‘Itchy uncomfortable genital region’

Discomfort whilst voiding is common in young children, particularly girls. The most common cause is a chemical vulvitis which once diagnosed is easy to manage. This condition involves inflammation at the end of the urethra, and the area around this. A urinary tract infection must be ruled out prior to making this diagnosis.

 

What Is It ?

Chemical urethritis or vulvitis means inflammation and irritation around the area where urine emerges.  The urethra is the tube from the bladder and the vulva is the area around this urethral opening in the vagina. Something, usually chemicals found in soaps such as bubble baths has resulted in inflammation of these tissues. This results in a reflex response by the bladder to ’empty’ frequently in order to ‘flush’ out anything that could potentially cause infection.

What causes it?

Itching may be a significant factor as this will result in damage to the skin, which will cause discomfort when urine comes in contact with this irritated area.

The common irritants that can cause this condition include

  • Sandpits – where grains of sand get into the underwear and cause the itch
  • Bubble bath – soaps and shampoo often cause chemical vulvitis
  • Wet bathers – this will cause some friction – particularly chorinated pools
  • Scratching – some toddlers will ‘discover’ this area and will play or scratch this area leading to inflammation
  • Sometimes pinworm infestation can be a cause.

What are the Symptoms ? 

This usually occurs in a young girl from 2years to 10 years. Sometimes it occurs during the night. The child may have scratched the area in their sleep and when they void this is extremely uncomfortable. The most common symptoms include.

  • Pain when urinating
  • Urinating frequently, small amounts
  • Crying about discomfort around the vulval region
  • Itching – which can lead to inflammation.
  • Is otherwise healthy and has no fever.

The examination is usually unremarkable. There maybe some redness from the scratching but otherwise there is little to see. I do not regularly examine the older girls (5yo and older) unless the parent tells me that there is something that needs checking.

If  the child appears unwell, has a fever, appears lethargic then a urinary tract infection must be ruled out urgently. Any untreated urinary tract infection can potentially affect the kidneys. This is easily done by a ‘dipstick’ test at the doctors surgery after a clean catch of urine is obtained. (easier said than done).  See article on urinary tract infections.

How is it treated ?

Firstly it is important to identify the above factors and eliminate those. Clean the area with water only and follow up with a non – irritating cream. It is a good idea to have brief baths or showers rather than long baths in soapy water. The most important treatment is a simple barrier cream to stop the itching and protect the skin from irritation.  Simply using vaseline is as good as any other cream.  There is no place for anti-fungal creams as this is not thrush.

What if there is an unusual looking rash ?

There are two other conditions that although rare do crop up from time to time in toddlers and children. The first is psoriasis. This is a condition similar to eczema that causes scaling and a well demarcated rash around the vulval area. The second and rarer rash is a condition called lichen sclerosis which has a distinctive white rash around the vulva.

Is it due to poor hygiene ?

This is a very common question and answer is no. The opposite often holds true. The irritating nature of soaps and shampoos especially if they are aggressively washed on using flannels etc can be the main cause.

What about Thrush ? 

Thrush is not seen in pre pubertal girls and this is not the cause of dermatitis, vulvitis or urethritis. Anti fungal creams will have no benefit.

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