Infantile vulvovaginitis

　　One, etiology

　　1. Anatomical characteristics of infants and young children Poor development of the vulva in girls makes it easy for bacteria to invade.

　　2. The vaginal environment of infants and young children is different from that of adults. Within a few hours after birth, bacteria can be detected in the vagina. Due to the influence of maternal estrogen and placental estrogen, the vaginal epithelium is rich in glycogen, and the vaginal pH value is low, at 4-4.5. At this time, the dominant flora in the vagina is Lactobacillus. After 2-3 weeks of birth, the estrogen level decreases, the pH value rises to 6-8, and it is susceptible to infection by other bacteria.

　　3. Poor hygiene habits in infants and young children Unclean vulva, fecal contamination, vulvar injury, or pinworm infection can all cause inflammation.

　　4. Accidental insertion of foreign objects into the vagina Curiosity leads to the insertion of rubber, buttons, fruit seeds, hairpins, and other foreign objects into the vagina, causing secondary infection.

　　Disease Mechanism

　　Infants and young children have poor development of the vulva, which cannot cover the urethral orifice and the anterior fornix of the vagina, making it easy for pathogens to invade. Common pathogens include Escherichia coli, Staphylococcus, and Streptococcus. In addition, Neisseria gonorrhoeae, Trichomonas, and Candida albicans are also common pathogens. Escherichia coli is the most common, accounting for about 80%. Within the first 2 weeks after birth, the vaginal discharge of newborns is acidic, with a pH value of about 5.5. After that, the estrogen excreted from the mother is almost exhausted, the estrogen level decreases, the vaginal epithelium gradually becomes thin, and glycogen decreases. The discharge is mostly alkaline or neutral, the vaginal pH value rises, and Lactobacillus is no longer the dominant flora in the vagina, leading to a decrease in resistance. Infants and young children themselves have poor resistance to infection, and poor hygiene habits during care, unclean vulva, direct contamination by feces, pinworms, etc., can cause vulvar itching, skin scratching, mucosal injury, and foreign bodies in the vagina, leading to bacterial invasion and inflammation.

　　Due to the infection of the vulva and vagina, the protective barrier of the vagina and vulva can be destroyed, which is easy to induce trichomoniasis and candidiasis infections, causing fungemia. Secondly, due to the infection of vaginitis, the resistance of the baby is low, and the pathogen can ascend to infect the cervix and uterus, causing cervicitis, even sepsis and infectious shock, so attention should be paid to the infection of infants and young children.

　　Some children often cry and be restless due to vulvar pain or itching, which is caused by a large amount of secretion stimulation leading to vulvar itching, causing the child to cry, be restless, or scratch the vulva with their hands. The main symptoms are increased vaginal discharge, which is purulent. Clinically, it is often found by the mother that the infant's underwear has purulent discharge and seeks medical attention. Some children have urinary tract infections, with symptoms of urgency, frequency, and dysuria. Some have adhesion of the labia minora, the urine stream becomes thinner or divided during urination, and examination can show that the vulva, clitoris, urethral orifice, and vaginal orifice mucosa are congested and edematous. The adhesion of the labia minora is thin and translucent, and purulent discharge comes out from the vaginal orifice. In severe cases, ulcers can be seen on the vulva surface, and the labia minora can be adherent. The adherent labia minora sometimes cover the vaginal orifice and urethral orifice, and there can be a fissure above and below the adhesion. Urine is excreted through the fissure, and sometimes it is misdiagnosed as congenital malformation of the reproductive organs.

　　This disease is only seen in infants and young children. Vulvar itching often causes the child to cry and be restless, scratching the vulva with their hands, and vaginal purulent discharge can be seen. Examination can show that the vulva, clitoris, urethral orifice, and vaginal orifice mucosa are congested and edematous, and the pathogen can be found in the secretion examination.

　　1. Clean the vulva with female hygiene fluid every day;

　　2. Change underwear every day;

　　3. Pay attention to wiping from front to back after defecation to avoid fecal contamination of the vulva;

　　4. When the parents have candidal vaginitis, the cleaning utensils (bathtub, towel, bath sheet, etc.) should be separated from the child to avoid cross-infection;

　　5. When there is an infection in other parts of the child's body, do not arbitrarily use antibiotics, or follow the doctor's advice, and the duration of medication should not be too long. Avoid dysbiosis (if antibiotics are used for a long time, it will cause dysbiosis of the flora);

　　Children with diabetes (changes in urine acidity and alkalinity can also lead to candidal vaginitis) should be paid attention to by parents. Use female hygiene fluid to clean the vulva and actively treat to reduce the occurrence of candidal vaginitis.

　　Use a fine cotton swab or straw to collect vaginal discharge to find Trichomonas, Candida albicans, and perform Gram staining or bacterial culture on the vaginal discharge smear, drug sensitivity test, to find pathogenic bacteria including Neisseria gonorrhoeae, mycoplasma, chlamydia, etc., to clarify the pathogen for diagnosis; drug sensitivity test is convenient for treatment.

　　Perform anal examination to exclude vaginal foreign bodies and tumors or perform vaginal examination under anesthesia to exclude vaginal foreign bodies and tumors.

　　It should be noted that some stimulating foods cannot be eaten by babies, and spicy foods should be avoided. Eating too much of this kind of food is prone to dryness and heat, causing internal organs to accumulate heat and toxicity, which can worsen symptoms; seafood should be avoided as it can help grow dampness and heat, making vulvar itching worse after eating, which is not conducive to the regression of inflammation; sweet and greasy foods should also be avoided. Sweet and greasy foods have the effect of increasing dampness and heat, which can increase the secretion of leukorrhea and affect the effectiveness of treatment.

　　Keep the vulva clean and dry, reduce friction. Do not wear open pants to reduce the chance of vulvar contamination. After urination and especially after defecation, the vulva should be cleaned to avoid using soaps or bath liquids with strong irritants. After cleaning, sprinkle baby powder or zinc oxide powder to keep the area dry. In the acute stage, sit in a potassium permanganate solution at a concentration of 1:5000 for 2-3 times a day, each for 10-15 minutes. After sitting in the bath, wipe the vulva with a cloth and apply antibiotic ointment such as erythromycin or gentamicin ointment. For those with significant itching, hydrocortisone cream can also be applied.

　　For the treatment of pathogens, choose corresponding oral antibiotics or use a straw to drop antibiotic solution into the vagina.

　　For those with pinworms, deworming treatment should be given; if there is a foreign body in the vagina, it should be removed promptly.

　　For those with adhesions of the labia minora but not very tight, they can be gently separated downwards and outwards with the fingers after disinfection, generally they can be separated. They can be coated with 0.1% estrogen cream for 10-14 days, and for those with more firm adhesions, a curved mosquito-type hemostat can be inserted into the small hole, then vertically backward, separating the transparent sections. The wound should be coated with 40% purple grass oil or antibiotic hydrocortisone cream, or antiseptic vaseline cream every day to prevent re-adhesion until the epidermis is normal. For more stubborn cases, ethinyl estradiol can be locally applied in the purple grass oil or the aforementioned cream.