24 hours after the female child is born, microorganisms colonize in her vagina and vaginal ecosystem begins to form. Vaginal ecosystem keeps its presence throughout the entire life cycle of a woman. It is a very fragile and dynamic system. Therefore, it may get impaired with both internal (i.e pregnancy) and external (i.e. antibiotic use) factors.
In the vagina of a woman in reproductive ages, there is a colonization of 6-9 different bacteria. In one gram of vaginal secretion there is 10 to 20 million vaginal bacteria while in one gram of oral secretion there is 100 million bacteria and 600 different bacterial colonization. So, it may feel weird but oral cavity has way more bacterial colonization than vagina. Secondarily, the immune system of oral cavity is very strong.
Vagina of a newborn is just life an adult’s due to the effect of estrogen that passes from her mother. Its pH is acidic, it has all the features of a grown woman. However, the effect of this estrogenic activity ends along with disappearance of the estrogen that came from the mother. Late effects of estrogen, such as protective effect on perineum continues for 1-2 years than ends in 2 years. In subsequent childhood period, there is no estrogenic effect so vagina of children is exposed to colonization of any bacteria.
As you may understand from the explanations above, genital system of childhood has its specific character. In childhood, from the period after disappearance of estrogen’s effects that came from mother until the puberty (estrogenic activity will begin after puberty), there is no lactobacilli in the vagina because there is no estrogenic activity. In an environment without lactobacilli, vagina is expose to any kinds of infection. Therefore, discharge is not easily treated in childhood ages, it is very resistant. The fact that there is no natural defense mechanism reduces the efficiency of drugs. The cause of frequently relapsing vaginal infections is this.
When talking to the family, it should be told that present vaginitis will not harm child’s fertility in the future, but it will be difficult to cure the discharge completely. If patient is above 4-5, she should be talked before beginning to treatment (it requires certain experience). For example, it should be asked how she cleans the perineum after toilet or whether someone is helping her, her teachers must be talked with if she goes to kindergarten.
Treatment is very different in this process. The first option MUST NEVER BE antibiotic treatment in treatment of vaginal infections. There is a very different treatment scheme. In treatment of vaginal discharge of children, first phase is to teach genital hygiene. Mother should be told how to do cleaning. Child will urinate with her legs closed. This results in triggering the infectious environment even more. Mother and/or babysitter must be told to make her urinate with her legs open.
While cleaning the genital area of children, soap must not be used and drying should not be done with toilet paper. Towels should be used instead. Antibiotics must not be used in the beginning of treatment process and they should be administered only if there is a growth in the culture (its frequency is between %15 and 25). Mechanical vaginal cleaning methods should be preferred. Vaginal culture must be taken and antibiotics should only be used when necessary.
If it is necessary to use antibiotics, it must be used for at least 10 days, ideally 14.