Vulvit at girls – an acute or recidivous inflammation of the mucous membrane covering genitalia. Vulvit at girls it is shown by an itch and burning in a vulva, puffiness and hyperaemia of vulvar lips and surrounding skin, allocations of various character from a genital tract. The diagnosis of a vulvit at girls is made on the basis of data of survey, vulvo-and vaginoskopiya, microscopy of dab, bacteriological crops of allocations from genitals, scrape PTsR, etc. Local therapy of a vulvit at girls includes sedentary trays, Ural federal district of a vulva, use of ointments; system therapy is defined by an etiology of inflammatory process.
Vulvit at girls
Vulvit at girls – inflammatory process in external genitals in which vulvar lips, a clitoris, an external opening of an urethra, a vagina threshold are involved. At children's age the combined inflammatory damage of a vulva and vagina is quite often observed – vulvovaginit. At girls from 1 year to 8 years of a vulvita and a vulvovaginita win first place in structure of gynecologic pathology. Inflammatory processes make 65-70% of cases of all diseases of genitals in children's gynecology. Recidivous vulvita and vulvovaginita at girls can serve as the reason of violations of menstrual, sexual, reproductive functions in mature age. Besides, the long and slow inflammation can break the coordinated interaction - hypophysial systems.
The reasons of a vulvit at girls
Anatomo-physiological features of genitals at children's age contribute to development of a vulvit in girls. First of all, it should be noted that a genital tract of newborn girls is sterile; for 5-7 day of life mucous becomes populated by opportunistic microflora. In the first years of life vagina contents poor, has alkalescent or neutral reaction ( 7,0); in dab leukocytes the mixed flora are found (bacillary and kokkovy), there are no lactobacilli. By the beginning of puberty (8-9 years) there are lactobacilli, the epithelium of a vagina begins to develop a glycogen, reaction of the vaginal environment becomes sour ( 4,0-4,5). And only with the advent of periods microflora of a vagina of teenage girls approaches on quantitative and qualitative structure a microbiocenosis of women of reproductive age.
Penetration of an infection insufficient bactericidal functions of skin, hormonal rest facilitate decrease in the local anti-infectious protection which is in process of formation (level of sekretorny immunoglobulins A, a lizotsim, a fagotsitoz, system of a complement).
As immediate cause of a vulvit at the child the infection most often acts: nonspecific (opportunistic aerobic and anaerobic flora, viruses, barmy fungi, the elementary) or specific (gonokokk, hlamidiya, tuberculosis mikobakteriya, diphtheritic stick, etc.). The specific infection can be transferred in children's age in various ways: at early age the household way (is prevailing at non-compliance with hygiene, through objects of leaving and the public place); at the girls having experience of the sexual relations – a sexual way. Vulvit at newborn girls it can be caused by transplacentary infection or infection in labor, when passing the child in obsemenenny patrimonial ways.
Quite often vulvit at girls develops owing to a helminthic invasion (enterobioz), hit of a foreign matter (blades, grains of sand, insects, foreign objects), masturbation, violation of reactivity of an organism at a secondary infection (for example, pharynx diphtheria, chronic tonsillitis, caries, etc.).
Emergence of a mikotichesky vulvit at girls is promoted by treatment by antibiotics, hypovitaminoses, an immunodeficiency, endocrine violations (first of all, diabetes). The vulva and a vagina at girls can be surprised viruses of flu, herpes, paraflu, adenovirus, a cytomegalovirus, papillomavirusy, etc. Less often at girls it is observed allergic (atopic) vulvit as reaction to some alimentary factors (a citrus, chocolate and so forth), fragrant grades of soap or detergents with additives, hygienic laying. At babies diaper dermatitis can serve as the reason of an inflammation.
Maintenance of a vulvit can be defined by anomalies of a structure of genitals of the girl (a low arrangement of an opening of an urethra, lack of back soldering, a gaping of a sexual crack, anomalies of development of genitalia), and also functional features (a neurogenetic bladder, a vaginal and urethral reflux). The role during a vulvit at girls is played by constant carrying diapers, a microinjury of external genitals hard linen, non-compliance with intimate hygiene, the wrong equipment of a podmyvaniye of the child.
Mucous genitals at girls very thin and vulnerable therefore the frequent and diligent podmyvaniye, especially with soap, can easily lead to violation of integrity of epitelialny covers, decrease in a local immune barrier and development of a vulvit.
Classification of a vulvit at girls
Vulvit at girls can have sharp (up to 1 month), subsharp (up to 3 months) and a chronic current (more than 3 months). Depending on a causal factor, a vulvita at girls share on infectious and noninfectious.
Infectious vulvita at girls, in turn, are presented by the nonspecific inflammations (caused by the opportunistic flora which normal is present at the child's vulva) and specific inflammatory processes (gonorrheal, chlamydial, trikhomanadny, herpetic, ureaplazmenny, diphtheritic, tubercular, etc.).
