What to do if the girl has reddened labia. What does vulvitis look like in girls? The girl has red pussy what to do

Vulvitis - inflammation of the female external genitalia due to injury or infection. Vulvitis can affect the vestibule of the vagina, the labia, the clitoris, the outer part of the urethra. The disease ranks first among all gynecological infections in girls aged 1-8 years. It is about 65-70%.

Primary vulvitis in girls is more common due to the anatomical features of the genitals. With prolonged and recurrent vulvitis at a younger age, in the future there may be a violation of the menstrual cycle, problems with reproduction.

Causes

At birth, girls' genitals are sterile. Gradually, conditionally pathogenic microorganisms appear on their mucosa. Initially, the vaginal environment has a slightly alkaline or neutral pH. There are no lactobacilli in the smear, leukocytes and mixed microflora are present. Lactobacilli appear at puberty. Gradually, the vaginal environment is oxidized, glycogen begins to be produced. It becomes similar in composition of the microflora of sexually mature women in girls with the advent of menstrual cycles.

The immediate causes of vulvitis are nonspecific or specific infections:

• viruses (adenovirus, influenza, papillomavirus);
• fungi;
• protozoa;
• chlamydia;
• gonococci.

Ways of transmission of infection:

• in newborns, infection can occur when passing through an infected birth canal;
• at a younger age, the household way prevails (in places of mass use, in case of non-compliance with hygiene rules);
• with sexual experience in adolescents - sexually.

Often vulvitis occurs in the presence of helminthic invasions or penetration of foreign objects (grains of sand, insects, blades of grass) into the genitals.

Secondary vulvitis in girls develops as a result of the spread of infection into the vulva from other foci (with tonsillitis, caries).

Fungal infection of the vulva is due to:

• taking antibiotics;
• endocrine disorders;
• weakening of the immune system.

If an allergic reaction occurs to certain irritants (fragrant detergents, pads, chocolate, citrus fruits), atopic vulvitis develops. It doesn't occur often.

The mucous membrane of the genital organs can be damaged with frequent diligent washing with soap, wearing tight underwear, improperly selected diapers.

Anomalies of the genitals also predispose to vulvitis:

• no posterior commissure;
• abnormal development of the external genitalia;
• low position of the urethral opening.

Signs and symptoms

Symptoms of vulvitis in children are in many ways similar to other infections of the genital organs (colpitis, vulvovaginitis).

Signs of the disease:

• burning and itching;
• pain in the genital area, which becomes more intense when urinating;
• swelling and redness of the clitoris, labia, vulvar mucosa;
• sometimes there are erosions and sores on the mucosa.

Vulvitis in girls is characterized by vaginal discharge (leucorrhea). They can be different, depending on the type and cause of the disease. They are mostly clear, but can sometimes be purulent or bloody. If the cause of the disease is Escherichia coli, then the whites have an unpleasant fecal odor and a greenish-yellow color. If the infection develops when the vulva is affected by staphylococci, they are viscous and yellow. Fungal vulvitis is accompanied by cheesy, white discharge.

Sometimes the disease can be accompanied by general symptoms:

• temperature increase;
• enlarged lymph nodes;
• nervousness;
• sleep disturbance;
• irritability.

If pinworms provoked vulvitis, the anal folds thicken and redden in girls, abdominal pain appears, and appetite worsens.

When the disease becomes chronic, the swelling and hyperemia become less pronounced, and itching and leucorrhoea persist. With relapses of vulvitis, complications can develop in the form of cystitis, cervical erosion, urethritis, and vaginal atresia.

Diagnostics

The disease can be diagnosed by a pediatrician. But a pediatric gynecologist should examine, observe and treat the child. He examines the genitals, uses instrumental vaginoscopy and vulvoscopy.

To identify the causative agent of the infection, laboratory diagnostic methods are prescribed:

• bakposev and microbiological examination of the smear;
• scraping by PCR;
• general analysis of blood and urine;
• analysis of feces for worms;
• scraping for enterobiasis;
• allergy tests.

A selection of effective treatments

Treatment of vulvitis in girls consists of a set of measures depending on the etiology of the infection.

Note! It is possible to treat a child at home only if the disease proceeds in a mild form without complications.

Nutrition and mode

In an acute process, girls need to provide bed rest. At the time of illness, you should change the diet. Reduce the intake of foods that promote the formation of acids and spices (fried, meat broths, smoked, pickled vegetables, sour fruits). In the diet, you need to increase alkalizing foods (milk, fresh and boiled vegetables). If vulvitis is allergic in nature, a hypoallergenic diet is indicated. It implies the exclusion from the diet of allergenic foods:

• nuts;
• eggs;
• citrus;
• chocolate;

After an acute period, to restore the microflora of the vagina and intestines, you can diversify the menu with fermented milk products.

Local therapy

It is indicated for the elimination of hyperemia and swelling of the genital organs, the removal of unpleasant symptoms of burning and itching. For this, disinfectants are used in the form of baths, irrigations, lotions.

Local antiseptics:

• A solution of potassium permanganate (light pink shade);
• Chlorhexidine;
• Miramistin;
• Furacilin;
• Chinosol.

Herbal infusions:

• calendula;
• chamomile;
• sage;
• nettle;
• succession;
• oak bark.

Read the instructions for use of Ambrobene solution for inhalation at the address.

Inflamed areas can be effectively treated with ointments:

• Tetracycline (after 8 years);
• Olethetrinic;
• Sangiviritin 1%;
• Erythromycin.

Apply the ointment carefully on pre-washed and dry genitals. Prolonged use of ointments is not recommended. If the inflammation does not go away, you need to show the child to the doctor to correct the treatment.

