Prepubertal vulvovaginitis accounts for about 40% to 50% of gynecological outpatient cases in young girls. Due to the complex etiology of the disease, the lack of cognitive ability of young girls and the limitation of gynecological examination, the diagnosis and treatment are often not timely and some of them have recurrent inflammation, which brings great trouble to families. The correct diagnosis and proper management of vulvovaginitis are directly related to the health of young girls. 1. Non-specific vulvovaginitis 1.1 Diaper dermatitis: It is a common skin disease in newborns and infants, mainly manifesting as erythema and even blisters, erosions or ulcers in severe cases. Treatment:Keep vulva clean, breathable and dry, use cotton diapers to avoid stimulation, dry after local warm water cleaning, and apply vegetable oil or zinc oxide ointment directly. 1.2 Bacterial vulvovaginitis: Escherichia coli, Haemophilus spp., Streptococcus gramineus, Enterococcus spp., Streptococcus pyogenes, Streptococcus haemolyticus infections predominate, but there is no statistically significant difference in the isolation rate of vaginal flora in children with vulvovaginitis compared with normal young girls, indicating that bacteria-induced vulvovaginitis is mainly related to low hormone level and dysbiosis in the vagina before puberty. The manifestations are redness and swelling of vulva, much discharge with pain and itching, and some children have ulcers on the skin or difficulty in urination. Treatment: Keep the vulva clean, select the appropriate antibiotics according to the type of pathogens and drug sensitivity test, and use systemic and local medication. However, the normal vaginal flora crosses with the conditionally pathogenic bacteria, and whether the positive pathogens cultured are the real cause of clinical symptoms still needs to be explored. Amoxicillin should be given orally at 30 mg/kg three to four times a day. Cephalosporins should be given intravenously if there is vulvovaginal pustules with elevated temperature and leukocytosis; however, if treatment is ineffective for 2 weeks, vaginal examination should be considered to further search for the source of infection, except for vaginal foreign body, tumor, rectovaginal fistula, etc. 2. Atopic vulvovaginitis 2.1 Pseudomonas infection main: to be caused by Pseudomonas albicans infection. It rarely occurs in young girls before puberty if antibiotics and glucocorticoids are not applied in high doses; infants and children are mostly infected by maternal transmission, and the diagnosis can be confirmed by finding pseudomycelia and spores in the secretions. The main manifestations are itching and burning pain in the vulva and white bean curd-like discharge. Treatment: 2-4% sodium bicarbonate solution in sitz bath, 1 time/day, 7-10 days as a course of treatment. Local vaginal application of dacrynic acid or clotrimazole ointment, or in severe cases, catheterized anti-pseudomonal ointment can be pushed into the vagina 2-3 times a day, rarely systemic. Pseudomonas infection during pregnancy must be cured before delivery to reduce the possibility of transmission to the newborn. For all pregnant women who have had Pseudomonas infection during pregnancy, if the delivery is vaginal, the newborn can be prophylactically treated with mycophenolate suspension oral spray or put into the milk. 2.2 Vaginal foreign bodies: If vulvovaginitis is persistent and recurrent, especially if the vaginal discharge is bloody or purulent, sometimes with a foul odor, the possibility of a vaginal foreign body should be considered. It is difficult for the child to admit to a history of vaginal foreign body insertion and for the parents to detect it. Treatment: In principle, vaginal foreign bodies should be removed under anesthesia by anal pushing or by nasal or hysteroscopy. 2.3 Pinworm vulvovaginitis:Pinworm vulvovaginitis is not common under normal circumstances. If the clinical diagnosis is other types of vulvovaginitis but clinical treatment is ineffective according to its etiology, and the child has unexplained rubbing and scratching at the vulva, with nighttime itching as the main cause, then consider pinworm vulvovaginitis. Laboratory examination:Swabbing the perianal skin folds with a plain cotton swab or tongue depressor wrapped in cellophane in the early morning before stool for 1 week and bringing it to the laboratory to find pinworm eggs microscopically can be confirmed. Treatment:Complete elimination of intestinal pinworms is necessary to prevent recurrence. Give the child 30 mg/kg of thiamphenicol bis(hydroxynaphthalate) orally once. Or use anti-pinworm anal ointment (containing thiacil dihydroxynaphthalate 3% ), wash the vulva and perianal area before bedtime, squeeze out a little ointment and apply it around the anus, then insert the plastic injection tube into the anus 1 cm and squeeze out 1 g of ointment for 7 days. Or mebendazole 100 mg in one dose. Keep the vulva clean, dry, reduce friction, avoid stimulation, give potassium permanganate solution (concentration 1:5000) sitz bath, l~2 times a day, apply antibiotic ointment externally. If the treatment is not completely cured, it can be treated again, and at the same time, parents should be instructed on hygiene and take mebendazole, and be rechecked after 7 days. 2.4 Contact inflammation: Inflammation of vulvar skin due to contact with certain irritants or allergic substances, or due to obesity, fluid exudation from vulvar skin and skin between thighs rubbing against each other, burning sensation at the contact site, rash, blistering, necrosis and ulceration in severe cases. Treatment: Remove allergens, avoid irritating substances, use local zinc oxide ointment; in severe cases, oral anti-allergy drugs and local glucocorticoids can generally be cured. 