaction of the external genitalia is the appearance of unusual discharge from the child’s vagina, which gynecologists call leucorrhoea. These discharges cannot be confused with the norm. In most cases, there is profuse, watery leucorrhoea that is colorless and has an unpleasant odor. Discharge when infected with E. coli is considered one of the important diagnostic signs, as it has a greenish tint and emits a very strong fecal or putrid odor. At the same time, candidal forms of pathology are accompanied by white, curdled leucorrhoea, which resembles the classic manifestation of thrush.
The general condition of a child who has developed vulvitis or vulvovaginitis is often weakened; the girl may have a fever and sleep disturbances. Children often complain of pain in the lower abdomen and show increased excitability and irritability. If the disease is the result of helminthiasis, the child may refuse to eat.
