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Tell us what you think about Healio. The main symptom is itching in this area. Vaginitis refers to any inflammation or infection of the vagina. Gynaecological examination of the prepubertal girl This must be done with sensitivity Green vaginal discharge in children gentleness. Differential diagnosis See Box 3. She does take bubble baths frequently. A sample of the discharge will be collected for disxharge. A urine culture was sent, as was a vaginal bacterial culture. Ascending infections are rare in this population. Healthy discharge varies throughout dicsharge menstrual cycle, and may be slightly brown towards the end of the period, but does not have a strong smell or color.
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- Patient Presentation A 1-month-old female came to clinic with a 2 day history of increased vaginal discharge.
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- Green Vaginal Discharge Symptom Checker.
- Girls can get vaginal irritation and infection resulting in discharge.
Skip to content. Along with outward physical differences, an adolescent may notice a discharge from their vagina and become concerned. The mucus is produced normally from the cervix see illustration. Healthy discharge varies throughout the menstrual cycle, and may be slightly brown towards the end of the period, but does not have a strong smell or color.
Any change in the amount, color or smell of vaginal discharge — or other symptoms like itching, pain or unexpected bleeding — could indicate a vaginal infection vaginitis and should be promptly assessed by an adolescent medicine specialist.
Vaginitis refers to any inflammation or infection of the vagina. While a number of factors may cause abnormal vaginal discharge, it is usually an infection that upsets the natural balance of yeast and bacteria in the vagina.
The color, consistency and smell of abnormal vaginal discharge can help identify what may be causing the condition. However, it is important not to self-diagnose and self-treat any gynecological condition. More than one type of infection may be present in the vagina at one time — with or without symptoms — and many of the conditions have similar symptoms.
Any adolescent or young person with abnormal vaginal discharge should be examined and treated by a healthcare professional. Thick, white, cottage cheese-like vaginal discharge that is watery and usually odorless, may be a symptom of a vaginal candida infection, commonly known as a yeast infection.
Yeast infections are very common and may cause itching and redness of the vulva and vagina. These infections are caused by a disruption in the balance of healthy bacteria and yeast that is present in the vagina. For example, taking an antibiotic to treat an infection in another part of her body, can affect the bacteria that normally protect and balance the yeast in the vagina. When the yeast overgrows, it causes an infection.
Vaginal discharge that is thin and milky, or gray and heavy, and has a fishy smell, may be a symptom of bacterial vaginosis. While yeast infections are the most commonly discussed vaginal infections, bacterial vaginosis is actually the most common type of vaginitis in people of reproductive age. This infection is caused by bacteria, not yeast, and occurs when certain species of normal vaginal bacteria grow out of control and trigger inflammation.
A frothy, musty-smelling, greenish-yellow vaginal discharge, may be a symptom of trichomoniasis also known as trich. Increased vaginal discharge as well as pelvic pain, pain when urinating or bleeding between periods, may be symptoms of chlamydia or gonorrhea , two of the most common sexually transmitted infections in the United States.
Abnormal discharge, along with pain, lesions or sores in the vaginal area, may be symptoms of viral vaginitis. In some cases, vaginal discharge, itching and burning may occur without an infection being present.
This is called noninfectious vaginitis. Most often, noninfectious vaginitis is caused by an allergic reaction to, or irritation from, vaginal sprays, douches, or spermicidal products.
It may also be caused by sensitivity to perfumed soaps, detergents, or fabric softeners. Adolescents with abnormal vaginal discharge should be referred to clinicians who have expertise in Adolescent Medicine. To help young people develop the skills needed to be responsible for their own health, clinicians typically ask to spend time alone with patients during each visit.
This helps young people become comfortable talking with their healthcare providers about their concerns and allows patients to ask questions that may be more difficult to say in front of their parents and caregivers. A physical examination will follow the interview, along with a pelvic examination if appropriate. A sample of the discharge will be collected for examination.
Depending on what clinicians find during the initial assessment, additional tests may be ordered including:. These routine tests can confirm or rule out certain infections, including sexually transmitted infections, allowing the specialist to recommend the best treatment.
Treatment for abnormal vaginal discharge will be recommended by our Adolescent Medicine specialist based on:. Abnormal Vaginal Discharge Vaginitis. Contact Us. Request an Appointment. What is abnormal vaginal discharge? Watery or white vaginal discharge with intense itchiness Thick, white, cottage cheese-like vaginal discharge that is watery and usually odorless, may be a symptom of a vaginal candida infection, commonly known as a yeast infection.
Gray or white discharge with fishy smell Vaginal discharge that is thin and milky, or gray and heavy, and has a fishy smell, may be a symptom of bacterial vaginosis.
