“My four year old daughter seems to have a lot of discharge. Even though she is bathed every day, but the end of the day her panties are messy, almost greenish tinged. I don’t know if it is normal for this age, or should I be concerned?”
This is common problem in girls less than 8-9 years of age. Although it is impossible for me to make an exact diagnosis, I will describe the various possible causes of vaginal discharge known as “vulvovaginitis”. The exact treatment will depend on the cause. The term vulvovaginitis refers to inflammation of the female external genital area. Inflammation can occur in any of the following ways:
- Irritation from bubble baths or the use of strongly scented soaps. Other products than can irritate the area include soaps, detergents or softeners used to wash the underwear. Wearing tight fitting nylon underwear can also result in irritation.
- Another cause of vaginal irritation in young girls has to do with the way the anal area is wiped with toilet paper. We recommend that wiping be done from “front to back” rather than “back to front”, as the latter way can spread fecal matter and bacteria to the genital area.
- Pinworms can cause vulvovaginitis: by coming out of the rectal area the tiny worms can cause vaginal irritation. With pinworm infestation, there are usually associated signs making it easy to make the diagnosis, such as extreme itchiness and irritation of the rectal area.
Mechanical pressure or rubbing
- Constant or repeated rubbing, pressure or abrasion in the genital area can result in vulvovaginitis. Examples include regular masturbation and frequent or prolonged contact with play equipment(saddles on play horses) or sitting in sand boxes.
- Not infrequently, irritation results from applying too much pressure on the genital area when drying it with a towel after a bath. The best way to dry a girl’s genital area is by gently patting with a towel and avoiding rubbing movements.
- Infection is another cause of vulvovaginitis. The bacteria usually come form the rectal area. It is important to distinguish that a genital infection is not the same as a urinary tract infection. The latter is an infection of the urine originating in the bladder or kidneys, and not the result of inflammation of the external genitals.
- If a young girl inserts a toy or other article into the vagina, this it can lead to an infection resulting in a foul smelling discharge.
- It is shocking to find that some sexually transmitted infections have been detected in young girls; a sign that sexual abuse has occurred. This is a part of pediatrics that I dislike.
- In the case of an infection, the treatment varies depending on the germ that is causing the infection ranging from creams to oral antibiotics.
In most cases, the problem is minor and the source can easily be determined by going through the checklist of possible causes. It is important to teach and practice proper genital hygiene and wiping techniques, and to avoid the possible irritants in order to prevent vulvovaginitis in the first place.
Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.