Children may develop itching of the vulva or itching and/or vaginal discharge. Symptoms may also include irritation and burning.
Genital symptoms can occur in females before puberty, during and between menstrual periods, during pregnancy, and after menopause.
In children, vaginal discharge is usually a symptom of inflammation or infection, and discharge that is persistent, bloody, or accompanied by other symptoms requires a doctor's evaluation. However, vaginal discharge is normal:
During the first 2 weeks of life
A few months before a child has her first period
Vulvar itching and vaginal itching or discharge in children is discussed here. Vulvovaginal itching or discharge in adult women is discussed separately. (Also see vaginal bleeding.)
External Female Reproductive Anatomy
Causes of Vaginal Itching or Discharge in Children
During childhood, common causes of vaginal itching and discharge include
Chemicals in bubble baths or soaps
A foreign object (such as a piece of toilet paper or sometimes a toy) in the vagina
An infection due to bacteria or parasites from the anus
Infection or irritation may occur when hygiene is poor. For example, young girls, especially those 2 to 6 years old, may transfer bacteria or parasites from the anus to the genital area if they wipe from back to front or do not wash their hands after bowel movements. Yeast infections are uncommon in children.
If a foreign object is the cause, the discharge may contain small amounts of blood.
Sexual abuse may be the cause of vaginal itching or discharge. Such abuse can result in injury or a sexually transmitted infection.
Some Causes of Vaginal Itching and Discharge in Children
Cause | Common Features | Diagnostic Approach |
|---|---|---|
Irritation caused by urine or stool | Itching or redness of the vulva or vaginal opening, and sometimes a vaginal discharge Sometimes pain during urination | A doctor's evaluation |
Foreign object in the vagina (often toilet paper or a small toy) | Vaginal discharge, sometimes with a foul odor and/or containing small amounts of blood | A doctor's evaluation, sometimes done after the girl is sedated or given a general anesthetic |
Itching of the anal area (and sometimes vaginal opening) that worsens at night | Examination of the vulva and vaginal opening and anus to check for pinworms | |
Infections such as | Irritation, redness, and sometimes swelling of the vulva or vaginal opening Vaginal discharge, usually yellow or green Sometimes pain during urination | Examination of the discharge under a microscope and analysis of a sample to check for microorganisms that can cause vaginal infections |
Chemical irritation (such as that due to soaps, bubble baths, hygiene sprays, or vaginal creams and ointments) | Redness, itching, swelling, and soreness of the vulva | A doctor's evaluation |
Skin disorders such as psoriasis, lichen sclerosus, lichen simplex chronicus, and lichen planus (due to an autoimmune reaction, when the body attacks its own tissues) | Rashes, itching, or other symptoms, depending on the disorder | Usually a doctor's evaluation alone Sometimes a biopsy |
Bruising, redness, or injury to the vulva, vagina, anus, and/or mouth Sometimes vaginal discharge that may have a foul odor or contains blood Often vague symptoms (such as fatigue or abdominal pain) or changes in behavior (such as starting to have temper tantrums or withdrawing from daily activities) | A doctor's evaluation To check for sexually transmitted infections, examination of the discharge under a microscope and analysis of a sample |
Evaluation of Genital Itching or Discharge in Children
Doctors can usually determine the cause of genital itching or discharge by asking about symptoms and examining the vulva and vagina.
Warning signs
Vaginal discharge in children is usually abnormal. Certain characteristics are cause for concern:
Fever
Yellow or green discharge
Blood-tinged discharge
Vulvar itching accompanied by masses or lesions of the vulva is concerning.
When to see a doctor
Children with warning signs should be seen by a doctor within a day.
What the doctor does
The doctor asks about a child's symptoms and medical history. For infants, the doctor asks about whether there were any complications during pregnancy or birth. The medical history is obtained from the parent (or caregiver) and the child, if age appropriate.
If there is vaginal discharge, doctors ask
What it looks and smells like
Whether other symptoms (such as itching) are present
Doctors also ask about other symptoms, such as vaginal bleeding, pain, fever, and chills.
Doctors do a general physical examination.
If a pelvic examination is necessary, the doctor talks to the parent and child about the examination so they know what to expect and to build trust between the child and doctor. The goal of the examination should be to obtain necessary information without causing fear or unnecessary discomfort to the child. An external pelvic examination (of the vulva [labia]) and opening of the vagina may be performed, If an internal pelvic examination is needed, the child is usually given anesthesia so that the examination can be done without causing discomfort.
If there is a vaginal discharge, a sample can be collected for testing using methods appropriate for children.
The information from the history and physical examination often suggests a cause and additional tests that may be needed.
If sexual abuse is suspected, documentation is done based on the physical examination and local medical and legal requirements for sexual assault victims. Children should be examined and receive support during and after the evaluation by trained health care professionals.
Treatment of Genital Itching or Discharge in Children
If a specific cause of the itching or discharge is identified, it is treated.
General measures that can help avoid vulvar or vaginal irritation include
Wearing underwear made of cotton instead of synthetic fabrics
Allowing vulva and groin area to dry completely after bathing, before putting on clothing
Changing clothing that is wet for a prolonged period of time (such as a wet bathing suit)
Using unscented soaps, laundry detergents, and toilet paper
Placing ice packs on the genital area or sitting in a warm sitz bath may reduce soreness and itching. A sitz bath is taken in the sitting position with water covering only the genital area. Sitz baths can be taken in the bathtub or in a large basin. Parents or caregivers should be cautious about applying too much cold or heat to the area, to avoid injury.
Girls should be taught vulvar hygiene (for example, wiping front to back after bowel movements and urinating).
Sometimes medications may be needed, if general measures are not successful.
Key Points
A vaginal discharge may be accompanied by itching, redness, burning, and soreness.
Common causes of vaginal itching or discharge in children are an infection due to bacteria from the digestive tract, chemicals in bubble baths or soaps, and a foreign object (such as a piece of toilet paper or sometimes a toy) in the vagina.
Treatment depends on the cause, but applying cold packs or sitting in a warm sitz bath can help relieve symptoms.
