Clive Anderson - AT THE DERMATOLOGIST READERS' FEEDBACK
I would like to share a problem with you about my step daughter. I notice that from she was four years old she had a discharge... when I take her to the doctor it always clears up ...but the problem returns. Last year the doctor said she has serious germs/disease. Now she is six I notice that the discharge has a yellow colour. I remember once she say an old man was fingering her but her parents denied it.
DERMATOLOGIST'S RESPONSE
A vaginal discharge does not occur only in adult women. Complaints of a vaginal discharge, itching or redness are relatively common in young girls before puberty. Vulvovaginitis (inflammation of the external genetalia and vagina) in children can occur at any age but peaks at around age five.
Most often the cause of the irritation is straightforward and easy to avoid. However, one should always remain alert for any hint that there may have been sexual abuse and have the child examined for a sexually-transmitted disease (STI).
Most new-born girls have some mucoid white vaginal discharge. This is normal and disappears by three months of age. Prepubertal children are particularly susceptible to non-specific infection of the vulva and vagina (vulvovaginitis).
Factors that predispose a child to vulvovaginitis are inadequate hygiene, the lack of protective hair and labial fat pads and a thin vaginal wall. Other predisposing factors include skin diseases like eczema, an atopic predisposition, the wearing of tight fitting nylon garments, long periods in wet swimwear and obesity.
Mild vulvovaginitis itching, discharge, redness and some times burning with urination, is a very common problem. This is often caused by moisture - synthetic fibre underwear, tight clothing, wet swimming costumes and obesity. Irritants such as soap residue, bubble baths and antiseptics are also common causes.
Keep in mind that harsh toilet paper, residue from fabric softeners or detergents can irritate the vulva leading to a discharge and an environment that encourages bacterial growth. This condition usually responds to avoidance of the factors above, vinegar baths (one-half cup white vinegar to shallow bath and soak) and soothing creams such as those used to treat nappy rash.
More severe and persistent symptoms require medical assessment and treatment. There are several causes for moderate or persistent vulvovaginitis:
Little girls are prone to poor hygiene and may clean themselves inadequately. Improper wiping after passing stool results in a little faecal matter entering the vagina. This rapidly starts an infection. You should ensure that your stepdaughter wipes in a backward direction.
Some times one organism (a bacteria like Streptococcus or Haemophilus) has overgrown in the area and treatment with appropriate antibiotics is necessary.
Candida or yeast is only rarely a cause of infection in a girl who no longer wears diapers.
A possible cause is threadworms, which migrate from the anus and can cause itching and a discharge.
A bloody or offensive smelling discharge should also raise suspicions of a foreign body in the vagina. Young children have a tendency to explore their bodies and sometimes small objects may be introduced into the vagina. The most common foreign body is a wad of toilet tissue
A sexually transmitted infection must immediately raise the suspicion of sexual abuse.
As you mentioned that the child may have been abused it is very important that she sees a doctor urgently. Unfortunately sexual abuse is all too common in our society and some deranged persons still hold the view that they can cure themselves of a sexually transmitted disease by having sex with a virgin. This is of course completely wrong and results in the spread of disease to children.
The doctor will take a careful history and do tests to determine the cause of the discharge. If the history of abuse is accurate, a report must also be made to the police. Such an abused child will in, addition to treatment for any possible STI, require professional counselling and the support of caring and sympathetic loved ones like yourself.
Dr. Clive Anderson is a Dermatologist and Venerologist.
