Vulvar Disorders in Young Girls
By Frederick R. Jelovsek, M.D.,
Vulvar diseases are usually considered problems of older women. They can, however, occur in girls prior to their first menses (prepubertal) and when they do, they encompass a wide range of conditions and are often different problems than seen in older women.
In a recent literature review, Fivozinsky KB, Laufer MR: Vulvar disorders in prepubertal girls: A literature review.J Reprod Med. 1998;43:763-773, the different conditions seen were summarized. The occurrence ranged from newborns to toddlers to girls before they started their first menstrual periods.
Causes Of Infection
In addition to diaper rash, infants have an increased risk of skin infection because the sweat gland function is not fully developed and skin is continually exposed to urine and feces. Milaria rubra is a skin rash with blisters and pustules due to sweat gland obstruction and overheating. Impetigo is another skin rash with vesicles that crust over and is caused by staphylococcal and streptococcal organisms.
Labial adhesions in which the lips create a flat, scarred appearance can occur in young girls less than 6 years of age. It's cause is unknown but it responds to topical estrogen creams. Since the anus is closer to the vulva in young girls and they lack the protection of the vulvar fat pads and hair that older women have, they are more prone to a vulvar infection by gastrointestinal bacteria such as shigella or Yersina enterocolitica. Pinworms can infect the vagina and cause a secondary vulvitis just as a foreign body in the vagina (toilet tissue, hair pins, pieces of stick etc.,) by a 2-4 year old can cause vaginitis and vulvitis.
A true bacterial vulvitis is most commonly caused by staph or strep or haemophilus influenzae. Yeast (candida) is rare in the prepubertal girl except as seen with diaper rash, antibiotics or diabetes. Other fungal infections can occur and many have no cause found. Occasionally, overly aggressive cleaning regimens can break down the skin of the vulva and actually cause vulvitis.
Allergic and contact dermatitis occurs in prepubertal girls just as it does in any women. About 48 hours after exposure to a sensitizer, a rash, occasionally blisters and often itching and burning takes place. Common allergic sensitizers include topical steroid preparations, local anesthetics, benzyl alcohol, propylene glycol, feminine hygiene sprays and deodorized sanitary products, nickel, rubber, latex, neomycin sulfate, Balsam of Peru, and nickel sulfate. Irritant dermatitis, on the other hand, gives an immediate stinging and burning and redness. Common irritants include soaps, alcohol, propylene glycol, fragrances, adhesives and even bromide in swimming pools.
Viruses And Bacteria
Viral infections can affect the vulva such as herpes, molluscum contagiosum, chickenpox, and human papilloma virus (HPV). With HPV and herpes infections in young girls, doctors always worry about the possibility of sexual abuse, but they can sometimes happen by hand contact.
Non bacterial inflammation can take place with conditions such as lichen sclerosis (an itchy white/red lesion around the opening), lichen planus (small violet color polygon spots), and lichen simplex chronicus (a rash from incessant rubbing and scratching). Skin manifestations of drug reactions, psoriasis, pemphigoid, and skin rashes of generalized medical diseases can also occur just as it can in later years.
Tumors of the vulva are fortunately rare in childhood; moles (nevi) and hemangiomas (vascular birth marks) are more frequent, while smooth muscle tumors or melanomas are not.
In summary, there are many of the same processes that occur on the vulva in children as do in older women. So if there is any indication of a problem, the same biopsy steps should be carried out if they would be indicated in older women. There are unique problems, especially infectious vulvar problems that may take different diagnostic detective work and therapies to tackle these unusual problems in female children.
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