INFECTIONS AND OTHER PATHOLOGIES IN PREPUBERTY (Part Two)

Physical Examination

- To perform a correct physical examination, the doctor must be specialized in children and have good knowledge about them.
- Have something to calm and focus the child (e.g., reading a book by the mother)
- Have a warm, tidy environment and good light for examination
- If vaginal secretions are noticed during the examination, material is taken for culture

General rules for therapy

- Correct perineal hygiene, wiping carefully from front to back
- Sitz baths twice a day for 30 minutes. Eliminate vaginal secretions from the vulva
- Cotton underwear, not synthetic
- No tight clothing and no tight jeans
- No overly foamy baths
- Urinating with knees apart (prevents urine from entering the vagina)
- Vaginoscopy, excludes a foreign body, a neoplasm or fistulas
- Irrigation of the vagina with 1% Betadine solution
- Cream with estrogen, no more than 3-4 weeks
- Antibiotic therapy, based on the results of the analyses

Some vaginal infections

1 - Bacterial Vaginosis

One of the most common causes of bacterial vaginosis is Gardnerela vaginalis. It is an infection that also affects virgin females. The microbe belongs to the group of facultative anaerobes. It is not known if it is transmitted during the perinatal period.

Clinically, the affected may be asymptomatic or present with: thick, white, fishy-smelling vaginal secretions, local irritation.

The diagnosis is confirmed through the analysis of vaginal secretions and their culture.

Treatment is carried out with metronidazole or clindamycin orally and locally with their creams and gels.

2 - Vaginal Candidiasis

Most often caused by candida albicans. It is a microorganism that is normally found on the skin, oral mucosa, colon, vaginal mucosa. When the body's immunity drops, conditions become favorable for these microorganisms to thrive.

Predisposing factors are: diapers, antibiotic use, diabetes, immunodeficiency.

Clinically, it is expressed with increased vaginal secretions, white, thick like curd, itching, erythema. Sometimes the inflammation can be very pronounced, severe and lead to erosive changes that cause burning during urination and otherwise.

The diagnosis is established through the analysis of vaginal secretions and their culture to evaluate the microbe and the appropriate antifungal.

Treatment is carried out with local and oral antifungal. In children with a weakened immune system, we can use oral fluconazole syrup 4-5 mg single dose, nystatin solution... Use ointments with antifungal such as miconazole, econazole, nystatin, clotrimazole, terconazole... In an intensive and wide erythema, we can also use hydrocortisone ointment.

3 - Chemical/irritant/allergic Vaginitis

This type of vaginitis is caused by various agents that cause irritation to the skin in the external genital area. In the forms of chronic irritation, we can also have adhesion of the labia majora. It is more often encountered in children aged 2-6 years.

The causing factors are nonspecific such as: local irritation from soap, overly foamy baths, shampoo, diapers, various lotions used locally, synthetic underwear.

The treatment in this case is the termination of contact with these irritating substances, discontinuation of their use, maintaining good perineal hygiene, treatment with local hydrocortisone cream to soothe symptoms, in labial adhesion local treatment with estrogen cream is done.

4 - Cutaneous Pathologies

Cutaneous pathologies often cause the development of vulvovaginitis. Mentioned are: psoriasis, eczema, lichen sclerosis...

Mostly affect the labia majora, minora, and other parts of the body.

Lichen Sclerosis

Lichen sclerosis leads to vulvovaginitis and vaginal bleeding. It is often associated with autoimmune diseases. The lesions are small, cyclamen in color, are flat papules that lead to the formation of plaques that can become atrophic and are located on the vulva and perineum.

The most common complications are: excoriation and secondary infection.

Treatment includes good hygiene, local corticosteroid ointment, antiseptic, and antibiotic.

Lichen Simplex Chronicus

It is a chronic eczematoid inflammatory disorder that presents with pruritic plaques that cause vaginal bleeding and excoriation. It is in the primary and secondary form. The primary form is most often caused by exposure to irritating substances, leading to chronic irritation, scratching, and this leads to a localized and isolated area of pruritus. The secondary form is a reaction to another vulvar disease such as lichen sclerosis or planus.

Treatment is done with steroid creams and antihistamines.