Frothy, green or yellow discharge A frothy, musty-smelling, greenish-yellow vaginal discharge, may be a symptom of trichomoniasis also known as trich. Abnormal discharge with bleeding or pain Increased vaginal discharge as well as pelvic pain, pain when urinating or bleeding between periods, may be symptoms of chlamydia or gonorrhea , two of the most common sexually transmitted infections in the United States.
Abnormal discharge with warts or blisters around the genitals Abnormal discharge, along with pain, lesions or sores in the vaginal area, may be symptoms of viral vaginitis.
Increased vaginal discharge with itching and burning In some cases, vaginal discharge, itching and burning may occur without an infection being present. Depending on what clinicians find during the initial assessment, additional tests may be ordered including: Pregnancy test Blood tests Urine tests Microscope evaluation Genital swab tests These routine tests can confirm or rule out certain infections, including sexually transmitted infections, allowing the specialist to recommend the best treatment.
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A foreign body that has been left in the vagina for a long time, such as a tampon, may result in a modification of the normal bacteriological flora of the vagina, subsequently causing the appearance of an malodourous yellow to green or brown vaginal discharge. This list does not constitute medical advice and may not accurately represent what you have. Do not try to get the foreign object out yourself. Allergic contact dermatitis may develop as a result of prolonged exposure to irritant substances, such as perfumes and clothing dyes. However, the mainstay of treatment is careful vulval hygiene, which will relieve symptoms and help to prevent recurrence.
Green vaginal discharge in children. Greenish vaginal discharge and Vaginal discharge in children
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Vulval hygiene and the use of appropriate emollients form the cornerstone of successful management. Prepubertal vaginal discharge. The incidence of troublesome vaginal discharge in prepubertal girls is unknown; however, it is the most common gynaecological complaint in this age group.
The majority of girls are diagnosed and treated by their general practitioner and only come to the attention of a gynaecologist when the symptoms are resistant to treatment or are recurrent. Vaginal discharge can be very distressing to a child, especially if associated with discomfort. In addition, parents are often highly anxious, particularly if the symptoms have been present for several weeks or months.
Vaginal discharge has been associated with pelvic infection, lack of cleanliness and sexual abuse; these are all factors about which parents will be very concerned. Prepubertal anatomy plays a major aetiological role in vaginal discharge, especially where it is the result of infection. In the prepubertal female the labia are small, undeveloped and there are no labial fat pads or pubic hair.
Thus, there is the risk of faecal contamination, which can lead to infection. The squamous epithelium is undifferentiated and unestrogenised and the pH is neutral. This must be done with sensitivity and gentleness.
If the girl is very small the examination can be done with her on her mother's lap. Gentle separation and retraction of the labia should allow visualisation of the external genitalia, introitus and hymen.
Discharge can pool in the posterior fourchette and a swab can be taken from this area. Instrumentation of the vagina in an awake, prepubertal girl can be painful, unpleasant and distressing for her and her mother and should be avoided. If inspection of the upper vagina is necessary for example, in the presence of vaginal bleeding or if there is a suspicion of a foreign body this should be done under a brief general anaesthetic.
Vulvovaginitis is the most common cause of prepubertal vaginal discharge and can be infective or chemical. See Box 1. Vulval and perianal inflammation secondary to vulvovaginitis More serious causes, such as tumours, precocious puberty and sexual abuse, must be excluded before attributing bleeding to vulvovaginitis.
On inspection of the genital area, the skin around the vagina will look reddened and inflamed and this may extend around the anus. There may be a pool of discharge at the posterior fourchette. In addition. Poor personal hygiene is a common trigger factor, as the onset of symptoms usually occurs when the child has responsibility for her own anal hygiene; for example, on first attending nursery or school.
Group A streptococci are sensitive to penicillin; erythromycin is a suitable alternative for a girl who is sensitive to penicillin 1 , 9 , 11 , 12 Relapse can occur in up to a third of treated individuals. Topical antibiotics are of no use for treatment of vaginal infection. Haemophilus influenzae is the second most common cause of vulvovaginitis.
Most strains are sensitive to penicillin; resistance is increasing, therefore, clinicians should be guided by sensitivity test results. Attempts have been made to clarify the normal vaginal flora in prepubertal girls. If one of these organisms is found in an asymptomatic child, antibiotic treatment is not appropriate. Candida is a very uncommon cause of vulvovaginitis in the prepubertal girl, although many cases are treated with antifungals by the mother or general practitioner—usually without benefit.
In most studies reporting Candida in children, those girls with candidiasis isolated were pubertal. It has been suggested that vaginitis associated with Candida is more likely to be associated with sexual abuse. Inflammation of the vulva and perineal area and white plaques adherent to the vagina often occur. Treatment is usually with a topical antifungal agent. Some systemic infections such as varicella, measles and rubella can cause an associated vulvovaginitis, which can be severe.
Resolution is usually complete, although secondary bacterial infection from vulval organisms can occur and prolong symptoms.
