Pediatric vulvovaginitis.

Childhood gynecologic problems are different from adult problems in physiology, disease, psychology, evaluation and management. The most common is vulvovaginitis. The child is susceptible to vulvovaginitis because of a relatively exposed vulva, a thin vaginal wall and poor hygiene. Additional problems are heat and moisture, clothing, coverings and possible sexual abuse. Most vulvovaginitis is primary, nonspecific vulvitis with secondary vaginitis. It is set off by poor hygiene and responds to keeping the vulva clean, cool and dry. Persistent or recurrent vulvovaginitis may be due to a variety of causes, including vulvar skin disease, a foreign body in the vagina, primary vaginitis, ectopic ureter and rhabdomyosarcoma. Vaginoscopy is indicated for recurrent vulvovaginitis or bleeding and for suspicion of a foreign body, neoplasm or congenital anomaly. The extent of evaluation depends on the anxiety of the child versus the extent of the problem, and therefore individualization is required.