With the recurrent nature of the disease, estrogens (Folliculin, Estriol) are applied topically to accelerate the reparative processes.

Systemic treatment

When the nature of the vulvitis and its causative agent are determined, the doctor may prescribe oral medications.

Candidiasis vulvitis is treated with antimycotic agents:

• Levorin;
• Fluconazole;
• Itraconazole.

At the same time, inflammation sites are treated locally with antifungal ointments (Clotrimazole, Decamine ointment).

When trichomonads are detected within 7-10 days, the following are prescribed:

• Metronidazole;
• Tinidazole;
• Ornidazole.

With prolonged trichomonas vulvitis with relapses, Solcotrikhovac is administered intramuscularly (3 injections of ½ ml every 14 days). A second injection is carried out in a year - ½ ml once.

Gonococcal infections are treated with cephalosporin antibiotics:

• Cefatoxime;
• Cefix;
• Ceftriaxone.

In the presence of chlamydia and mycoplasmas, broad-spectrum antibiotics are prescribed:

• Sumamed;
• Doxycycline.

Vulvitis against the background of helminthic invasions begins to be treated with anthelmintic drugs:

• Wormil;
• Pirantel;
• Levamisole;
• Albendazole.

General state normalization

Be sure to take desensitizing agents with vulvitis to relieve swelling and itching:

• Suprastin;
• Tavegil;
• Zyrtec.

Enzymatic agents for the normalization of digestion:

• Baktisubtil;
• Creon;
• Wobenzym.

Immunomodulators to increase the protective functions of the body:

• Immunal;
• Immunoflazid.

Folk remedies and recipes

In the treatment of vulvitis in girls, traditional medicine methods can be highly effective. Recipes:

• Infuse 1 tablespoon of St. John's wort in 200 ml of boiling water for 1 hour and strain. Take orally three times a day, 50 ml.
• 1 spoon of dried viburnum flowers pour a glass of water. Leave in a water bath for 10 minutes. Filter and drink 1 scoop three times a day.
• To relieve itching and burning, baths and washing with a decoction of chamomile or oak bark (2 tablespoons per 1 liter of water) are used externally.

Prevention measures

Preventive measures against this disease should be based on careful care for the genitals of girls and instilling hygiene rules from an early age:

• In infants, change diapers and diapers immediately after contamination.
• Wash the perineum from front to back after each emptying.
• Wash underwear with a hypoallergenic detergent, rinse it well.
• Change panties twice a day.
• Soap should not be used to wash the perineum more than once a day. Its pH should be neutral.
• Linen should be made from natural fabrics that do not contain aggressive dyes.
• Do not use aromatic oils, powders, creams.
• Have separate hygiene items (washcloth, towel).

It is better to prevent any disease than to spend great efforts to treat it. Vulvitis in girls often occurs due to improper care of the genitals. Therefore, from an early age, parents should pay great attention to the hygiene of the child, timely detect infections and treat them. This will help to avoid unpleasant consequences for women's health in the future.

Video. Dr. Komarovsky about the causes of vulvitis and vulvovaginitis in girls:

Diseases of the organs of the reproductive system occur not only in adult women, but also in girls. They may develop vulvitis, vaginitis, anomalies of the genital organs. The problems of the sexual sphere in girls are dealt with by a pediatric gynecologist.

Approximately 10% of girls under 2 years old have synechia - fusion of the labia (small or large). This developmental defect generally does not pose a serious danger. But if a film forms between the lips and the splice is large enough, then this causes a lot of inconvenience to the child and can lead to unpleasant consequences in the future. Therefore, specialist supervision and treatment for synechia is mandatory.

Reasons for the development of pathology

The fusion of the labia is most often a congenital anomaly. This has an insufficient amount of estrogen in the body of a woman during pregnancy. Other factors can also lead to synechia:

• Frequent washing of the genitals. The girl's genitals must be kept clean. But it must be done in moderation. Intense and too frequent washing can cause lip fusion. It is harmful to use ordinary soap for washing small children. It acts very aggressively on the delicate membrane of the vulva, and can damage it. The alkaline composition of soap in contact with water can cause redness and irritation of the labia. Then the affected areas begin to heal, forming synechiae. Therefore, it is better to use special delicate products for care.
• Tight clothes made of synthetic fabrics. This cause of the disease is more common in girls 3-8 years old who wear uncomfortable synthetic clothing. There is friction of the tissue on the vulva, which causes the development of a defect. Strongly fitting things provoke an increase in sweating, irritation of the labia. Rough fabric and sloppy seams can also cause friction on delicate skin.
• Presence of urinary tract infections. The labia can grow together under the influence of inflammation. Pathogenic organisms can enter the urethra and genitals with insufficient hygiene, using other people's towels and washcloths, swimming in dirty water, public baths. The infection may be latent, and at first looks like a slight reddening. With untimely treatment, synechia may develop.
• allergic reactions. The disease can occur as a reaction to irritating factors (allergens). The mucous membrane of the vulva is very sensitive to various irritants, from which the tissues become inflamed. Without proper treatment, the labia fuse together.

Signs and symptoms

At the beginning of the adhesive process of the labia, the girl does not experience much discomfort. But with complete or partial splicing, symptoms appear that should not be ignored:

• slow passage of urine and with tension;
• restlessness or crying while urinating;
• direction of the urine stream upward;
• frequent irritation of the genitals and thighs of the child;
• genitals have an atypical structure.

What do synechia look like in girls? Pathology has the appearance of a thin whitish-gray film that connects the labia at different lengths.

