Q: My daughter is now 4, and since she was 18 months old she has had pain in her vagina. Her doctor said it is probably yeast infections.
Could it be anything else? What can be done to help reduce the pain and the recurrence?
A: Your question presents a puzzle difficult to put together without more information. We can only work with the clues provided by your description and your doctor's reaction.
We're not certain your daughter is having vaginal pain, especially beginning at 18 months. We believe the answer lies in thinking about what can cause irritation to the vagina or vulva.
If your daughter has "discharge," a liquid coming out of the vaginal opening, she could have a yeast infection. These infections seem to be more common when a child has been on antibiotics for a long time, and they require treatment with a cream or ointment that kills yeast
Discharge sometimes indicates a foreign object has been lodged in the vagina. A piece of toilet paper, for example, would be found.
Other diagnoses to consider are urinary tract infection, which can cause pain and stinging, and vulvar irritation, the older child's version of diaper rash. Constant wetness, caused when a child's underwear becomes damp from urine leakage, can cause soreness. Loose-fitting cotton panties during the day and pajamas or a nightgown without panties at night help by allowing air next to the skin. Feces that remain after a bowel movement can also make the skin sore.
Avoid bubble bath, perfumed soap and scented toilet paper while she has the soreness.
Occasionally, a child will have pain for a short time because of falling on a tricycle seat or similar occurrence.
Finally, the most serious cause of true vulvar or vaginal pain in a young girl is sexual abuse. We are not suggesting this as a cause of your daughter's problem; however, parents and doctors must think about this disturbing possibility when little girls have persistent symptoms that involve the genitals.
As you see, solving the puzzle of vaginal pain is not easy. It can take time to sort out.
Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.