On examination there may be vulval or peri-vulval erythema, wrinkling of the skin, excoriation, and possibly some discharge. With consent, the perianal area should also be inspected to look for excoriation or the presence of threadworms, although worms are often not seen during the day3 (See link to Threadworms)
Around half the girls who have vulvovaginitis will have it more than once during their childhood. It usually gets better as girls grow up and will not cause them any long-term harm4.
Vulvovaginitis can generally be managed within the community using the advice below, however the following are reasons why referral to paediatrics would be appropriate:
- Persistent symptoms not responding to the strategies suggested below
- Uncertainty about diagnosis e.g. foreign body, bacterial infection
- The presence of pallor, erosions or ecchymosis should prompt referral to exclude lichen sclerosis. (Referral directly to paediatric dermatology would be appropriate).
- Concerns about anatomical variations in the context of persistent symptoms e.g. labial adhesions.