Treatment of noninfective prepubertal vulvovaginitis

Mild prepubertal vulvovaginitis is most commonly noninfective and caused by dermatitis – general measures and patient reassurance may be sufficient.

General measures that can help prevent or manage mild vulvovaginitis includeThe Royal Children’s Hospital General Medicine and Gynaecology departments (RCH), 2018:

• wearing breathable fabrics (eg loose cotton underwear) and avoiding tight pants
• maintaining a healthy body weight
• rinsing the vulvar area well with water after showering or bathing, and avoiding local irritants (eg soap, bubble bath, antibacterial products, perfumed products)
• avoiding vaginal douching
• avoiding daily use of panty liners
• using barrier creams (eg nappy rash creams, paraffin creams) for symptom relief.

Patients may find salt or vinegar baths helpful. To prepare a vinegar bath, add half a cup of white vinegar to a shallow bath and soak for 10 to 15 minutes daily for a few daysThe Royal Children’s Hospital General Medicine and Gynaecology departments (RCH), 2018. A nonfragranced emollient may be used as a soap substitute, moisturiser and barrier creamSaxon, 2020.

For more information on management of mild vulvovaginitis, see the Royal Children’s Hospital (Melbourne) fact sheet.

If vulvovaginitis is recurrent, reassess for other possible causes; however, mild prepubertal vulvovaginitis caused by dermatitis is often recurrent. The above measures may need to be used intermittently. A swab is not usually necessary for recurrent cases unless symptoms become severe (eg if there is profuse, bloody or offensive discharge). Consider referral to a specialist if recurrent symptoms are not sufficiently controlled by general measures, or if the diagnosis is uncertain.