In this section
The perineum is best examined either with the girl supine with heels together and knees flexed and hips abducted, or in the lateral position with knees drawn up to the chest.
Do not perform an internal vaginal examination or take
Mild vulvovaginitis, comprising itch, discharge, redness, and sometimes dysuria, is a very common problem.
The causal factors are:
In mild cases, no investigations are necessary (swabs, if taken, usually grow a mixture of perineal organisms).
Provide vulvovaginitis parent information sheet (
Blood stained discharge in an older girl may indicate:
Sometimes the medial edges of the labia minor become adherent. This is probably due to a combination of thin vaginal mucosa (the normal prepubescent state) and minor irritation.
This is a normal variant and will resolve spontaneously in late childhood. Provided the child is able to void easily, no treatment is needed other than reassurance.
Other treatment options include manual separation of adhesions (distressing for the child and followed by a high risk of recurrence), or use of oestrogen creams (also followed by a high risk of recurrence). These options are not recommended.
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This condition of unknown cause may present with the same symptoms as vulvovaginitis. Sometimes it is asymptomatic but presents when first noticed by a carer.
It usually consists of pale atrophic patches on the labia and sometimes more extensive areas of the perineum. The patches can be confluent and extensive. The condition is often itchy and uncomfortable. Scratching and other minor trauma may lead to further inflammation and purpuric haemorrhage into the skin.
Occasionally this is mistaken for sexual abuse.
For asymptomatic cases, no treatment is required other than reassurance.
In symptomatic cases, avoidance of potential irritants (as for vulvovaginitis) is important. Barrier ointments (eg paraffin ointment, nappy rash creams) may help as a short-term measure. In more severe cases a brief course of topical steroid may be
used to settle the inflammation. Start with 1% hydrocortisone ointment.
The condition is usually persistent with episodic symptoms. Most cases resolve before puberty but some may continue with problems into adult life.
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