The vagueries of vaginas
February 25, 2019 9:04 AM   Subscribe

My almost five year old has been having a tough time with her poor little nethers. We're going through various steps with various doctors but the two questions are 1) are we missing something obvious that might be helpful 2) Before our upcoming meeting with a specialist what should we be ready to talk about/shoot down?

Obviously YANMD but I actually could really use help on how best to use my actual doctor(s)!

Beginning about 6 months ago now, my otherwise totally healthy 4.5 year old had what we thought was a yeast infection (treated it twice) turned out to be a silent UTI which required two rounds of antibiotics to treat. We plied her with all the probiotics and kefir. Then an additional possible UTI which we went ahead and treated. More Probiotics and Kefir. Then swabbed for BV and yeast which was negative but we treated for yeast anyways at the doctor's recommendation.

Nothing has worked. She has been complaining consistently that her vagina hurts. We've tested her two more times for UTI all negative and she doesn't complain of pain while peeing. The pain seems to be not deeply internal more like inner labia? But she's 5 so it's pretty hard for her to explain. What's clear is that it is REALLY bothering her.

We've tried bathing her less/more. We already do all the wiping for her when it comes to pooping but are trying to do the pee wipes too. She sleeps in a pull up but we are slathering her with past. Nothing looks especially raw, red, irritated. She's not big into playing with vulva/vagina yet (although her younger brother has discovered his penis with a vengeance!) so I don't think that could be the cause either.

But this kid is a very accurate reporter and she says at least twice a day that her vagina hurts. Sometimes it even wakes her up in the night. We took her to a specialist (who was a real asshole) for some imaging and everything is normal on the anatomy front.

We have an upcoming meeting with another specialist in two weeks but we're at our wits end.

Questions for you all:
Any ideas around how to help with the symptoms/discomfort?
Anyone else's kid go through something similar? What did you do?
Given how counter productive the last specialist visit was, how can we go in prepared to make this time count?
posted by jeszac to Health & Fitness (20 answers total) 8 users marked this as a favorite

Does she know the difference between itching and hurting?
posted by aabbbiee at 9:12 AM on February 25, 2019 [7 favorites]

Oh my god this was my life as a child!!!! It sucked and my mom totally thought I was making it up. My labia was too long and I had it corrected with surgery 5 years ago and it’s awesome after a lifetime of suffering!
posted by catspajammies at 9:18 AM on February 25, 2019 [2 favorites]

I hate to mention it, but is there any possibility of abuse?
posted by praemunire at 9:21 AM on February 25, 2019 [7 favorites]

Did they check if it looks like lichen sclerosus? Totally treatable but needs to be diagnosed.
posted by cnidaria at 9:21 AM on February 25, 2019 [1 favorite]

Did they check for lichen sclerosus or lichen simplex? I had simplex as a child and experienced similar symptoms, but remained undiagnosed until a specialist saw the scarification on my skin as an adult.
posted by lydhre at 9:23 AM on February 25, 2019 [2 favorites]

Fungal infection? Material alergy? These would probably form a rash eventually, but you never know. Another possibility could be a pinched nerve nearby or ghost pain from a back injury. I have at times gotten a sharp pain in my inner thigh and other places that was definitely related to my movement in my back.
posted by Short End Of A Wishbone at 9:54 AM on February 25, 2019

a friend's daughter had strep down there at age 3. I know you said she had antibiotics but I don't know whether they'd all work for that.
posted by fingersandtoes at 10:12 AM on February 25, 2019

Have you tried switching to a different laundry detergent (one that does not have added scents or colors)? I've had very unpleasant & itchy reactions to chemicals in various detergents.
posted by belladonna at 10:15 AM on February 25, 2019 [9 favorites]

From childhood on I would have occasional spells of pain inside my vagina. I could only describe it as feeling like a sharp jab, or, when it was at its worst, like a knife had been poked in there. It'd last for a few minutes or an hour or so, then go away.

As a kid, I couldn't figure out why it hurt, and ended up guessing it was maybe caused by too-tight underwear chafing at the groin. My parents never took us kids to the doctor so that was out.

