Vulval Disease in Children

Introduction

Young children in primary school sometimes complain of itching and soreness of the vulva. This is nearly always due to a harmless skin disease. The commonest causes are:

• Irritation from soap, bubble bath, nylon clothes and chlorinated water
• Dermatitis (eczema)
• Psoriasis

Much less commonly infections such as worms and bacteria, a skin condition called Lichen Sclerosus (which appears white), foreign bodies in the vagina and reactions to pain killers (eg paracetamol and ibuprofen) can cause vulval discomfort in children. In very small children the inner lips of the vagina may get stuck together (labial fusion) and this may also cause some discomfort and difficulty urinating.

The emotional impact of a vulval problem in a child can be quite severe. Girls with vulval problems often wake up very distressed at night with night terrors. In these days when there has been so much publicity about paedophiles, it is only natural for these thoughts to occur to parents and sometimes teachers. As a result everyone is very worried and this can make the symptoms seem even worse.

Many children with vulval itching are assumed to have thrush. This is hardly ever true. Thrush infection of the vagina does not happen before puberty in healthy children.

In most children, vulval pain and itch is the result of a physical skin complaint or an infection with a bacteria called Streptococcus (the same one that causes tonsillitis), not sexual abuse.

What should I do if my child complains of vulval itching?

Firstly don’t worry that something frightening or serious is going on. See your doctor, but while you are waiting for an appointment try the following suggestions.

Skin care in children with vulval disease

• Do not allow your child to use soap on her vulva. Use a soap substitute.
• Remove all the bubble bath from your bathroom.
• Don’t shampoo in the bath.
• If your child is wearing nappies at night, this may be aggravating the problem. Can she do without them?
• Don’t use perfumed wipes.
• Use hypo-allergenic toilet paper, easily obtained from supermarkets.
• Having a bath with a moisturising bath additive such as bath oil or bland moisturising cream is the best way to wash. If your child has a shower, make sure she understands how to wash her vulva and anal area. You may need to supervise.
• Only wear cotton underwear. Avoid wearing underwear at night.
• If your child does ballet, gymnastics or similar sports that require her to wear close fitting nylon or lycra tights or clothes, these are likely to irritate her skin. They may be compulsory for competitions or other special events, but can she wear loose cotton clothes for practice sessions?
• Are nylon tights part of your child’s school uniform in winter? Will the school let her wear long socks? If needed your doctor can give you a certificate.
• Does your child have trouble with any form of incontinence either urine or faeces? This is likely to be part of the problem. Ask your doctor what you should do.
• Does your child do swim lessons or training in a chlorinated pool? Apply some petroleum jelly (Vaseline) beforehand, and shower afterwards. Don’t let her go home in her wet swimming costume.
• Don’t use antifungal creams or other over-the-counter medications, and avoid perfumed moisturisers on the vulva. Sorbolene cream may sting. Try nappy rash cream but ask your doctor and stick with what your doctor has recommended.
• If itch is a problem and you as yet haven’t had any medical advice, you can apply 1% hydrocortisone ointment (not cream) available over the counter from your chemist. Be prepared for your chemist to caution you about the dangers of cortisone but don’t be scared by such advice. Mild cortisones that are available over the counter are very safe, but see your doctor as soon as you can for further advice.