Infantile vaginitis mostly occurs in young girls aged 2 to 9 and is a common condition among female infants and toddlers. Since vaginitis is often accompanied by vulvitis, it is commonly referred to as infantile vulvovaginitis.

bubble_chart Etiology

1. Poor local hygiene of the vulva. The child's mother or caregivers fail to pay attention to the cleanliness of the child's vulva, handle bowel movements improperly, or use contaminated paper to wipe the anus, allowing intestinal bacteria to invade the vagina and cause vaginitis. In HuHiman's study of 438 cases of infantile vulvovaginitis, 68% were caused by the aforementioned disease factors, with Escherichia coli detected in 80% of the cultures.
2. Foreign objects. Items such as peanuts, rice, beans, hairpins, pins, or small stones inserted into the vagina can cause injury to the vaginal epithelium, leading to secondary infections.
3. Pinworm-induced vulvovaginitis. Under normal circumstances, this condition is relatively rare. It occurs when intestinal pinworms are transmitted to the vagina via feces or due to improper fecal handling, where pinworm eggs contaminate the vulva of young girls through the hands, clothing, or toys of the mother or caregivers, causing inflammation.
4. Secondary vulvovaginitis. After upper respiratory tract or urinary tract infections, bacteria can directly enter the vagina through dust, leading to infection in young girls.
5. Specific vaginitis. Trichomonas or fungal vaginitis is rare in infants and young children. The reason may be that the vaginal pH in infants and young children is alkaline, which is unsuitable for fungal growth. Trichomonas feeds on glycogen, which is scarce in the vagina at this age, making it unsuitable for Trichomonas proliferation. Hemophilic vaginitis is extremely rare in infants and young children.

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bubble_chart Clinical Manifestations

The main symptoms are itching of the vulva and increased vaginal discharge. Infants and young children, unable to accurately describe their symptoms, often scratch the vulva with their fingers, which can further spread the infection through their hands and the scratched areas. The vulva, urethral opening, and vaginal orifice may exhibit mucosal congestion, edema, and purulent discharge. However, parents may overlook the condition during the acute phase, or due to mild symptoms, labial adhesions may develop after the acute phase. These adhesions may leave small openings above or below, through which urine may leak. Foreign bodies in the vagina can cause excessive discharge, which may be bloody, purulent, and foul-smelling. Vaginitis caused by pinworms leads to intense itching around the vulva and anus, along with a large amount of thin, yellow, purulent vaginal discharge.

bubble_chart Diagnosis

Due to the anatomical characteristics of infants and young children and their inability to cooperate with the doctor's movements, diagnosis presents certain difficulties. However, physical examination is the primary basis for diagnosis, so doctors need to exercise great patience and care in obtaining a detailed medical history from the child's mother and caregivers. During the examination, techniques should be gentle and agile. Sometimes, to achieve satisfactory results, it is necessary to distract the child, such as by talking to them while examining to relax their abdominal wall. In some cases, the child may need to be examined under general anesthesia. Several commonly used examination methods:

1. **Examination of the Vulva** Use the middle and index fingers to gently separate the labia majora, carefully observing the vulva, urethra, and vaginal vestibule.
2. **Vaginal Speculum Examination** The best instrument for this examination is the Kelly air cystoscope. A bronchoscope or nasal speculum can also be used as a vaginal speculum. For older girls, a specially designed small vaginal speculum may be used. Through these instruments, the vagina and cervix can be clearly visualized, allowing examination of the vaginal epithelium and secretions, as well as detection of any foreign bodies. Additionally, a small cotton swab can be used to collect vaginal secretions for Gram staining or culture, along with drug sensitivity testing, to identify the causative pathogen.
3. **Rectal-Abdominal Bimanual Examination** Use the left middle and index fingers to separate the labia majora, while the right index finger (or the little finger if the index finger is too large for younger children) is inserted into the child's anus. The other hand is used to palpate the abdomen, allowing for coordinated examination to detect any foreign bodies in the vagina, assess uterine size, and evaluate pelvic conditions. The rectal examination can also assist in collecting vaginal secretions. This is done by pressing the posterior vaginal wall with the rectal finger while using the other hand to hold a sterilized glass tube, simultaneously squeezing the rectum and aspirating the vaginal secretions.

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bubble_chart Treatment Measures

1. Pay attention to keeping the vulva clean. The vulva can be treated with a 1:10,000 potassium permanganate sitz bath.
2. Foreign objects in the vagina must be removed as soon as possible.
3. For labial adhesions, a small curved forceps can be gently inserted along the upper or lower opening to separate them. This separation procedure is easy to perform and does not require anesthesia.
4. Use a 0.5–1% lactic acid solution to irrigate the vagina through a rubber catheter inserted into the vagina. Sulfonamide or antibiotic emulsions can also be administered via the catheter once daily for a treatment course of 5–7 days.
5. Topical application of estrogen ointment can help reduce inflammation. Apply an ointment containing 0.1mg diethylstilbestrol deep into the vagina using a small cotton swab once daily for two weeks, then every 3–4 days for a total treatment duration of 4–6 weeks.
6. Oral diethylstilbestrol is also effective. Take 0.1mg diethylstilbestrol once daily, then reduce to twice weekly after two weeks, continuing for 4–6 weeks. Prolonged use may lead to the development of secondary sexual characteristics.
7. For the treatment of pinworm-induced vaginitis in infants and young children, Pyrvinium Pamoate can be used. The dose is 5mg per kilogram, taken once in the evening. If recurrence occurs, another dose can be taken after 2–3 weeks. This medication has low dermatitis medicamentosa potential, but a few children may experience nausea, vomiting, abdominal pain, or diarrhea. The drug may turn stools red and stain clothing. Pyrvinium Pamoate is highly effective against pinworms and is the first-line treatment for pinworm infections.