Some Causes of Vulvovaginal Pruritus and Vaginal Discharge in Children

Poor perineal hygiene

Pruritus, vulvovaginal erythema, vaginal odor, sometimes dysuria; no discharge

Pelvic examination

Foreign bodies (often toilet paper or a small object)

Vaginal discharge, usually with a foul odor and vaginal spotting

Pelvic examination (may require examination under anesthesia)

Infections (eg, streptococcal, staphylococcal)

Pruritus and vaginal discharge with vulvar erythema and swelling, often with dysuria

Significant erythema and vulvar edema with discharge

Microscopic examination of vaginal secretions for yeast and hyphae and culture to confirm

Pinworm infestation

Perianal pruritus, worsening at night

Examination of the vulva and anus for pinworms

Sexual abuse*

Vulvovaginal soreness, bloody or malodorous vaginal discharge

Often, vague and nonspecific medical complaints (eg, fatigue, abdominal pain) or behavior changes (eg, temper tantrums)

Physical examination

Testing for sexually transmitted infections

Hypersensitivity reactions

Vulvovaginal erythema, edema, pruritus (often intense), vaginal discharge

History of recent use of hygiene sprays or perfume, bath water additives, topical treatment for candidal infections, fabric softeners, bleaches, or laundry soaps

Physical examination alone

Skin disorders (eg, psoriasis, lichen sclerosus, lichen planus)

Characteristic genital and extragenital skin findings

Usually physical examination alone

Sometimes biopsy