[Genital infections in prepubertal girls]

Vulvitis and vulvovaginitis are the most common gynecologic complaint in prepubertal girls. The frequently observed therapeutic failures are due mainly to lack of knowledge of the characteristics of this age group, of age and development in appropriate diagnostic procedures and of therapeutic measures similar to those in the adult female patient. Prepubertal girls are anatomically, physiologically and behaviorally at relative risk for vulvovaginitis. Symptoms include pruritus, genital pain, "vulvar dysuria" and discharge. History taking and a general pediatric examination are mandatory, thereafter an age appropriate careful anogenital examination should follow. It requires time, patience and knowledge of the different non traumatizing examination techniques. The findings in girls with vulvovaginitis are variable and erythema, excoriations and discharge can be found. The genital inspection and the use of microscopy and microbiologic studies are helpful in planning an appropriate therapy. The majority of vulvovaginal infections in children are nonspecific but they can also be caused by specific organisms and are mostly bacterial. Yeast infections are not found in otherwise healthy prepubertal girls. The therapeutic approach consists of improved anogenital hygiene, sitz/tub baths and use of non irritating soaps. However if an abnormal population of bacteria is present antimicrobial therapy should be considered. Reassurance and a review of preventive methods are crucial in the management of girls with vulvovaginitis.