Vaginal discharge in young girls

Is vaginal discharge normal in young girls?

The answer to this is yes. Vaginal discharge can be normal among all age groups.
The vagina is covered with a mucosal membrane. It can therefore sometimes secrete clear, odourless discharge, even in young girls. That is the vagina’s way to clean itself.
In addition, about a year prior to the onset of menstruation, the discharge increases in amount and thickens in consistency, due to the influence of the hormone estrogen. The discharge becomes similar to the discharge present after menstruation begins.
These are all normal types of discharge that do not require further investigation.

What kind of vaginal discharge requires investigation?

Signs and symptoms of vaginal discharge that require medical investigation are as follows:
a. A large quantity of discharge
b. The discharge is not clear in colour (it will usually be yellow or green)
c. The discharge has foul odour
d. The discharge is bloody
The discharge can be accompanied with pruritis (itching), pain in the genitals and/or burning/stinging sensation during urination.

What is the most common cause of abnormal vaginal discharge?

In 80% of the cases, abnormal discharge is a result of poor hygiene and vaginal irritation secondary to stool, and bacteria found in stool or urine. This can result in a nonspecific inflammation called vulvo-vaginitis.
This does not mean that the young girl is “dirty,” but it is simply the result of the proximity of the vagina to the rectum, where stool that is rich in bacteria is found.
Young girls have very soft and gentle skin, and the combination of that, together with the absence of pubic hair, exposes the vagina to the bacteria found in stool.
Exposure to a variety of chemicals can also lead to inflammation in the vaginal site (referred to as contact dermatitis).

What are other causes of abnormal vaginal discharge?

A large quantity of greenish/yellow discharge, with or without foul odour, can be the result of an infection. The most common bacteria causing this infection is Group A Streptococcus, the same GAS bacteria that we are familiar with from other common infections in children.
If the young girl complains of an itching sensation around the anus or genitals that wakes up her in the middle of the night, there could be a concern for pinworms and her pediatrician should be consulted for management. Find out more about pinworms in children in the following link.
A fungal infection of the vagina due to Candida, which is very common in older women, is not commonly found in young girls and only rarely will it be the cause of their complaints. Therefore, anti-fungal treatment in young girls should only be considered after a thorough examination.
In addition, there are skin diseases that can manifest in the genitals. Such conditions can cause pain, pruritis and abnormal discharge. Some of the common skin conditions that can lead to this are atopic dermatitis (more about it here), psoriasis and lichen sclerosis. Therefore, certain cases require a dermatological assessment, especially when the child has skin symptoms in other parts of the body.
Additional cause of abnormal vaginal discharge are foreign objects, especially if the discharge is bloody or has foul odour.

How is vaginal discharge treated in girls who have not yet started menstruating?

When vulvo-vagintis (inflammation of the vulva and vagina) is suspected, it may be helpful to obtain a culture from the vagina and treat with antibiotics, depending on the pathogen isolated in the culture.
When pinworms are suspected, treatment with mebendazole is advised, as explained here.
All other conditions are treated differently, depending on the specific cause of the discharge.

How can vaginal discharge and pruritis be prevented?

Keep in mind that most of the time the cause of the discharge is a non-specific inflammation, and so the best way to prevent it is by maintaining good personal hygiene in the following ways:
– Make sure the young girl knows how to wipe her bottom in the right direction – from the front (vaginal area) towards the back (rectal area)
– Make sure the young girl urinates with her legs open wide. This is because urine/wetness on the vagina and between the thighs can cause irritation and contact dermatitis, similarly to the irritation caused in an infant with a diaper that hasn’t been changed for a while.
– Scented toilet paper and wet wipes should be avoided as these could irritate the skin and cause harm. Washing the genitals with soap and bubble baths should be avoided.
– It is recommended to wear underwear made of cotton only and to avoid wearing tight or wet clothes for a long period of time.
– It is recommended to air out the vaginal area by sleeping without underwear.
– An oily diaper cream can be applied to the area to provide a barrier and to calm the skin.

Who should examine the area of the genitals when vaginal discharge is present or an infection is suspected?

Examination of this area in young girls should be performed by specialists. The examination needs to be done in a non-stressful way all while keeping the child’s autonomy a priority, respecting her privacy, and explaining to her exactly what is being done.
Keep in mind that in most cases it will not be an invasive examination, as it is in older women.
I recommend you take your child to a specialist whom you trust, one that will provide you with comprehensive care and I recommend you see a gynecologist who specializes in children.

In summary, this is a common problem in young girls, and it can usually be prevented and treated by maintaining good personal hygiene. However, if symptoms are unusual or persist – make sure to see a specialist.