Toddler Vagina

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Mild Skin Rash near Genital Area - Treatment
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Posted on July 6, 2020 August 10, 2021 by Susan Taylor

Posted on July 6, 2020 August 10, 2021 by Susan Taylor

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When it comes to little vaginas there’s not too much you need to worry about. That said, they can get itchy, sore, irritated and infected from time to time so it’s good to know how to identify, treat and prevent these issues – especially because babies won’t be able to tell you what’s wrong. Here are seven problems to look out for down below.
Thrush is a fungal infection caused by an overgrowth of the yeast, Candida albicans, which is naturally found on the skin or in the gut. A small amount of the yeast can be found in the vagina too and this is mostly harmless, unless the yeast numbers grow.
Symptoms of vaginal thrush can include itching or burning, a white discharge and stinging or burning while urinating. Vaginal thrush is often caused by wiping your baby’s bottom from back to front (so spreading the Candida albicans from the anus to the vagina) or using soaps to clean the genital area.
Once you see symptoms of vaginal thrush, you can quickly clear it up with an over-the-counter thrush cream available from the chemist, and after that, make sure that you use a soap substitute when cleaning the area, as well as ensure you are wiping in the right direction.
It is worth noting too, that there is another form of thrush – oral thrush – that breast-fed babies sometimes get when candida is transferred from their mother’s nipple to their mouth. Oral thrush requires a different treatment.
Vulvovaginitis is when the vagina and vulva are inflamed which can be pretty painful and uncomfortable. It’s common in very young girls because the lining of their vagina and vulva is quite thin which means it can easily be irritated. Many things can cause this, such as moisture and dampness in the area, tight nappies or clothing, soaps and threadworms.
Other signs your child might have vulvovaginitis include redness on the outside vaginal area, pain during or after she urinates, itchiness in the area and discharge from the vagina. When vulvovaginitis is mild, it can be treated by putting them in loose clothing and avoiding things like bubble baths and soaps. Adding some white vinegar to the tub and using nappy rash cream can also help soothe symptoms. If there is any blood, or your child seems very distressed, take them to the doctor.
While it’s prevalent for young children in nappies (both boys and girls) to get a Urinary Tract Infection (UTI) , it is essential to attend to one immediately. If left untreated, it can cause kidney damage. Signs of a UTI include fever, appearing to be in pain when urinating, vomiting, seeming generally unwell, smelly or discoloured urine, pain in their lower abdomen, or attempting to urinate more frequently than usual.
A urine infection occurs when bacteria get into the urethra or bladder, usually from poo or bowel germs after wearing a nappy. If you suspect a UTI, take your daughter to the doctor immediately for a urine test. If positive, your child will be required to have antibiotics, possibly an ultrasound and a brief hospital stay. She will need a lot of rest and fluids once she is back at home. Ways to prevent a UTI include wiping from front to back when changing your child’s nappy or helping them on the toilet, avoid leaving them in a dirty nappy for long periods of time and steer clear of soaps and other irritants.
Apparently up to one third of all babies and toddlers have nappy rash at any time – although newborn babies are less prone to this condition (possibly because we change their nappies so often!) – so this is clearly a pesky condition that likes to bother little bottoms.
Nappy rash causes red patches on the bottom and over the genitals with skin that looks sore and raw and feels hot to touch. If extreme, you may see broken skin with pimples or blisters in patches. Nappy rash can be really uncomfortable and may make your baby pretty unhappy.
The most common causes of nappy rash include: your baby’s skin being in contact with a wet or dirty nappy for too long; a wet nappy rubbing against the skin; or using soap on the skin (causing it to dry out) – so the best ways to tackle nappy rash are to ensure that you change your baby’s nappy often, as well as giving her bottom plenty of fresh air to dry the skin well before putting a clean nappy back on, as well as avoiding using any products that are drying, like soap or alcohol.
Nappy rash is equally common in baby girls and boys, however, with more bits to clean and care for, little girls can seem more prone to nappy rash. With a bit of loving care and the proper time given to cleaning and drying your baby girl’s genitals at each nappy change, you will keep her rash-free most of the time.
The most common intestinal worm that children get is threadworm (also called pinworm). They look like tiny white threads (hence the name) and come out of the anus to lay eggs at night, which is why kids get very itchy bottoms especially in the evenings. In little girls, though, the worms often travel into the vagina as well, which can lead to scratching, causing redness and irritation. Not only are worms itchy and uncomfortable for children, but they will also interfere with their sleep and can cause a low appetite. T hreadworms spread very easily (usually via scratching and the eggs transferring to their fingernails and then the mouth), so the whole family will need to be treated quickly, even if they have no symptoms.
To treat worms, buy the medicinal worm chocolate squares from the chemist and give them to your child. Ensure she has a shower (not a bath) before bed, thoroughly cleaning her bottom and genitals. As for the rest of the house, vacuum carpets, clean surfaces including door handles and wash all bedding and towels in hot water to kill any eggs. To prevent worms, encourage good hygiene with your child by washing her hands regularly (especially after toilet visits), keeping fingernails kept short and not letting her eat food that’s been on the floor.
Also called labia adhesion, this is when the labia (outer lips of the vagina) become stuck together with a very thin membrane. It usually occurs between the ages of one and two and is most likely caused by a previous infection. If you’re worried, please speak to a doctor; however, in most cases, it usually rectifies itself over time without any treatment or surgery.
Vaginal or hymenal skin tags occur in about ten percent of all female newborns and are caused by a swollen hymen due to oestrogen passed down from the mother. They will look like a small, smooth pink tissue coming out of the vagina and will usually disappear after about two to four weeks on their own with no treatment required.
While things beyond our control cause some of the above conditions, when it comes to infections, prevention is the key. Here are some vaginal care tips to remember for keeping your child’s genitals healthy.
If you are at all concerned about a vaginal issue your child might have or suspect a UTI, please speak to your doctor.

