NASPAG Clinical Recommendations| Volume 29, ISSUE 6, P673-679, December 2016

Clinical Recommendation: Vulvovaginitis

  • Andrea Zuckerman
    Department of Obstetrics and Gyneology, Tufts University School of Medicine, Tufts Medical Cetner, Boston, Massachusetts
    Search for articles by this author
  • Mary Romano
    Address correspondence to: Mary Romano, MD, MPH, Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital at Vanderbilt, 719 Thompson Lane Ste 36300, Nashville, TN 37204; Phone: (615) 830 4680
    Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital at Vanderbilt, Nashville, Tennessee
    Search for articles by this author
Published:September 21, 2016DOI:


      Vulvovaginitis is a commonly encountered condition among prepubertal and adolescent females. The objective of this report is to provide the latest evidence regarding the diagnosis and management of vulvovaginitis in prepubertal and adolescent females. In this systematic review we used the Grading of Recommendations Assessment, Development and Evaluation evidence system. Vulvovaginal complaints are common in the pediatric and adolescent age group. The patient's age in conjunction with history and associated complaints will guide evaluation, diagnosis, and treatment. Treatment should include counseling on hygiene and voiding techniques as well as therapy for any specific pathogens identified.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pokorny S.F.
        Prepubertal vulvovaginopathies.
        Obstet Gynecol Clin North Am. 1992; 19: 39
        • Stricker T.
        • Navratil F.
        • Sennhauser F.H.
        Vulvovaginitis in prepubertal girls.
        Arch Dis Child. 2003; 88: 324
        • Syed T.
        • Braverman P.
        Vaginitis in adolescents.
        Adolesc Med. 2005; 15: 235
        • Allsworth J.
        • Peiper J.
        Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey Data.
        Obstet Gynecol. 2007; 109: 114
        • Huppert J.
        • Hesse E.
        • Bernard M.
        • et al.
        Accuracy and trust of self-testing for bacterial vaginosis.
        J Adolesc Health. 2012; 51: 400
        • Verstraelen H.
        • Swidsinski A.
        The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment.
        Curr Opin Infect Dis. 2013; 26: 86
        • Feathers K.A.
        • Fairley C.K.
        • Hocking J.S.
        • et al.
        Sexual risk factors and bacterial vaginosis: a systematic review and meta-analysis.
        Clin Infect Dis. 2008; 47: 1426
        • Sutton M.
        • Sternber M.
        • Koumans E.
        • et al.
        The prevalence of trichomonoas vaginalis infection among reproductive-age women in the United States, 2001-2004.
        Clin Infect Dis. 2007; 45: 1319
        • Kissinger P.
        Epidemiology and treatment of trichomoniasis.
        Curr Infect Dis Rep. 2015; 17: 31
        • Sobel J.D.
        • Subramanian C.
        • Foxman B.
        • et al.
        Mixed vaginitis: more than coinfection and with therapeutic implications.
        Curr Infect Dis Rep. 2013; 15: 104
        • Nakhal R.S.
        • Wood D.
        • Creighton D.M.
        The role of examination under anesthesia (EUA) and vaginoscopy in pediatric and adolescent gynecology: a retrospective review.
        J Pediatr Adolesc Gynecol. 2012; 25: 64
        • McGreal S.
        • Wood P.
        Recurrent vaginal discharge in children.
        J Pediatr Adolesc Gynecol. 2013; 26: 205
        • Paradise J.E.
        • Willis E.D.
        Probability of vaginal foreign body in girls with genital complaints.
        Am J Dis Child. 1985; 139: 472
        • Simon D.A.
        • Berry S.
        • Brannian J.
        • et al.
        Recurrent, purulent vaginal discharge associated with longstanding presence of a foreign body and vaginal stenosis.
        J Pediatr Adolesc Gynecol. 2003; 16: 361
        • Kung F.T.
        Use of flexible hysteroscopy in prepubertal aged girls with genital complaints.
        Taiwan J Obstet Gynecol. 2005; 44: 338
        • Briselden A.M.
        • Hillier S.L.
        Evaluation of affirm VP Microbial Identification Test for Gardnerella vaginalis and Trichomonas vaginalis.
        J Clin Microbiol. 1994; 32: 148
        • Bradshaw C.S.
        • Morton A.N.
        • Garland S.M.
        • et al.
        Evaluation of a point-of-care test, BVBlue, and clinical and laboratory criteria for diagnosis of bacterial vaginosis.
        J Clin Microbiol. 2005; 43: 1304
        • Van Der Pol B.
        • Williams J.
        • Orr D.
        • et al.
        Prevalence, incidence, natural history, and response to treatment of Trichomonas vaginalis infection among adolescent women.
        J Infect Dis. 2005; 192: 2039
        • Huppert J.
        • Mortensen J.
        • Reed J.
        • et al.
        Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women.
        Clin Infect Dis. 2007; 45: 194
        • Pappas P.
        • Kauffman C.
        • Andes D.
        • et al.
        Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.
        Clin Infect Dis. 2009; 48: 503-535
        • McClelland R.
        • Richardson B.
        • Hassan W.
        • et al.
        Prospective study of vaginal bacterial flora and other risk factors for vulvovaginal candidiasis.
        J Infect Dis. 2009; 199: 1883
        • Workowski K.
        • Bolan G.
        • Centers for Disease Control and Prevention
        Sexually transmitted diseases treatment guidelines, 2015.
        MMWR Recomm Rep. 2015; 64 ([erratum in 2015; 64:924]): 1
        • Bradshaw C.
        • Morton A.
        • Hocking J.
        • et al.
        High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence.
        J Infect Dis. 2006; 193: 1478