What are the dangers of synechia in girls

Synechia, the size of which does not exceed 5 mm, are considered harmless to health. They do not affect the outflow of urine, do not cause pain in girls. There is no need to treat them. But regular supervision of the gynecologist is necessary.

With significant gluing of the labia majora and labia minora, the vagina turns into a closed space. All vaginal discharge begins to accumulate in it. And this is a beneficial environment for the reproduction of pathogenic microflora. First, an inflammatory process occurs, which subsequently leads to an infectious disease.

Note! Synechia tend to progress. The development of the organs of the reproductive system may occur incorrectly. This is a dangerous violation of the reproductive function, which leads to infertility.

Diagnostics

To identify synechia, a simple examination is sufficient. If an accretion of the labia of the child is found, it is necessary to show the doctor, to determine the next course of action. To find out if the adhesive process has become a focus of infection, it is necessary to pass several tests:

• smears;
• urine culture;
• research on urogenital infections;
• Ultrasound of the pelvic organs.

General rules and methods of treatment

Sometimes the treatment of synechia in girls is not carried out if their size is very small and they do not affect the physiological processes in the body. At the same time, there should be constant monitoring by a doctor who will monitor probable inflammatory processes. In the absence of signs of inflammation, it is enough for the child to provide proper hygiene care.

Conservative therapy

It is prescribed in the initial stages of the adhesive process, with minor synechia. It consists in the external application of drugs that contain estrogen (for example, Kolpotrofil). Such agents loosen the tissues in the area of ​​adhesions, separate them. The duration of such therapy should be several weeks (about 3-4).

The cream is applied only to synechia, it does not need to be applied to the nearest healthy tissue. During the first half of the treatment, the agent is applied 2 times a day. Subsequent use: 1 application of estrogen cream once a day, 2 application is replaced by a neutral baby cream. Then you need to completely switch to baby cream. During the treatment period, the child should be shown to the gynecologist at least 1 time in 2 weeks.

Cream application rules:

• apply with a clean finger clearly along the adhesion line;
• when processing adhesions, there should be soft pressure;
• it is forbidden to forcibly try to separate the splicing points;
• during treatment with cream, avoid irritation of the clitoris.

Hormonal creams can be prescribed only if there are no contraindications. Most experts agree that such funds can be used by children only after 1 year. With successful conservative treatment, the girl should be under the supervision of a gynecologist for another year with a visit once a month.

To relieve skin irritation, you can prepare baths using medicinal herbs:

• chamomile;
• series;
• calendula;
• sage.

It is useful to do such baths before applying a hormonal cream.

Surgical intervention

This method is resorted to in case of fusion of a large length and with the ineffectiveness of conservative therapy. During surgery, the synechiae are separated under local anesthesia. As an anesthetic, lidocaine or special creams with an anesthetic effect are used. In rare cases, with very strong adhesions, general anesthesia is done.

After surgery, a course of treatment with Kolpotrofin is carried out in order to exclude repeated relapses. AND the main thing for recovery is compliance with the rules of hygiene and visiting a gynecologist.

In order to prevent the development of such a pathology as synechia, or their reappearance after surgery, one should especially closely monitor the girl's hygiene and teach her to take care of herself from an early age. Recommendations:

• Wash the child after each bowel movement and keep the perineum dry.

• It is necessary to wash the perineum in the direction from the labia to the anus in water of 37 ° C.
• Wash the genitals with clean hands (not sponges and washcloths), nails should be trimmed.
• Underwear should only be made of natural cotton and not dyed in bright colors.
• Do not use wet wipes, creams, powders in the perineal area, except as prescribed by a doctor.
• Replace soap with a special intimate hygiene product.
• There is no need to add flavorings and antiseptics to the water.
• Do not eat allergenic foods.

Synechia is a pathology that occurs quite often. Therefore, parents should respond in time to various alarming symptoms that are associated with the genitourinary system. The disease is dangerous if it causes problems with urination or becomes a source of inflammation. And neglected synechia can lead to problems in the reproductive sphere in the future.

No matter how sad it is to talk about it, but women's problems lie in wait for the girl from the moment of her birth. Vulvitis in girls occupies the top line in the list of gynecological diseases and reaches 70%. The most vulnerable category of girls for this pathology is girls aged 1-9 years. This pathology requires immediate treatment, as it not only causes a lot of inconvenience and anxiety to the child, but also threatens the development of serious complications that may affect sexual and reproductive functions in the future.

What is vulvitis

The vulva refers to the external genital organs, which include the small and large labia, the external opening of the urethra, the clitoris and the vestibule of the vagina. In the case of inflammation of the vulva, one speaks of vulvitis. Vulvitis rarely occurs as an independent disease and is often combined with an inflammatory process of the vagina, so this pathology is called vulvovaginitis.

Classification

Depending on the duration of the disease, vulvitis is divided into:

1. acute (leak up to 1 month)
2. subacute (up to 3 months, alternating periods of exacerbation and remission)
3. chronic

Depending on the age category, the following types of disease are distinguished:

• inflammation of the vulva during infancy (0 to 12 months);
• inflammation of the vulva and vagina in childhood (from 1 to 8 years)
• inflammation of the vulva and vagina in prepubertal age (from 8 years to the onset of menarche);
• inflammation of the vulva and vagina of puberty (after the onset of menarche).

Also, this pathology can be infectious (caused by pathogenic and opportunistic microbes) and non-infectious genesis (trauma, including the introduction of a foreign body into the vagina, burns, allergies, or metabolic disorders).

Infectious inflammation of the vulva is divided into non-specific, which causes opportunistic microflora and specific.

