Advice about Girls' Genitals

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Preschool girl with sore girl parts

May 2009

My four-year-old daughter has been suffering from sore genitals, with varying degrees of soreness, for months now. Sometimes her outer labia look quite red and irritated and a crack forms just above where the labia join together. We've seen her with her hand down her pants, but she doesn't seem to play with herself excessively. We have questioned her, and carefully examined her environment, to rule out any possibility of abuse by others. I took her to her pediatrician, who seemed puzzled by my daughter's condition, as if she'd never seen anything like it. She called in another pediatrician in the practice, who was equally at a loss. They didn't know what to suggest.

Things we have tried include reminding my daughter to wipe after she pees (it seems unlikely that traces of urine could have caused the problem, but they certainly don't help it heal); reminding her to touch herself gently; putting Aquaphor on the area; and mostly recently, I tried some cream intended for women with yeast infections (which seemed to help a bit). Could this be a yeast infection? Any other ideas? I don't want my little girl to be sore

I can't speak directly to what your little girl is experiencing but I'll share that when my 2 y/o girl says she's sore or is showing any irritation there, I fill a peri bottle (squirt bottle) with warm water and a squirt or two of calendula tincture which we then squirt on the area. This is what my midwife had me do for my healing after childbirth. Calendula is very healing to the skin and can give quite rapid relief. My daughter specifically asks for it when she feels the need. good luck and speedy healing

I don't know why the doctors acted so puzzled. It's either a yeast infection or something is irritating her. If she uses bubble bath, stop using that and make sure that area is kept clean (clean underwear and showering gently with a hand held shower). Also try adding some salt (regular table salt is fine) to her bath and let her sit in it for a while. This acts like a saline solution and may soothe the soreness. mom of three girls

I don't know what insurance you have, but at Kaiser in the East Bay there is a Pelvic Pain Clinic. There are doctors and NPs that specialize in pelvic pain. Dr. Renee Perry, at Oakland, recently saw me and diagnosed a condition that has plagued me for decades (and I'd always been told was ''all in my head'' or had simply baffled other OB/Gyns). If you have Kaiser, I highly recommend getting your daughter a referral to Dr. Perry or see if she can recommend a pediatrician with expertise in this area. It's not a big field, but there ARE people who study it exclusively. And their center has many options for treatment, from medication to physical therapy to acupressure (depending on needs). Best of luck - my pain started when I was little too. I feel for your little girl! also ouchy in my girl parts

I work full time & my daughter is in preschool. It's hard to be aware of everything that goes on. You might try to spend a vacation week together where you really watch what she's doing and also maybe treat her genital area. See if a focused week can help get her back in better shape. - Anon

Could your daughter be allergic to latex/other synthetics in clothing or additives in soaps? I must wear cotton underwear and my outer clothing must also have lots of natural fabric in it. If clothing is too tight in the genital area that can create problems too. Also, I have to use detergent that is unscented and Dove soap for sensitive skin (suggested by dermatologist). Oh,and make sure the toilet paper is unscented too. anonymous

I am going to just lay this out there,with no delicate preamble...It took my daughter two years of abuse (from age 2 to age 4) to finally disclose what was happening. It was a very close, very loved, very trusted relative. Like you, I saw raw, chapped- looking labia....I would give an identical description... about 6 months prior to disclosure. Like you, I gently asked some pretty direct questions and got no real answers. But I KNEW something was not right. This is most often the case...not telling. You cannot force disclosure. You could try reading a few books for kids to her on the subject of child sex abuse. It may encourage a dialogue if, in fact, she is being ''messed with'' by someone. The ones I would recommend are ''A Very Touching Story'' and ''Please Tell'' and ''My Body is Private''. These are ones that my kids have responded to very favorably. I would also talk with someone who is experienced professionally with this sort of thing. That, actually, would be my first course of action. If you decide you have any questions you'd like to ask of me, feel free to email. Best wishes to you and your girl.

