Tackling vaginal discharge in children

Written by by Rotimi Adesanya - Nigeria 

Case 1

Dr. Rotimi Adesanya

A nursing mother once ran to our clinic to be treated for sexually transmitted disease because she thought her two-month old baby girl acquired STD from her. The baby girl was having a whitish vaginal discharge. The mother was checked and tested for evidence of STD at her request. The TEST was normal. She was reassured that the vaginal discharge her baby was having was not STD but it was as a result of hormonal withdrawal. This does not REQUIRE treatment, as it will cease after a period.

Case 2

Another mother brought her seven-year-old daughter who has much vaginal discharge. The mother said though she bathed the baby every day, at the end of the day, her panties were always messy with somewhat greenish tinge but without offensive smell.

The genital examination showed that the hymen was intact. A laboratory TEST (swab) of the discharge was sent for culture and came back positive for Eschericcha Coli, which suggested a faecal source, probably from improper toilet hygiene.

Case 3

A nine-year-old girl, accompanied by her mother, PRESENTED to the clinic with a recurrent history of green vaginal discharge. She reported no other symptoms. A thorough history and physical examination was done, including inspection of the vagina.

The genital examination showed that the hymen was not present. A test (swab of the discharge) was sent to the lab for culture and came back positive for Neisseria gonorrhea, which suggested gonorrheal infection.

Her parents were INFORMED of the possibility of sexual transmission, but they claimed no history of such. This requires an urgent medical intervention.

Medical explanation

Baby girls who are less than THREE months old often have vaginal discharge and may sometimes develop vaginal spotting or bleeding. Both conditions are temporary and normal. These changes are caused by exposure to maternal estrogen, a hormone that crosses the placenta and enters the baby's bloodstream before birth.

And because a newborn baby's body takes longer than an adult female's to remove this hormone, it remains after birth. The hormone has the effect of making a newborn's body "think" that she is in puberty, and discharge and bleeding occur. As the hormone levels drop, the effects disappear. No treatment is REQUIRED.

The causes of vaginal discharge in older children include irritation from bubble baths or the use of strongly scented soaps. Wearing tight-fitting nylon underwear can also result in irritation.

Again, pinworm can cause vulvo vaginitis by coming out of the rectal area. When that happens, the tiny worms can cause vaginal irritation.

Constant or repeated rubbing, pressure or abrasion in the genital area can also result in vulvo vaginitis. Examples include masturbation, frequent or prolonged contact with play equipment (saddles on play horses) or sitting in sand boxes.

If a young girl inserts a toy or other article into the vagina, this can lead to an infection, resulting in foul smelling discharge.

Infection is another cause of vulvo vaginitis. The bacteria usually come from the rectal area. It is shocking to find that some sexually-transmitted infections have been detected in young girls - an indication that sexual abuse has occurred.

Sexual abuse (rape) should be considered in children with unusual infections and recurrent episodes of unexplained vaginal discharge with no hymen. This is because the hymen is supposed to be protective against any infections.

Neisseria gonorrhoeae, the organism that causes gonorrhoea, produces gonococcal vulvo vaginitis in young girls and it is considered a sexually-transmitted disease. If lab TESTS confirm this diagnosis, young girls should be evaluated for sexual abuse.

Treatment

No treatment is required; both of these changes are normal in a three-month old infant. However, seek medical intervention if the amount of the discharge increases in a three-month old infant, or if the discharge BECOMES foul-smelling and blood-stained

The usual treatment for vaginal discharge in older girls seems fairly satisfactory, because with ordinary measures ensuring cleanliness and mild antisepsis, the condition is apt to go on its own.

Some may benefit from antibiotics, depending on the result of high vagina swab done in the laboratory.

Sexually-abused girls will need to be given psychological support, in addition to antibiotics.

Prevention

Improved perineal hygiene is necessary to help healing and to prevent future re-infection for those whose infections are caused by bacteria normally found in stool.

Young girls should be taught how to clean up after defecating. They should be taught to clean their perineal area from front to back and not vice versa. They must also be taught to wash their hands before and after using the toilet.

Sitz baths (a bath in which a person sits in water up to the hips) may be recommended. It is often helpful to allow more air to reach the genital area. Wearing cotton underwear (rather than nylon) or underwear that has a cotton lining allows greater air flow and decreases the amount of moisture in the area.

Removing underwear at bedtime may also help.