In addition, vulvitis is divided into primary, when infection of the vulva is caused by microbes from outside, and secondary, if there are other foci of infection in the girl's body (carious teeth, tonsillitis, otitis media, etc.).

Causes

The high probability of developing the disease in girls is due to the anatomical and physiological characteristics of the vulva. At the time of birth and a few hours after it, the child's vagina remains sterile and only by the 5th - 7th day of life is populated by opportunistic microflora. The reaction of the vaginal contents of the girl before the onset of puberty remains alkaline or neutral, since there are no lactobacilli that produce lactic acid in the vaginal microflora.

The absence of lactic acid in the vaginal contents reduces local protection against infectious agents, and a reduced number of sweat and sebaceous glands on the skin of the vulva, incomplete closure of the genital slit, delicate and vulnerable skin of the external genitalia increase the risk of developing inflammation of the vulva.

Primary nonspecific vulvitis

The cause of primary nonspecific vulvitis is opportunistic microorganisms that live in a small amount in the vagina (protozoa and yeast fungi, anaerobes, proteus and others).

• Recurrence of episodes of nonspecific inflammation of the vulva is typical for girls who suffer from chronic somatic diseases(pathology of the urinary system, hormonal diseases: diabetes mellitus, hypothyroidism, blood diseases, etc.).
• It is noted that the frequency of inflammatory processes of the external genital organs increases in children who are often ill diseases of the nasopharynx(tonsillitis and chronic tonsillitis, rhinitis, SARS).
• In addition, nonspecific infectious vulvitis can be provoked by helminths (in particular, pinworms),
• penetration into the vagina of foreign bodies during the game (sand, insects, blades of grass).
• Factors that weaken the body's immune defenses, also play a role in the development of the disease (antibiotic therapy, lack of vitamins, immunodeficiency states).

Allergic atopic vulvitis

Separately, it is necessary to highlight the causes of allergic vulvitis (or atopic).

• some highly allergenic foods (chocolate, citrus fruits, strawberries) contribute to its development
• hygiene products with aromatic additives (soap, pads)
• synthetic underwear
• in infant girls, the onset of the disease provokes diaper dermatitis
• excessive enthusiasm of the mother for the hygiene of the child (frequent and unnecessary washing, the use of ointments, powders and creams), which leads to irritation and violation of the integrity of the skin and vulvar mucosa
• non-compliance with hygiene rules and the use of common hygiene items (towels, washcloths) contributes to the development of the disease in older girls
• if a teenage girl is sexually active, the sexual route of infection is not excluded

Specific causative agents of the disease are gonococci and trichomonas, chlamydia and ureaplasma, tuberculosis and diphtheria bacillus, genital herpes virus and papillomavirus infection, fungi and pathogens of childhood infections (measles, scarlet fever and chicken pox).

In newborn girls, inflammation of the vulva may be due to infection of the child during childbirth through an infected birth canal of the mother or transplacental infection.

Clinical picture

Acute vulvitis develops when infectious agents enter the damaged mucosa (intertrigo or mechanical impact, thermal or chemical burns) or due to wetting of the external genitalia with infected urine, as well as with an existing foreign body in the vagina. It should be noted that inflammation of the vulva and / or vagina of non-infectious etiology exists for a short time, since in the near future, microorganisms will colonize the foci of the primary non-infectious process.

The main symptoms of vulvitis include itching and burning of the labia majora and labia minora, mucopurulent discharge from the vagina, in severe cases, purulent discharge. The described signs significantly worsen the general condition of the child, the girl becomes whiny and irritable, her sleep and appetite are disturbed. In case of a severe course, body temperature rises, abdominal pains join, and palpation of regional lymph nodes (inguinal).

Examination of the external genitalia allows a correct diagnosis to be made. In the case of acute inflammation of the vulva, redness and swelling of the labia majora and labia minora are clearly visible, which can spread to the perineum and even the inner thighs.

The constant outflow of purulent discharge from the vagina leads to maceration (the tissues of the vulva soften, loosen and swell) of the mucous membrane, which aggravates the condition of the girl. A pathognomic sign is whites, which have characteristic manifestations for each type of pathogen, and help to make a differential diagnosis.

So, in the case of trichomonas inflammation of the vulva, itching, swelling of the vulva and vagina, as well as liquid and foamy yellow discharge occur. The candidal nature of the disease is evidenced by significant itching of the vulva, its redness and cheesy or crumbly white discharge, tightly soldered to the mucosa. In the case of an inflammatory process of the vulva caused by Escherichia coli, a viscous discharge of a yellow-green color appears, with an unpleasant odor (smell of feces). Severe inflammation, significant itching and burning leads to the appearance of punctate hemorrhages and ulcerations on the vulva. The child tends to comb the affected area, which provokes the formation of ulcers of considerable size and the appearance of bloody-purulent discharge.

In the absence of treatment and a long-term acute process, it passes into the chronic stage, which is characterized only by pathological leucorrhea in a small amount and a weakening of subjective symptoms.

