Abnormal Discharge In Adolescent Girls - How To Avoid It?

Pruritus Vulvae is the most common cause of vulvar soreness and abnormal discharge in adolescent girls. The growing years are a transition phase where most body parts are undergoing changes to reach the adult stage. While some changes would be obvious externally, there are a lot of internal changes, which would not be very apparent. And for growing girls, especially the changes that they see in their private parts are worrisome, sometimes unpleasant and uncomfortable. About 50% of them would not even discuss these with someone to avoid embarrassment.

Some amount of vaginal discharge is normal and contains bacteria, which are essential for normal genital health. It also provides lubrication and keeps the area clean. However, the amount, colour, and type of discharge can vary and is a good indication of any underlying abnormal condition. Most genital tract issues manifest with a change in the vaginal discharge along with irritation or soreness.

In adolescent girls, the most common problem is pruritus vulvae, which is itching of the vulva region. It is a variant of contact dermatitis caused by irritation. In the growing years, the vulva is thin and delicate with a neutral pH. This makes it easily irritable, unlike in mature women, who also have the protection of pubic hair, thick skin, and labial fat pads. This irritation leads to a condition called pruritus vulvae.

Causes of soreness:
These are primarily non-infectious and infectious (genital).

Noninfectious causes:

1. Poor hygiene leading to irritation, soreness and itching
2. Contamination with urine or feces
3. Mechanical irritation from itching, use of toilet paper, ill-fitting undergarments.
4. Chemical irritation from soaps, detergents, shampoo, chlorinated water, etc.
5. Foreign body such as toilet paper leading to vaginal discharge can cause vulval irritation
6. Skin diseases like atopic dermatitis, seborrheic dermatitis, or psoriasis presents with vulvar symptoms too in the form of soreness and itching

Infectious causes:

1. Sexually transmitted infections like trichomoniasis, gonorrhea and chlamydia.
2. Viral infections like genital herpes and genital warts.
3. Fungal infections such as Candida such as and tinea are rarely the cause of pruritus vulvae in prepubertal females.
4. Worms like pinworms which move from the anus to the vagina, causing itching
5. Bacteria like Shigella, Yersinia and E. coli can also lead to non-sexually transmitted infections and subsequent symptoms like soreness and discharge.

Prevention/Management:

1. Awareness is the first step in prevention. The girl must be educated about the changes her body is going through and the reasons behind it.
2. Hygiene habits, especially after urination or passing feces, should be enforced.
3. Avoid undergarments that are tight fitting and can be irritating
4. Avoid soaps/chemicals when cleaning the genital area
5. Topical creams (emollients/hydrocortisone) are usually effective
6. Infections would need a course of antibiotics

When the girl is complaining of soreness and itching, it is best to visit a doctor to get a thorough examination and manage accordingly.