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Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?
Selected Differential Diagnosis of an Abnormal Vaginal Opening in a Child
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NIKHIL HEMADY, MD, AND DHARMESH SHAH, MD, North Oakland Medical Center, Pontiac, Michigan

Am Fam Physician. 2008;77(3):355-356
Author disclosure: Nothing to disclose.
A two-year-old girl's mother was concerned that her daughter's vaginal opening appeared to be closed. The mother had noticed this a few months earlier when her daughter had severe diaper rash. The patient did not have urinary problems or vaginal discharge, and her birth and development histories were unremarkable. Genital examination revealed a thin vertical raphe over the site of the vaginal opening (see accompanying figure) . The labia majora were intact and separated, although only the upper third of the labia minora was identifiable.
The answer is C: labial adhesions. Labial adhesions are acquired abnormalities involving the labia minora, but not the labia majora. Adhesion is the most common interlabial abnormality in child urology patients. 1 The adhesion usually begins at the posterior fourchette and extends to varying degrees superiorly to the clitoris. The abnormality is generally discovered between 13 and 23 months of age by the child's parents or by the physician during a routine well-child examination. Most cases occur before six years of age. 2
Children with labial adhesions usually have a history of a local inflammatory process, such as diaper rash. Most patients are asymptomatic; however, the adhesions occasionally cause local inflammation, recurrent vulvovaginitis, or recurrent urinary tract infections. Adhesions do not occur in newborns, presumably because of the protective effect of circulating maternal estrogens.
Treatment of adhesions is nonsurgical and includes application of topical estrogen cream. Estrogen cream applied daily to the affected area for one to two weeks has an effectiveness rate between 49 and 90 percent. 3 , 4 Occasionally, six to eight weeks of therapy is needed. 5
Cleaning the affected area and keeping the labia separated with short-term (one to two months) application of a petrolatum-based barrier ointment (e.g., Vaseline) can help prevent recurrence. Simple hygienic measures may be sufficient for asymptomatic children because most adhesions resolve during early puberty. 5 Topical steroids may also be effective, but they have not been prospectively studied. 6 Surgical treatment is reserved for patients with unresponsive cases.
Bartholin's gland is a small vestibular gland located bilaterally between the labia minora and hymen. Occasionally, the duct of the gland becomes obstructed, causing unilateral vulvar swelling. Bartholin's gland abnormalities are uncommon in children.
An imperforate hymen is the most common congenital obstructive anomaly of the female reproductive tract, 1 although it may not be diagnosed until adolescence. The labia are intact in affected patients. An imperforate hymen should be suspected in an adolescent presenting with primary amenorrhea; cyclic abdominal pain; and a bluish, bulging hymen. Newborns with this condition may have a bulge at the posterior introitus, representing retained vaginal fluid. Referral to a pediatric urologist is recommended for surgical repair of the hymen.
A complete transverse vaginal septum may occur at various levels inside the vagina, although most are located in the upper vagina. 1 Patients have a vaginal opening, and the labia are intact and separated. Non-fusion or canalization of the urogenital sinus and müllerian ducts cause the abnormality. Children are usually asymptomatic, but they may present with amenorrhea and a distended upper vagina during adolescence. Transperineal ultrasonography and magnetic resonance imaging (MRI) can help establish the diagnosis and determine the location and thickness of the transverse septum. Treatment is surgical resection.
Vaginal atresia is suspected when a vaginal opening cannot be identified and, instead, a shallow dimple is seen inferior to the urethral opening. Failed formation of the lower portion of the vagina leads to the condition. The labia are intact and the upper vagina, cervix, and uterus are normal. Palpation of a distended vagina on rectal examination may help to distinguish vaginal atresia from agenesis (failed formation of the upper vagina or testicular feminization). Ultrasonography with or without MRI is necessary to define the abnormal anatomy. Patients should be referred to a pediatric urologist for surgical reconstruction.
Address correspondence to Nikhil Hemady, MD, FAAFP, at nhemady@nomc.org . Reprints are not available from the authors .
Author disclosure: Nothing to disclose.
Rink R, Kaefer M. Surgical management of intersexuality, cloacal malformation, and other abnormalities of the genitalia in girls. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology . 9th ed. St. Louis, Mo.: Saunders; 2007.
Vulvovaginitis. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics . 17th ed. St. Louis, Mo.: Saunders; 2004.
Muram D. Treatment of prepubertal girls with labial adhesions. J Pediatr Adolesc Gynecol. 1999;12(2):67-70.
Aribarg A. Topical oestrogen therapy for labial adhesions in children. Br J Obstet Gynaecol. 1975;82(5):424-425.
Omar HA. Management of labial adhesions in prepubertal girls. J Pediatr Adolesc Gynecol. 2000;13(4):183-185.
Myers JB, Sorensen CM, Wisner BP, et al. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol. 2006;19(6):407-411.
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Labia are intact; vaginal opening is intact, but obstructed by the hymen; congenital
Labia majora are intact; however, labia minora are fused together; vaginal opening is obstructed to varying degrees; not present at birth, but typically develops between 13 and 23 months of age
Labia are intact; vaginal opening is present, but obstructed by a transverse septum, typically in the upper vagina
Labia are normal; distal vagina is absent; shallow dimple inferior to the urethral opening

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