Diagnostics

1. Diagnosis of the disease begins with the collection of anamnesis and complaints.
2. The somatic condition of the child and the factors that create a background for the activation of opportunistic microflora and the development of vulvitis / vulvovaginitis (obesity and exudative diathesis, metabolic disorders, allergies to food and non-food agents, improper or non-compliance with hygiene, etc.) are carefully studied.
3. A gynecological examination is performed, during which edema and hyperemia of the external genital organs, their maceration and ulceration, purulent, curdled, foamy or bloody leucorrhoea with an unpleasant odor are detected.
4. Recto-abdominal examination allows you to palpate foreign bodies in the vagina.
5. Vaginoscopy is mandatory (examination of the walls of the vagina through an intact hymen), if necessary, during the procedure, foreign bodies are removed from the vagina.
6. Since the disease is often combined with inflammation of the urinary tract, a urine test is indicated (general analysis, urine according to Nechiporenko and urine for bacteriological culture).
7. A general blood test, feces for helminth eggs and ultrasound of the pelvic organs are also prescribed.
8. To determine the type of pathogen, swabs are taken for microflora from the vagina and urethra and bacteriological seeding of the vaginal discharge for sensitivity to antibiotics.
9. If inflammation of the vulva of a specific etiology is suspected, PCR and a serological test for genital infections are prescribed.
10. It also shows the determination of blood sugar.

If there are indications, consultations of narrow specialists are appointed: a pediatric allergist, endocrinologist, gastroenterologist and others.

Treatment

Treatment of vulvitis in girls includes a number of specific activities and depends on the etiological factor that led to the onset of the disease:

Mode and diet

All girls with an acute process are shown bed rest, and in severe cases, hospitalization. Temporarily change the diet, increasing the amount of alkalizing foods (fresh, boiled and stewed vegetables, milk, mineral water). The proportion of acid-forming foods and spices should be reduced (fried meat, strong broths from meat and fish, seasonings and smoked meats, pickled and pickled foods, lemons, tomatoes).

With atopic vulvitis, a hypoallergenic diet is prescribed, which excludes the use of highly allergenic foods (seafood, eggs and citrus fruits, products with chocolate and honey, walnuts, strawberries).

Local treatment

Local therapy is aimed at eliminating swelling and redness of the external genital organs, eliminating itching and burning, and consists in the use of disinfectants, which are prescribed in the form of lotions, irrigations and sitz baths.

From medicinal herbs widely used infusions (1 tablespoon per liter of boiling water) from chamomile and sage, string and calendula, and St. John's wort, oak bark and nettle. The liquid in the bath should be warm, the duration of the procedure is 10-15 minutes (3 times a day).

From medical antiseptics for local therapy, an aqueous solution of furacillin, potassium permanganate (pale pink), chlorhexidine, chinosol, is used. Effective lubrication of affected skin areas with an oily solution of chlorophyllipt, sangiviritin (1% ointment), antibiotic ointments (antibiotics are prescribed for children only in severe cases). The following ointments are used for vulvitis: tetracycline ointment (over 8 years old), erythromycin, oletetrinova.

Systemic etiotropic therapy

If the causative agent of the disease and its sensitivity to antibacterial agents are identified, appropriate oral preparations are prescribed.

With candidal inflammation, antimycotic agents (fluconazole, levorin, itraconazole) are indicated, topical treatment of the affected areas with sodium tetraborate (borax) in glycerin, clotrimazole, decamin and other antifungal ointments is used. Previously, the vulva is treated with a 4% soda solution.

If trichomonads are detected, metronidazole, ornidazole or tinidazole is prescribed (the dose is selected taking into account the age of the girl) for 7-10 days. For a long-term recurrent trichomonas vulvitis, the Solcotrichovac vaccine is used (3 injections of 0.5 ml in 2 weeks, and then after 12 months, repeated administration of 0.5 ml once).

If gonococci are detected in a smear, treatment is carried out by a venereologist, antibiotics of the cephalosporin group (ceftriaxone) are the drugs of choice. Mycoplasma and chlamydial vulvitis are treated with broad-spectrum antibiotics (josamycin, sumamed, doxycycline).

Hygiene

Particular attention should be paid to intimate hygiene. In mild cases of inflammation, hygiene procedures will help to cope with the disease without the use of drugs.

• It is necessary to wash the perineum after each visit to the toilet (remember the direction of movement: from front to back).
• Change underpants twice a day, and diapers and diapers for infants immediately after they become soiled.
• Wash linen thoroughly (preferably with a hypoallergenic powder) and rinse additionally.
• The use of soap in older girls is allowed no more than once a day (soap must be pH-neutral).
• Refuse aromatic powders, oils and other products in infants.
• Choose underwear for girls from natural cotton and white (does not contain dyes).
• The child must have personal hygiene items (towels, washcloths).

General state normalization

In the treatment of this disease, desensitizing agents are mandatory that reduce tissue swelling, relieve itching and inflammation (suprastin, diazolin, calcium preparations).

In the case of allergic vulvitis, antihistamines are included in ointments for local therapy.

Reception shown:

• sedatives (valerian, motherwort)
• enzymes (Hilak-Forte, Wobenzym, Bactisubtil) to normalize bowel function
• vitamins (A, E, C and group B)
• immunomodulators (immunal, sodium nucleinate)
• interferon inducers (cycloferon, neovir)

If the disease is recurrent, local use of estrogens (estriol, folliculin) is indicated, which accelerate reparative processes and increase the concentration of glycogen in the epithelium of the mucous membranes.

After the removal of acute phenomena, the diet is changed, in which fermented milk products must be present, which is necessary to restore the biocenosis of the vagina and intestines.

When prescribing antibiotic therapy, it is additionally recommended to take antifungal drugs.

Sanitation of foci of chronic infection

Therapy of the inflammatory process of the external genital organs should be carried out with the simultaneous elimination of the source of infection (ARVI therapy, kidney disease, sanitation of carious teeth).

Separately, it should be said about vulvitis caused by helminths and a foreign body in the vagina. Treatment of vulvovaginitis against the background of enterobiasis (pinworms) should begin with the appointment of anthelmintic drugs (pirantel, piperazine).