If your pediatrician can't help, can you ask your own gynecologist about this? At the very least, your pediatrician may be able to recommend something to try. If you do use a cream meant for vaginal yeast infection, at least use one with the lowest percentage of the active ingredient you can find. I have a vague memory of my own doctor telling me that those creams are too strong for little girls. (But our pediatrician did approve it for diaper rash caused by yeast.) F.

Your pediatrician left you with no ideas and sent you on your way? You must pester her or get another opinion. Of course you don't want your daughter being examined by multiple doctors (the LAST thing you'd want is for her interpret anything as shaming her, of course), but you've got to get to the bottom of this. You may get some good idea here, but really this belongs to a medical provider. Some doctor has seen it before -- I'm sure she's not the first girl in the world with this situation.

Good luck. And again, please be careful with any messages you could inadvertently give her (or misinterpretations she could have) with your concern over this -- that could cause her more damage than the condition itself. - A therapist who sees adults who had issues like this one

You are going to get a lot of extreme responses from your description, but to me it sounds like vaginal fissures. You can google them (but: no one seems to know the why's/wherefores). I started getting them after the birth of my second child (in my 40's), and because I had never had them before or heard of them, they puzzled me a lot. Also, they hurt like the dickens. (They look like paper cuts, and they feel like them too.) Also, they wouldn't go away. Also, they appeared for no real reason (ie., irregardless of activity levels in that area) -- except, for me, they are definitely associated with yeast infections, even very slight ones. The thing, the only thing that helped me is this: shower daily, don't use soap (or other products) around vaginal area, and spray front to back with plain warm water (a hand attachment thingy is very useful and effective). Pat gently dry. I do this daily as part of my shower, and it has totally cleared up the problem for me. Which is relieveing to no end, I can't begin to tell you. Good luck with your little girl! Poor thing. Fissureless at last

My daughter had similar issues - her genital area was always inflamed - started when she was about 1 1/2 and still in diapers. We discovered that by switching to lactose free milk it cleared up - we kept her on it for a long time and then when she was about 9 slowly reintroduced regular milk and she has had no problems since. - the doctor thought that it was causing a reaction in her urine, inflaming the area. She was able to eat other dairy without problems (altho we did limit/monitor - tried to keep to yogurt and yogurt products). Its an easy try. We also tried yeast medication but switching the milk was a quick easy fix. anon

My preschooler had several episodes of similar symptoms. We took her in for possible UTI's (negative) and we think it was yeast, in the end. Yeast cream (not just a ''make it feel better cream'', but a ''kill-it'' cream, like Monistat, but only rubbed on the outer genitals, not using the applicator) really helped. Also, I have had similar symptoms lately (age 42), with the soreness and ''cracks'' that you describe. This is new for me, and I am attributing it to yeast from eating too much sugar. When I cut down on sugar, it goes away. So I bet this is a yeast issue, and I bet cutting down on sugar a bit, and using the Monistat will help a great deal. Good luck; you're not alone! Berkeley mom

I had a really bad allergic reaction to laundry detergent last year. It shows up where your clothes hug the skin the tightest, especially in the crotch, and near the armpit where the arm meets the chest. So maybe she's having an allegic reaction to your detergent. Try rinsing her panties in hot water AFTER they have been washed to get all of the detergent out. Have her wear looser panties, and also undyed panties (white cotton probably is the best choice). Perhaps she could avoid wearing panties at certain times like when she sleeps or when she is home. s.

Hello in response to your daughters irritation, i have a friend who has a two year old who got constent yeast infections. I think you should have your daughters doctor check her for yeast. if she is still in pullups or diapers this could verywell be the reason. If it is found to be yeast you need to ask them for ways to treat it and maybe even try changing your daughters diet for a while to help prevent further infections. Plain yogurt is very helpful if eaten and it can also sooth the area if you want to place it on her like an ontiment to the outter areas. since she is so young i wouldn't suggest inserting anything inside the area. Check with your pediatrician. JM

Having sore genitals for months on end is too long! I can only imagine the discomfort you child is in. I don't know what the problem is, but either ask your pediatrician to refer you to a specialist (dermatologist?) who can identify the problem or seek the advice of a third pediatrician. Best of luck

