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Noninfectious vulvovaginitis - Anogenital in
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Noninfectious vulvovaginitis - Anogenital in

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Contributors: Mary Spencer MD, Ann Lenane MD, Sireesha Reddy MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
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Synopsis

Vulvovaginitis is considered to be the most common gynecologic problem in premenarchal girls. Multiple factors in prepubertal girls increase the risk of vulvovaginitis. These include:
  • Prepubertal anatomy, such as the absence of labial fat pads and pubic hair, leads to diminished protection of the introitus.
  • The proximity of the vagina to the anus and poor hygiene increases the likelihood of infection. Prepubertal girls have diminished estrogen concentration and lack lactobacilli, leaving the mucosa susceptible to irritation and microbial infection.
The most common cause of vulvovaginitis results from irritation secondary to poor hygiene or even vigorous cleaning during submersion in bubble bath. Most cases of vaginitis are not caused by sexually transmitted infections (STIs). However, it is challenging to differentiate between infectious and non-infectious causes. Nonspecific vulvovaginitis is found in 33–85% of cases. The diagnosis of non-infectious vulvovaginitis is given when vaginal cultures grow normal flora and no other etiology can be identified.

While candidal diaper dermatitis is common, Candida vulvovaginitis is uncommon in a healthy child who is no longer in diapers. However, it may occur in the face of predisposing factors including antibiotic use, diabetes mellitus (see diabetic vulvitis), an underlying primary skin disease, and immunosuppression. Infection with pinworms is present in up to 15% of children in the United States and is a common cause of childhood anal erythema and pruritus. Cases of vaginal pinworm infestation have been reported resulting in discomfort and discharge.

Vulvovaginitis typically presents in prepubertal girls with localized pain, dysuria, pruritus, erythema, or discharge, making it difficult to distinguish from an STI due to sexual abuse. Bloody, copious, or foul-smelling discharge increases the likelihood of an STI, a non-venereal pathogen, or vaginal retained foreign object.

Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate between vulvovaginitis attributable to child sexual abuse from those of non-sexually transmitted infections.

Codes

ICD10CM:
N76.0 – Acute vaginitis

SNOMEDCT:
53277000 – Vulvovaginitis

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 04/17/2018
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Noninfectious vulvovaginitis - Anogenital in
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Noninfectious vulvovaginitis (Adult) : Vaginal discharge, Vaginal-labial burning, Vaginal-labial itching, Vulvar pain, Dysuria, Painful sexual intercourse
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