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.
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.
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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