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Clinical Review

Do we need to treat vulvovaginitis in prepubertal girls?

BMJ 2005; 330 doi: (Published 20 January 2005) Cite this as: BMJ 2005;330:186
  1. Manohara Joishy, specialist registrar (,
  2. Chetan Sandeep Ashtekar, specialist registrar2,
  3. Arpana Jain, specialist registrar3,
  4. Rohini Gonsalves, consultant in obstetrics and gynaecology4
  1. 1 Department of Child Health, Llandough Hospital, Cardiff CF64 2XX,
  2. 2 Department of Community Child Health, St David's Hospital, Cardiff,
  3. 3 Department of Obstetrics and Gynaecology, Gloucester Royal Hospital, Gloucester,
  4. 4 Department of Obstetrics and Gynaecology, Royal Gwent Hospital, Newport
  1. Correspondence to: M Joishy
  • Accepted 15 November 2004


Vulvovaginitis is generally considered to be the commonest gynaecological problem in prepubertal girls,1 although the incidence is unknown. In practice, the terms vulvitis, vaginitis, and vulvovaginitis are often used interchangeably by doctors in diagnosing inflammatory conditions of the lower female genital tract.2 Diagnosing infection is confounded by the overlap between normal flora and potential pathogens. The presence of an organism does not itself denote causation, and the clinical picture as well as microbiology should be considered before infection is assumed.1 3 Despite vulvovaginitis being a common problem, the initial management is mostly empirical, and antibiotics are commonly prescribed.

In this review, we present available evidence on the management of vulvovaginitis focusing mainly on the microbiology.

Search strategy and selection

We made electronic literature searches with Medline (January 1965 to June 2004) and the Cochrane database to identify articles related to the aetiology and management of vulvovaginitis using the key words “vulvovaginitis and (prepubertal or premenstrual girls).” We limited our search to English language articles about children. We reviewed the abstracts of retrieved articles and obtained the full texts of relevant articles. We also reviewed the references of these articles. We excluded studies including pubertal girls.

Aetiology and pathogenesis

The hypo-oestrogenic hormonal milieu in a preadolescent girl is a major factor in making her vaginal mucosa susceptible to infection.4 The mucosa is thin, lacks cornification, and has an alkaline pH and is therefore susceptible to invasion from pathogens. Other factors putting the girl at risk are the close proximity of the rectum, lack of labial fat pads or pubic hair, small labia minora, and children's tendency to poor local hygiene and to explore their bodies,2 4 5 spread of respiratory bacteria from hand to perineum, and local irritants such as nylon underwear.6 7


The vaginal microflora of prepubertal girls has not been …

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