Feature Article

Vulval disease in children. Part 1: Presentation

Gayle Fischer



When a prepubertal girl presents with a complaint of an itchy or sore vulval rash, a common assumption is that she has ‘thrush’ or a urinary tract infection. She may be considered to have poor hygiene, or even to have been sexually abused. In fact, none of these diagnoses is likely to be true.

Key Points

  • Most children with an itchy vulval rash have dermatitis or psoriasis.
  • Vulvovaginal candidiasis does not occur in healthy prepubertal children.
  • The commonest cause of acute infective vulvovaginitis in children is group A beta-haemolytic Streptococcus.
  • Not all children with genital warts have acquired them sexually.
  • A greenish discharge on the underwear in an asymptomatic child with negative swabs is a normal variant.
  • Beware of the child who complains of persistent symptoms despite normal examination and negative bacteriology – she may be attention-seeking.