At girls carry the cases connected with foreign matters, a helminthic invasion, an onanism, change of reactivity of an organism at diabetes, a dismetabolichesky nephropathy, an intestinal dysbiosis, allergic diseases, sharp viral and children's infections to number of primary and noninfectious vulvit.
Most often the nonspecific vulvita having a chronic current occur at girls of preschool age.
Symptoms of a vulvit at girls
Signs of a sharp vulvit at the child are characterized by reddening and hypostasis of vulvar lips and a clitoris. Hyperaemia and maceration can extend to skin of a pubis, inguinal area and hips. At a vulvita of girls the itch and burning in the crotches amplifying at an urination, touches, the movements disturb. Small children express the physical feelings concern and crying; girls are more senior constantly touch and comb genitals, complain of discomfort, an itch, morbidity. Sometimes, especially at specific forms of a vulvit girls, on mucous genitals have erosion and sores.
Characteristic symptom of a vulvit and vulvovaginit at girls existence of allocations from a genital tract serves (grow white). Allocations can have various character: more often they watery and transparent, but can be bloody or purulent. So, at the vulvit caused by colibacillus girls have allocations of flavovirent color with an unpleasant fecal smell. At a staphylococcal vulvit at girls bleach yellow and viscous, at a kandidozny vulvit – white, dense, a curdled consistence.
In certain cases vulvit at girls can be followed by the general symptomatology - temperature reaction, increase in lymph nodes. The behavior of the child becomes nervous, the bad dream, irritability, tearfulness, hypererethism is noted. At the vulvit caused by pinworms at girls hyperaemia and a thickening of anal folds, belly-aches, a loss of appetite is noted.
At a chronic vulvit at girls hyperaemia and hypostasis decrease; the itch and allocations from a genital tract remain. The recidivous current of a vulvit at girls often is followed by complications: sinekhiya of small vulvar lips, vagina atresia, uretrity, cystitis, uterus neck erosion, imbibition (change of color of a vulva).
Diagnostics of a vulvit at girls
Vulvit for girls it can be diagnosed by the pediatrician, however further inspection and observation of the child has to be carried out by the children's gynecologist. Studying of the anamnesis (associated diseases, the provocative moments) and complaints is important for clarification of an etiology of a vulvit at girls.
At survey of genitals hyperaemia and puffiness of a vulva, maceration mucous, allocations from a genital tract comes to light. Diagnostics of a vulvit and vulvovaginit at girls is helped by tool methods of a research – a vulvoskopiya and a vaginoskopiya. The vaginoskopiya for removal of foreign matters of a vagina is especially irreplaceable.
For definition of an etiology of a vulvit at girls the microscopic research of dab and bacteriological crops of allocations on microflora and sensitivity to antibiotics is conducted. At suspicion on the specific nature of a vulvit at girls researches of scrapes are carried out by the PTsR method. The general analysis of urine and blood, blood sugar, the general and allergenspetsifichesky IgE, urine, scrape on , the analysis a calla on eggs of helminths, by kcal on dysbacteriosis are without fail investigated.
In need of the child other children's experts advise: children's endocrinologist, children's allergist, children's gastroenterologist, etc.
Treatment of a vulvit at girls
Therapy of a vulvit at girls is directed to knocking over of inflammatory process and elimination of a cause of illness. The special attention is paid to hygiene of genitals: sedentary trays with infusions of herbs (a camomile, a calendula, a St. John's Wort, etc.), washing of genitalia antiseptics (solution of potassium permanganate, Furacilin), sanitation of a vagina by means of a thin vaginal irrigator are carried out. For elimination of an itch and discomfort anti-inflammatory ointments and candles, sedative medicines are recommended.
At bacterial vulvita at girls purpose of antibacterial medicines is shown; at fungal - antifungal means inside and locally in the form of ointments and creams. At the vulvovaginit caused by existence of a foreign matter its removal is made. In case of a helminthic invasion the degelmitization is shown to the child. In a complex of treatment of a vulvit at girls carrying out sanitation of the chronic centers of an infection is necessary. As the all-strengthening therapy apply polyvitamins, immunomodulators, eubiotik. At the expressed itch or allergic reaction appoint antihistamines.
Prevention of a vulvit at girls
Questions of prevention of a vulvit demand education of the correct hygienic skills from young parents and girls. Hygiene of genitals at girls should be carried out daily – surely after defecation and before going to bed. Care of external genitals includes washing of a vulva, area of a crotch and an anus water in the direction in front back. It is recommended to use neutral children's soap ( 7,0) not more often than 2-3 times a week. Girls have to have separate bathing accessories (basts, towels).
For the prevention of a vulvit at girls and girls it is necessary to refuse wearing synthetic underwear, the fitting close clothes; it is timely to replace hygienic laying, to monitor good nutrition of children, to treat the accompanying pathology etc.