You know, a few conditions come to mind when reading your post. One of them is called ''lichen sclerosis et atrophicus'' and can definitely cause pain and cracking in this sensitive skin. Usually the labia appear pale rather than inflamed though. It is so hard to diagnose this sort of thing without actually seeing it. My advice to you is to ask for a referral to a pediatric dermatologist. Given the fact that 2 different pediatricians seemed to be scratching their heads over this, I'm actually amazed that you haven't been referred already. Please don't just wait and see if it resolves on its own (unless it already has of course!). You'll probably gets lots of suggestions of things to try but I'd be reluctant to do much until you see a specialist. This area is so sensitive sometimes you can inflame the area with a ''remedy'', and then its really hard to tell what you're dealing with. Oh, and if they won't give you an appointment right away, ask your pediatrician to call and explain the situation. a pediatrician

Both our girls have had the same issue over the past two years. We have found two things that where the source of their problem. We found that wiping the wrong way after the went pooping, causes irritation, so we help them wipe again. The other thing that seems to be the cause is contaminated sandboxes or dirt with the feces of cats. They can carry little worms (this is what the doctor told us), the eggs of these worms can be ingested by mainly kids since their hands go in their mouths easily. Since the worms will be in your childs feces it can irritated their private parts. There are medicines (we got pills) to kill them and the irritation will go away in a day. Just make sure everyone in your family takes them even if you don't have symptomes since you could potentially spread it around again. And clean your bathroom really well too. Also, we make them wash hands way more now than before and haven't had this issue for the past 6 months. Hope this helps, good luck! anon

Toddler with vaginitis

Oct 2008

My almost 3 year old daughter has vaginitis. She complained that it was painful when she was voiding. She even asked me to put medicine. That's when I checked her private area and found that the area was really red and even her skin was torn open...It looked really painful...I took her to doctor's office and he just said she has vaginitis. I don't know if it is really common at her age...Anybody with same experience with toddler with vaginitis??? anon

I'm willing to bet she has a yeast infection. Talk to a nutritionist or get info on line, then you can treat her accordingly by eliminating certain foods. It's VERY common in females of all ages. Good luck, been there

My daughter was having problems with vaginal irritations too. We first tried conventional yeast infection luck. Then anti-fungal meds (all with doctors consult). We even tried probiotics that did nothing. She never ate lots of yeasty things so that wasn't the issue. What finally worked after many months of the on-again, off-again irritation was getting her into the bathtub every night, no exceptions, no bubbles in the bath. She's 5 now, and we've been doing this for ~2 years, and it seems to work. We can even skip the bath once in a while now. Also- with the water situation, we only fill the tub about 5 inches, and then bail the water for our perennials. Liz

Vaginitis is not uncommon in toddlers. Some things that can cause vaginitis:
-bubble baths, or baths with ''perfumed'' soap. -wearing tight, nylon clothes for long periods of time (like bathing suits or tights/leggings). -not changing underwear right away after accidents. -wiping the wrong way when going potty (from back to front). -pinworms (the doctor can tell you how to test for them if they are suspected).
Applying a diaper rash cream can help with healing and prevention. A good one is Diaper Rash and Thrush Relief by Motherlove - you can buy it at Whole Foods.

Also, if your doctor didn't explain all these things to you, I think you need a new pediatrician. I highly recommend Katya Gerwein at Bayside Medical Group in berkeley/oakland. hope this helps.

A couple of things come to mind... the first is fecal contamination. From wiping or for some other reason, maybe some poop got in there. the other is harder.... and it is something I have dealt with... perhaps she is being sexually abused. People really are reluctant to consider this one (I know I was), and it may be worth considering. The main reason I mention this is your description of her genital area. Sounds like what my daughter was experiencing at about the same age. I asked her if anyone was bothering her private parts and she said ''no'' in a very faraway voice. I knew pushing the issue wouldn't help, so I became hyper- vigilant and paranoid. I missed it anyway. She was being ''molested'' (understatement) while the family slept by her teenaged half-brother. She told me 6 mos after I had asked. Just throwing it out there... Hope that isn't it. anon