In the case of vulvovaginitis caused by a foreign body in the vagina, it must be removed, followed by washing the vagina through a special catheter with antiseptic solutions. Removal of a foreign body is performed during vaginoscopy or through the rectum, pushing it to the entrance to the vagina, and then capturing it with a clamp.

Complications

Refusal of treatment leads to the development of the following complications:

• synechia of the labia minora (deposits of fibrin on the mucosa of the labia minora leads to their adhesion and fusion, which requires surgical treatment);
• vaginal atresia (gluing of the mucous membrane of the labia minora and vagina, and then their fusion);
• cystitis - the transition of inflammation to the urinary tract, which is accompanied by pain, urination disorder and burning;
• scarring at the site of former ulcers in the future lead to problems in sexual life;
• imbibition - the external genitalia acquire a bluish color (with a chronic process), and pigmentation can persist for a long time or for life, which leads to the development of complexes and problems in sexual life.

- acute or recurrent inflammation of the mucous membrane lining the external genitalia. Vulvitis in girls is manifested by itching and burning in the vulva, swelling and hyperemia of the labia and surrounding skin, discharge of a different nature from the genital tract. The diagnosis of vulvitis in girls is made on the basis of examination data, vulvo- and vaginoscopy, smear microscopy, bacteriological seeding of secretions from the genital organs, PCR scraping, etc. Local therapy for vulvitis in girls includes sitz baths, UVI of the vulva, the use of ointments; systemic therapy is determined by the etiology of the inflammatory process.

General information

Vulvitis in girls is an inflammatory process in the external genital area, which involves the labia, clitoris, external opening of the urethra, and the vestibule of the vagina. In childhood, a combined inflammatory lesion of the vulva and vagina is often observed - vulvovaginitis. In girls from 1 to 8 years old, vulvitis and vulvovaginitis occupy the first place in the structure of gynecological pathology. Inflammatory processes account for 65-70% of cases of all diseases of the genital organs in pediatric gynecology. Recurrent vulvitis and vulvovaginitis in girls can cause violations of menstrual, sexual, reproductive functions in adulthood. In addition, prolonged and sluggish inflammation can disrupt the coordinated interaction of the hypothalamic-pituitary-ovarian system.

Causes of vulvitis in girls

Anatomical and physiological features of the genital organs in childhood predispose to the development of vulvitis in girls. First of all, it should be noted that the genital tract of newborn girls is sterile; on the 5th-7th day of life, the mucosa is populated by opportunistic microflora. In the first years of life, the contents of the vagina are scarce, have a slightly alkaline or neutral reaction (pH 7.0); in the smear, leukocytes of mixed flora (rod and coccal) are found, there are no lactobacilli. By the beginning of puberty (8-9 years), lactobacilli appear, the vaginal epithelium begins to produce glycogen, the reaction of the vaginal environment becomes acidic (pH 4.0-4.5). And only with the advent of menstruation, the microflora of the vagina of adolescent girls approaches, in terms of quantitative and qualitative composition, the microbiocenosis of women of reproductive age.

The penetration of infection is facilitated by a decrease in local anti-infective protection that is in the process of formation (the level of secretory immunoglobulins A, lysozyme, phagocytosis, the complement system), insufficient bactericidal functions of the skin, and hormonal rest.

The direct cause of vulvitis in a child is most often an infection: non-specific (conditionally pathogenic aerobic and anaerobic flora, viruses, yeast fungi, protozoa) or specific (gonococci, chlamydia, mycobacterium tuberculosis, diphtheria bacillus, etc.). A specific infection in childhood can be transmitted in various ways: at an early age, the household route is predominant (if hygiene is not observed, through care items and common areas); for girls who have experience of sexual relations - the sexual path. Vulvitis in newborn girls can be caused by transplacental infection or infection during childbirth, when the child passes through the contaminated birth canal.

Often, vulvitis in girls develops as a result of helminthic invasion (enterobiosis), foreign body ingestion (grass of grass, grains of sand, insects, foreign objects), masturbation, impaired reactivity of the body during secondary infection (for example, diphtheria of the pharynx, chronic tonsillitis, caries, etc.).

The occurrence of mycotic vulvitis in girls is promoted by antibiotic treatment, hypovitaminosis, immunodeficiency, endocrine disorders (primarily diabetes mellitus). The vulva and vagina in girls can be affected by influenza viruses, herpes, parainfluenza, adenovirus, cytomegalovirus, papillomavirus, etc. Less commonly, girls have allergic (atopic) vulvitis, as a reaction to some nutritional factors (citrus fruits, chocolate, etc.), fragrant soaps or detergents with additives, sanitary napkins. In infants, diaper dermatitis can be the cause of inflammation.

Maintenance of vulvitis can be determined by anomalies in the structure of the girl's genitals (low location of the urethral opening, absence of a posterior commissure, gaping of the genital fissure, anomalies in the development of the external genital organs), as well as functional features (neurogenic bladder, vaginal urethral reflux). The role in the course of vulvitis in girls is played by the constant wearing of diapers, microtrauma of the external genitalia with tight underwear, non-observance of intimate hygiene, improper washing technique of the child.

The mucous membrane of the genital organs in girls is very thin and vulnerable, so frequent and diligent washing, especially with soap, can easily lead to a violation of the integrity of the epithelial integument, a decrease in the local immune barrier and the development of vulvitis.

Classification of vulvitis in girls

Vulvitis in girls can be acute (up to 1 month), subacute (up to 3 months) and chronic (more than 3 months). Depending on the causative factor, vulvitis in girls is divided into infectious and non-infectious.