3, sexually transmitted diseases (STD) due to the increase in adult sexually transmitted diseases, STD pathogens through the placenta, birth canal, close contact or sexual contact, including sexual abuse and other ways to lead to an increase in pre-pubertal sexually transmitted diseases, causing great psychological pressure on young girls, young girls, physical and mental development is impaired, seriously affecting their studies and life. The pathogens include trichomonas, gonorrhea, chlamydia, mycoplasma, syphilis, herpes virus and human immunodeficiency virus (HIV). 3.1 Trichomonas vaginalis: The incidence is low before the age of 12, but increases significantly after menarche. It manifests as redness and swelling of the vulva and clitoris, congestion of the vestibular mucosa, and purulent discharge from the vaginal orifice; in severe cases, ulceration of the vulvar skin and congestion and edema of the urethral mucosa are seen. Treatment: Metronidazole is well absorbed orally, highly effective, less toxic, easy to apply, and is a highly effective drug for the treatment of Trichomonas, and can kill trichomonas in the urethra and intestine at the same time. 7.5 mg/kg once, 3 times/day orally; Tinidazole 50 mg/kg, taken orally, can be repeated once at an interval of 3-5 days. Vaginal douching with a small rubber catheter can improve the vaginal environment to inhibit the growth and reproduction of Trichomonas vaginalis and improve the efficacy of the treatment. A solution of metronidazole should be applied to the vagina for 7 days. 3.2 Gonococcal vaginitis: It is the most common type of prepubertal STD in China, with an incidence of 10.04/100,000. Symptoms usually appear within 1 week after contact with the infection, manifesting as redness, burning and itching of the vulva, congestion and edema of the vagina and urethra, and discharge of purulent secretions, and due to the short urethra and unobstructed urination, urinary tract irritation is not typical, and sometimes redness and burning pain can appear in the anus. It should be noted that gonorrhea is often combined with Chlamydia trachomatis infection (40% ~ 60%). In addition to the vulva and vagina, smear examination or culture of rectal and oropharyngeal secretions can help confirm the diagnosis. Treatment: Intravenous infusion of ceftriaxone sodium, 0.25g/time for age ≤3 years, 0.5g/time for age 3-6 years, 1.0g/time for age 6-12 years, once a day for 3 days; vulva with 1:5000 potassium permanganate solution or 2%-3% boric acid solution sitz bath. If ceftriaxone sodium is allergic, change to azithromycin orally for 7 days. review after 1 week. 3.3 Mycoplasma infection: Mycoplasma infection is often indirectly transmitted from mother to child and is characterized by chronic and prolonged increase in plasma yellowish-white vaginal discharge and varying degrees of conscious symptoms. Treatment: Erythromycin should be given orally 4 times/day for 10-14 days; in more severe cases, the vulva and vagina can be rinsed with liquid, or azithromycin can be given intravenously. In addition to choosing the appropriate antibiotic treatment, with the syringe or small intravenous catheter rinsing vulva and vagina after the drug, can improve the improvement rate and cure rate. 3.4 Chlamydia trachomatis infection: Chlamydia trachomatis mainly invades the columnar epithelial cells of the genitourinary tract, with an incubation period of 10-20 days and a slow onset, manifesting as increased vaginal discharge, painful urination and vulvar itching in young girls, yellowish-white mucous discharge around the hymen of the vaginal opening, and redness and swelling of the vaginal opening, vestibule, and labia majora and minora. Most of them can be clearly diagnosed based on clinical symptoms, exposure to high-risk factors of the infected person, combined with chlamydia culture and enzyme-linked immunosorbent assay. Treatment: Erythromycin dry syrup powder or erythromycin succinate, 50 mg/kg daily in 4 oral doses for 14 days, and crushed erythromycin tablets placed in the vaginal orifice every night for 7 days, followed by doxycycline after 14 days, 2.2 mg/kg by body weight every 12 hours on day 1 for children over 8 years old, followed by 2.2-4.4 mg/kg by body weight once daily, or 2.2 mg/kg by body weight every 12 hours. 2. 2 mg/kg every 12 hours. The dosage for children weighing more than 45 kg is the same as that for adults. In conclusion, prepubertal young girls are a special group in gynecological clinics and have certain difficulties in the clinical consultation and treatment process. It is important to observe the characteristics of vulvovaginal discharge in young girls, and unnecessary medical interventions should be avoided before examination of the discharge. For nonspecific vulvovaginitis, maintaining good hygiene and symptomatic management is sufficient. For vulvovaginitis caused by atopic pathogens, treatment should be directed at the pathogen. Evaluation of susceptibility factors is quite important because the affected child may be indirectly infected by close contact with objects contaminated with pathogenic microorganisms. In prepubertal girls, due to the activation of ovarian function, physiological leucorrhea occurs under the influence of estrogen in the body. The discharge is plasma, yellowish-white, non-irritating and odorless, and there may be yellowish-brown stains on the underwear, which is normal and does not need to be treated blindly.