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.
- 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.