Infectious vulvitis in girls, in turn, is represented by non-specific inflammation (caused by opportunistic flora, normally present on the child's vulva) and specific inflammatory processes (gonorrheal, chlamydial, trichomanas, herpes, ureaplasma, diphtheria, tuberculosis, etc.).

Primary non-infectious vulvitis in girls includes cases of illness associated with foreign bodies, helminthic invasion, onanism, changes in the body's reactivity in diabetes mellitus, dysmetabolic nephropathy, intestinal dysbacteriosis, allergic diseases, acute viral and childhood infections.

Most often, non-specific vulvitis with a chronic course occurs in girls of preschool age.

Symptoms

Signs of acute vulvitis in a child are characterized by redness and swelling of the labia and clitoris. Hyperemia and maceration can spread to the skin of the pubis, inguinal region and thighs. With vulvitis, girls are concerned about itching and burning in the perineum, aggravated by urination, touch, and movement. Young children express their physical sensations with restlessness and crying; older girls constantly touch and comb the genitals, complain of discomfort, itching, soreness. Sometimes, especially with specific forms of vulvitis in girls, erosions and sores appear on the genital mucosa.

A characteristic symptom of vulvitis and vulvovaginitis in girls is the presence of discharge from the genital tract (leucorrhoea). The discharge can be of a different nature: more often they are watery and transparent, but can be bloody or purulent. So, with vulvitis caused by Escherichia coli, girls have yellow-green discharge with an unpleasant fecal odor. With staphylococcal vulvitis in girls, the whites are yellow and viscous, with candidal vulvitis - white, thick, curdled consistency.

In some cases, vulvitis in girls may be accompanied by general symptoms - a temperature reaction, an increase in lymph nodes. The child's behavior becomes nervous, there is poor sleep, irritability, tearfulness, increased excitability. With vulvitis caused by pinworms, girls have hyperemia and thickening of the anal folds, abdominal pain, and loss of appetite.

With chronic vulvitis in girls, hyperemia and edema decrease; itching and discharge from the genital tract persist. The recurrent course of vulvitis in girls is often accompanied by complications: synechia of the labia minora, vaginal atresia, urethritis, cystitis, cervical erosion, imbibition (discoloration of the vulva).

Diagnosis of vulvitis in girls

Vulvitis in girls can be diagnosed by a pediatrician, but further examination and observation of the child should be carried out by a pediatric gynecologist. To clarify the etiology of vulvitis in girls, it is important to study the anamnesis (comorbidities, provoking moments) and complaints.

When examining the genital organs, hyperemia and swelling of the vulva, maceration of the mucosa, and discharge from the genital tract are revealed. The diagnosis of vulvitis and vulvovaginitis in girls is helped by instrumental research methods - vulvoscopy and vaginoscopy. Vaginoscopy is especially indispensable for the removal of foreign bodies of the vagina.

To determine the etiology of vulvitis in girls, a microscopic examination of a smear and bacteriological seeding of secretions for microflora and sensitivity to antibiotics are performed. If a specific nature of vulvitis is suspected in girls, scrapings are examined by PCR. It is mandatory to examine the general analysis of urine and blood, blood sugar, general and allergen-specific IgE, urine culture, scraping for enterobiasis, fecal analysis for helminth eggs, feces for dysbacteriosis.

If necessary, the child is consulted by other pediatric specialists: pediatric endocrinologist, pediatric allergist, pediatric gastroenterologist, etc.

Treatment of vulvitis in girls

Therapy of vulvitis in girls is aimed at stopping the inflammatory process and eliminating the cause of the disease. Particular attention is paid to the hygiene of the genital organs: sitz baths are carried out with infusions of herbs (chamomile, calendula, St. To eliminate itching and discomfort, anti-inflammatory ointments and suppositories, sedatives are recommended.

With bacterial vulvitis in girls, the appointment of antibacterial drugs is indicated; with fungal - antifungal agents inside and topically in the form of ointments and creams. With vulvovaginitis due to the presence of a foreign body, it is removed. In the case of helminthic invasion, the child is shown deworming. In the complex treatment of vulvitis in girls, it is necessary to sanitize chronic foci of infection. As a general strengthening therapy, multivitamins, immunomodulators, eubiotics are used. With severe itching or an allergic reaction, antihistamines are prescribed.

Of the methods of physiotherapy for vulvitis in girls, UVI of the vulva, ultraphonophoresis with gels, ointments and antiseptic solutions, darsonvalization have proven themselves well.

Prevention of vulvitis in girls

Issues of prevention of vulvitis require the education of proper hygiene skills in young parents and the girls themselves. Hygiene of the genital organs in girls should be carried out daily - always after a bowel movement and before bedtime. External genital care involves washing the vulva, perineum, and anus with water from front to back. It is recommended to use neutral baby soap (pH 7.0) no more than 2-3 times a week. Girls should have separate bath accessories (washcloths, towels).

To prevent vulvitis in girls and girls, one should stop wearing synthetic underwear, tight-fitting clothing; replace sanitary napkins in a timely manner, monitor the proper nutrition of children, treat comorbidities, etc.

Intimate problems are faced not only by adult women, but also by little girls. Children's gynecologists diagnose anomalies of the genital organs, vulvovaginitis and other diseases in babies. A fairly well-known problem is considered to be synechia in girls (sticking together of the labia). A few years ago, doctors understood this term as congenital pathology. This view has since been refuted by research. It is now believed that synechia can appear in any girl due to the influence of certain factors.

This intimate problem occurs in babies aged 6 months to 6 years. Sometimes synechia appears earlier. As a rule, the child does not have any symptoms in this condition.