Vulval dermatitis most commonly causes vulval soreness but this can be associated with discharge. Irritant dermatitis has been reported as a result of using soap or bubble bath and playing in a sandpit, as well as prolonged contact of urine and faeces against the skin.
Allergic contact dermatitis may develop as a result of prolonged exposure to irritant substances, such as perfumes and clothing dyes.
Accurate allergy patch testing may help to identify the culprit. Vulval skin conditions can also present with vulval irritation and soreness. Vaginal discharge is usually a less prominent feature, although this can occur, especially if the skin is traumatised due to scratching.
Emollients are the mainstay of treatment but the use of mild or moderate strength steroid cream may be necessary for short periods. Lichen sclerosis usually presents with itching and soreness.
Vaginal discharge is unusual unless there is a secondary infection but bleeding can occur from purpura and blister formation. It is essential to make the correct diagnosis as the traumatised appearance of the skin can raise suspicions of sexual abuse. Symptoms of vulvovaginitis can last for months or even years.
Antibiotics should be used when a pure growth of a specific pathogenic organism has been identified; the clinician should be guided by the sensitivity results. However, the mainstay of treatment is careful vulval hygiene, which will relieve symptoms and help to prevent recurrence.
It is essential that the parents and child are given advice about good toilet habits. The girl should be taught to wipe from front to back after defaecation and when at home the parents should check for cleanliness. Tight jeans should also be avoided and wearing skirts encouraged.
Symptoms can be persistent and may only resolve completely with the approach of puberty and increasing estrogenisation of the vulva and vagina. Parents may find a simple fact sheet helpful Box 2. Foreign bodies are an unusual cause of vaginal discharge. They should be considered in a girl who keeps presenting with recurrent or chronic vaginal discharge and in the presence of bloodstained or very offensive discharge.
The most common foreign body is small pieces of tissue paper but other items that have been removed include coins, beads and small toys; for example a Barbie doll shoe.
The discharge may be purulent, foul smelling and occasionally bloodstained. Occasionally, a foreign body can be seen on inspection of the hymenal opening. If a foreign body is suspected, a vaginoscopy under general anaesthetic is necessary. Threadworms pinworms mainly present with nocturnal perineal pruritus. However, excoriation of the skin can lead to inflammation, soreness and discharge. Infections with threadworms are more common in areas of overcrowding and they can be associated with poor hygiene.
Treatment is with systemic therapy using mebendazole and this is worth considering on an empirical basis if symptoms appear to be characteristic. Urethral prolapse can cause a bloodstained discharge, which can be mistaken initially for vaginal discharge.
This condition is more common in girls of African origin. Local estrogen cream usually causes resolution, although occasionally surgical excision is required. Ectopic ureter is a rare condition that can be associated with a duplex renal system. The ectopic ureter can drain into the vagina and may present with a persistent, watery vaginal discharge.
A careful clinical examination or vaginoscopy may reveal the source of the discharge. Imaging of the urinary tract is sometimes helpful but if an ectopic ureter is suspected, referral of the girl to a paediatric urologist is necessary.
Rare tumours such as embryonal rhabdomyosarcoma, mesonephric carcinoma and clear cell adenocarcinoma of the vagina or cervix all present with a bloodstained discharge. Sometimes a tumour is visible at the introitus. Vaginal bleeding or bloodstained vaginal discharge needs urgent referral to an appropriate specialist for evaluation.
Sexual abuse must always be considered in girls with recurrent or persistent vaginal discharge or bleeding. It is important that the clinician specifically but sensitively asks the mother if she has any concerns about sexual abuse. In addition, if the child is old enough it is important to ask her about any inappropriate touching of the genital area. All Trusts are required to have written policies on suspected child abuse as well as a named, responsible clinician.
If child sexual abuse is suspected from the history or examination findings, immediate referral for assessment through the appropriate channels is essential. Identification of organisms associated with sexually transmitted diseases; for example, Neisseria gonorrhoeae or Chlamydia trachomatis , should mean automatic referral for child protection assessment. It is very important to remember that the majority of children who are abused do not have any physical complaints related to trauma or infection.
Vaginal discharge in the prepubertal girl is very common and often no pathogen is identified. These girls usually only present to a gynaecologist after initial treatment by their own general practitioner and a recurrence of symptoms. This is very stressful for the girl and her parents because of the uncertainty of the cause, repeated visits to see doctors and possible further implications. Volume 9 , Issue 3. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.
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Introduction The incidence of troublesome vaginal discharge in prepubertal girls is unknown; however, it is the most common gynaecological complaint in this age group. Prepubertal anatomy Prepubertal anatomy plays a major aetiological role in vaginal discharge, especially where it is the result of infection. Gynaecological examination of the prepubertal girl This must be done with sensitivity and gentleness.