What? Vulvodynia can lead to such consequences!

  This morning, we received a small patient, just over 2 weeks old.  When the mother came in, she said anxiously, “Last night, when I washed my child’s bottom, I found a small hole in his private parts, and recently he had a divergent urine stream. I don’t know what’s going on, but I didn’t sleep well all night! The doctor rushed to take a look”.  The child is the heart of the mother, the mother’s worry and anxiety is very understandable. But the baby girl was crying and upset, and when she saw the one in the white coat, she was screaming!  I instructed the mother and daughter to do down first, do not rush, let the child quiet down. I changed into a pink overalls, and it so happened that there was a delicate little light-up toy in the office. Slowly the child quieted down, and after a while, the child’s attention was gradually drawn to the light-up toy. I took the toy to the examination bed, and the child voluntarily ran up to the bed to get it, and by the way, I gave her a simple gynecological examination.  The results of the examination: the female child’s vulva was not obviously red and swollen, but the labia minora on both sides were fused together due to adhesions, almost covering the vestibule of the vulva, including the entire urethral opening and most of the vaginal opening was covered, leaving only a soy-sized hole near the body. The diagnosis was clear that the labia minora adhesions reached the urethral orifice causing the urinary stream to diverge.  Following up on the medical history, the female child did have a little discharge some time ago, and since the symptoms were not obvious, the parents did not pay much attention to it, but just washed the lower body with every day.  Adherent vulvovaginitis is a type of vulvovaginitis in young girls. Adherent vulvovaginitis is commonly associated with labia minora adhesions, a self-limiting result of chronic vulvovaginitis which means that the vulvar inflammation reacts protectively in self-repair.  Forced separation of labia minora adhesions usually causes unnecessary trauma. If the adhesions are not loosened naturally after a certain period of conservative treatment, or if the adhesions reach the urethra, affecting the direction of the urinary line and causing serious cases such as secondary urinary tract infections, surgery may be chosen to separate the adhesions.  In this case, the adhesions of the labia minora had completely covered the urethral opening and most of the vaginal opening, so there were indications for separation surgery.  On the same day, we did the preoperative examination, and after applying topical lidocaine cream, we gently separated the labia minora adhesions by blunt hand for a few seconds.  Infantile vaginitis, or infantile vulvovaginitis, is a very common disorder in female infants and children, mostly between the ages of 2 and 9. Treatment is often delayed due to poor self-reporting ability and parental neglect in infants and young children. The anatomy of young girls is characterized by poorly developed vulva, which cannot cover the urethral opening and vestibule, making it easy for bacteria to invade, low estrogen levels, thin vaginal epithelium, low glycogen, high pH, and low lactobacilli, making them susceptible to infection.  Therefore, prevention is very important. To prevent vulvovaginitis in young children, first of all, we should pay attention to vulva hygiene, take regular baths, change underwear regularly, don’t touch the vagina with hands or foreign objects, don’t let girls wearing crotch pants sit on the ground or crawl on the ground to play, and after the age of 2, it is better for girls to wear loose and easy to take off closed crotch pants, don’t share towels and bath tubs, and don’t take children to baths in complicated and crowded swimming pools.  Finally, I wish all the babies in the world to grow up strong and healthy.