The baby may not complain about anything. Most synechiae go away on their own, but in some cases surgical treatment is required. Let's see how parents and doctors detect this problem in children, what help can be provided.

By this term, doctors understand the adhesion (fusion) of the small or large labia along their entire length or only in the lower third. There is no entrance to the vagina. The labia are connected by a thin membrane. With complete fusion, it is impossible to see the opening of the urethra.

Synechia can be noticed by a doctor during a routine examination of a child. The fusion can also be seen by parents with the naked eye.

In some cases, the following symptoms are observed:

• tearfulness;
• capriciousness;
• straining during urination.

These signs appear when the baby's labia completely stick together. Additional symptoms appear with infectious diseases that begin due to a violation of the outflow of urine.

Wait or see a doctor?

If the child's labia is not completely stuck together, there are no symptoms of an infectious process, then you can postpone a visit to a specialist. In the vast majority of cases, the child does not need any help. You just need to observe hygiene and monitor the condition of the labia. You can use folk remedies for the treatment of synechia in girls (for example, use decoctions of chamomile for bathing).

If the baby has extensive adhesion, which makes it difficult for urine to flow out, or there are signs of an infectious disease, then you need to see a doctor as soon as possible. The specialist, depending on the condition of the child, will choose the most appropriate method of treatment.

1. Conservative method

Most doctors, when detecting synechia in a child, choose conservative treatment. The girl is prescribed a special cream containing estrogens (for example, Ovestin). The hormones that make up the product contribute to the separation of the stuck together labia.

Experts recommend using a cream with estrogens according to a certain scheme for two weeks. Then the result is evaluated. After that, the cream can be used for another two weeks, but less often. A huge role is played by the technique of applying a therapeutic agent in the presence of symptoms of synechia in girls.

Doctors advise using the ointment as follows:

1. Lay the child on the back.
2. Separate the legs and large labia.
3. Gently apply the cream with your finger on the gluing line (do not use cotton swabs, gauze, etc.).
4. Do not apply ointment to undamaged areas.

Creams containing estrogen do not pose a health risk to babies. Even with long-term treatment, serious side effects due to the agent used do not occur. In some cases, parents notice in a child pigmentation of the mucous membrane of the vulva, the first hairs on the pubis, swelling of the mammary glands. These signs appear due to the influence of estrogen. After stopping the use of the cream, all symptoms disappear.

The remedy should be gradually replaced by a neutral ointment. Any baby cream that contains lanolin and no flavors is suitable. Such funds prevent the repeated adhesion of the small and large labia.

2. Surgical method

If redness appears in the area of ​​adhesion of the labia, the child cannot urinate, then you should immediately consult a doctor. The specialist will choose a surgical method of treatment: he will separate the child's labia with a probe and apply an antibacterial ointment.

The process of separation of synechia is not traumatic for the child. The girl won't feel anything. Before surgery, anesthesia (local or general) is performed. Very often, doctors prescribe estrogens after separation of the synechiae. Hormone therapy is necessary to prevent re-adhesion, because the risk of relapse is 30%.

Causes of synechia and prevention

Parents can prevent this intimate problem in their daughters. However, to do this, you need to know the causes of synechia in girls. Fusion of the labia minora and labia majora occurs:

• due to frequent washing with soap, washcloths;
• due to wearing too tight underwear and inflammation;
• due to infectious processes occurring in the genital area or in the urinary tract.

Thus, the prevention of synechia of the labia should consist in proper hygiene, the use of high-quality underwear and the timely treatment of all diseases. Given all the tips below, you can prevent the formation of synechia in a child.

1. Hygiene features

Hygiene plays a very important role. girls need wash away morning, evening and afternoon, if necessary, without friction and effort, using clean water at room temperature. Experts recommend washing the genitals of children under running water, and not in a bath or basin. You can use special baby soap. It should not include fragrances, dyes. When washing, you need to make sure that the foam does not fall on the mucous membrane of the girl.

Soap is not recommended for frequent use. , because it causes irritation, dries out the skin and contributes to the appearance of microcracks (it is because of them that synechia occurs in girls, since the vulvar mucosa begins to restore its integrity).

Also, do not use sponges and washcloths to wash the child. All actions are recommended to be performed with clean hands from front to back in order not to bring infection into the vagina from the anus.

Can be used for washing decoctions of medicinal herbs but they should be chosen wisely. These drugs cause an allergic reaction in some children. Before using decoctions or before using herbal baths, you should consult a pediatrician.

After washing, you can not wipe the genitals, as you can damage the mucous membrane. This area should be blotted with a soft diaper or towel. After that, a clean diaper or panties can be put on the child.

2. Choice of underwear

Cotton is considered the best material for children's panties. It is products from this fabric that you need to purchase for your daughters. Natural panties are well breathable and allow the skin to breathe. Children in cotton products feel very comfortable. Skin irritation does not occur.

Underwear must be purchased in the correct size. Panties should not be too small, squeeze and rub. Otherwise, the babies will begin the inflammatory process. This, in turn, will lead to the fact that parents will have to see a doctor about the treatment of synechia in girls.

3. Timely treatment of infectious diseases

One of the important preventive measures is to visit a pediatric gynecologist when suspicious symptoms appear. If the baby has redness of the external genitalia, plaque on them, discharge from the genital tract appears, then you should immediately visit a doctor. These symptoms may indicate the presence of an infection in the body.

If the results of tests and additional examinations show that the child has some kind of disease, then the specialist will prescribe the appropriate treatment. The sooner it is started, the sooner it will be possible to get rid of the existing problem. Thanks to timely treatment, it will be possible to prevent the appearance of synechia.