I'm post-menopausal now, and I no longer experience it. It never turned out to be a big deal, but I've often wondered if other girls/women have experienced that.
posted by Lunaloon at 10:18 AM on February 25, 2019 [1 favorite]

I have a similar reaction to all laundry detergent. My doctor also thought yeast infection and/or BV and gave me antibiotics which didn't solve the issue (although it seemed like it did temporarily). What 100% fixed the problem for me was switching to washing my underwear with just hot water (no detergent). The one time I accidentally used detergent the symptoms immediately came back.
posted by mcduff at 10:27 AM on February 25, 2019 [2 favorites]

Does she ever have bubble baths? When I was a stepfather, my then-wife had this ongoing battle with her parents over the fact that they kept offering bubble bath products to her youngest, who loved them, despite the cost they always seemed to incur on her.
posted by kimota at 10:35 AM on February 25, 2019 [6 favorites]

I'm not sure what the imaging you mentioned would have entailed, so just wanted to say that labial adhesions are a thing that can happen in kids, and the first-line treatments are things you could try on your own if it seems plausible based on visual inspection.
posted by teremala at 11:12 AM on February 25, 2019 [2 favorites]

another thing I have seen causing genital pain in a little girl: pinworms. Pain is not a very common symptom (itching is) but as was pointed out above, those sensations are not always easy to distinguish; anyway, in this case, the child would wake up at night (which is when pinworms come out to feed) with pain in the genitals - she never described the more typical anal itching. Doctor never diagnosed it as they didn't show up during the daytime when the child was examined. Took a midnight episode with a flashlight to get it figured out.

Good luck to you and your girl. It's just terrible when they hurt, and especially there.
posted by fingersandtoes at 11:29 AM on February 25, 2019 [10 favorites]

I just read an article about this last week in the Guardian -- basically discussing how the ways we try to detect UTIs are outdated, and can mean that people do have UTI's when their doctors insist that they don't. The treatment is often long-term antibiotics (less scary than it sounds). One of the patients featured is a girl not much older than your daughter. I would absolutely raise this with a doctor -- it seems little known.
posted by caoimhe at 11:41 AM on February 25, 2019 [5 favorites]

I was going to suggest the possibility of pinworms as well. You can, if you like, go ahead with an over-the-counter treatment but you're already in touch with your doctor so ask them about it. Two doses over two weeks and they should be gone. If you want to test for that, you do a tape test around the anus for a few days and they can see if there are pinworm eggs. Kids are pretty grody with fecal bacteria so it's a common thing to get but thankfully easy to treat. Pain at night is one symptom that really aligns with pinworms.
posted by amanda at 12:20 PM on February 25, 2019 [2 favorites]

I was diagnosed with lichen sclerosus in my 20s when I finally saw a dermatologist for it. It caused severe itching on my vulva and labia. I don't know when it started. As a child, I hid a fork in my bedroom to scratch myself (I have always been a nail-biter), and it just continued until I finally saw someone who took me seriously. At that point, the itching was so constant and so severe that I would just scratch myself until I bled almost every day. I didn't have any relief with any of the steroid creams they prescribed until I was finally given a script for clobetasol propionate ointment.

My son is 4yo and eczema prone, but doesn't really scratch himself. He woke up in the night over the weekend because his legs "hurt" and I realized they were really dry. Aveeno Skin Relief lotion is our go-to for eczema relief and it helped tremendously. I don't know why he doesn't scratch but he never really has, while I know other kids who learned before age 1 to take off zippered pajamas to scratch themselves.
posted by aabbbiee at 2:14 PM on February 25, 2019

Does she have sensitive skin? I’ve had a lifelong battle with contact dermatitis due to an allergy to... toilet paper. Singulair has been a real life-saver.
posted by Andrhia at 5:01 PM on February 25, 2019 [1 favorite]

Not your doctor, and I give somewhat specific advice below that should be consulted with your doctors to ensure it is relevant to your situation but I appreciate that you have been round the traps a few times, although not clear what kind of specialist you saw.

Look, thrush is an uncommon disease-causing organism in small children because it is somewhat dependent on the ecosystem created by oestrogen in the vagina, which is minimal in a pre-pubertal child. So one should not have the same threshold for treating thrush in a child that one does in an adult woman and only treat after examination +/- swabs in consultation with doctors.

Children often poorly localise pain, so I would consider issues in the vagina, vulva, urinary tract, and also bowel as potential issues - constipation is super common and may not be as obvious as never going to the toilet, and is frequently a contributor to recurrent UTI. Pain may make children more reluctant to go to the toilet and cause a vicious circle of constipation.

I give people this information about non specific vulvovaginitis and from the royal children's hospital in melbourne - always best to make sure all the simple stuff has been taken care of before going down a rabbit hole of further diagnoses and investigations - wipe out pinworms in the house, stop using bubble bath, minimise skin irritants - all the stuff mentioned above but it's collected nicely on that fact sheet
posted by chiquitita at 5:13 PM on February 25, 2019

Also, if you're using a barrier cream maybe switch to a really bland vaseline/petroleum jelly based moisturiser to minimise the chance of a contact reaction or a zinc-based cream with minimal added ingredients or preservatives
posted by chiquitita at 5:23 PM on February 25, 2019

Super helpful. Thanks, y'all! Here's to happier nethers in the near future.
posted by jeszac at 6:33 PM on February 25, 2019 [1 favorite]

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