My daughter also had trouble with this, and still does occasionally (she just turned 5). What helps is to make sure baths are frequent, use a very gentle soap to wash her private parts (we use Cetaphil, which comes in a dispenser bottle), and then after the bath, I gently apply some Aquaphor to the vaginal area if it's reddened. Aquaphor is a diaper-rash ointment that comes in a large tube; it's clear and thick, and feels kind of like Vaseline. anonymous

I'm hoping other people will have good advice about this, because my four-year- old daughter has a similar problem, though she doesn't generally complain about it hurting. Her outer labia get all red and sometimes crack (it *looks* painful!). We keep asking her if she has any idea why this is happening, and she never does. The only theories we've come up with are that she likes to touch herself (and maybe her hands aren't always clean when she does so) and she usually forgets to wipe after peeing, so there's probably a bit of pee in her underpants. I worried about whether anyone else could be touching her, but we don't see how anyone could possibly have access to her, and we've questioned her about this (while trying not to freak her out) and nothing has turned up. I took her to the pediatrician, who had no idea what it was, and suggested not using soap on her girl parts in the bath. We tried that for a while, and also tried Aquaphor, which helped a bit, but didn't get rid of the problem. Mother of another little girl with sore girl-parts

If your child is in daycare, you might ask how they help her wipe after she pees. We found that our daycare providers were using baby wipes even after our daugher was no longer in diapers and which left the vaginal area too moist. Once they switched to toilet paper, the vaginitis cleared up. anon

4 y.o. girl cries when private parts are washed

January 2005

Please, help! My daughter cries when her private parts are being washed with soap. She says it hurts a lot. I myself am sensitive to some soap, and I think I know the kind of pain she is talking about, but I now use only baby wash for her, and it doesn't seam to help. Is it normal? Is there any milder soap that would be better than baby soap? Should I have her see a doctor? Any input would be very much appreciated.
concerned mom

How about skipping the soap all together? The inner folds of female genitalia are better off without soap. Water does just fine. I'm nurse-midwife and often need to tell women to stop using soap.
it's a self cleaning oven!

I suggest showing her how to wash herself and using more water than soap. A hand held shower should help.

Please mom! No soap is necessary in the genital area, and definitely no scrubbing. It's a self cleaning body part... Give your daughter a bubble free bath (bubble bath can be very irritating down there). The water alone should get her vagina as clean as it needs to be. Happy bathing!
Mother of 3

I have been sensitive all my life to soaps on the vulva, and on checking it out, I've found that I am not alone, and that water alone is perfectly adequate for washing the female genitals. My OB/GYNs have always made a general recommendation not to use soap there. I'd suggest washing very gently with water only from now on. Also, if her vulva is irritated by washcloths (or has lasting irritation from soaps used in the recent past), a shower nozzle on a flexible hose can be used with lukewarm water and a gentle water flow to wash without a washcloth. Who knows, maybe she'd find it fun! (I learned this trick following childbirth. If you don't have that kind of shower nozzle, a bottle such as a bike water bottle can be used to create a similar gentle flow by just filling it with plain bath water or lukewarm water from the sink, and using it on the toilet or in the tub.)

Either way, being gentle is key. I'll say from experience that a chronically irritated vulva can become a multi-year chronic itch, from the irritation alone (no disease involved). Not an experience I recommend.
Sticking to Water

hello, my 3 year old little girl is the same way, but when we saw the pediatrician her advice was simple: just wash with water, and it will be fine. I would still consult with her doctor to make sure she doesn't have a yeast infection, or you could look if she has a rash and just treat with desitin. Good luck! anon

You might try Cetaphil liquid soap. It's extremely mild. anon

Soap stings me down there too. Through trial and error I've found that olive oil based soaps do not sting. I like the brand Kiss my Face, and also the EO line of liquid soaps, which you can get at Elephant Pharmacy I think. They are gentle and they smell nice too. I don't think you should be using a wash cloth or anything rough like that. Hope that helps.
Sensitive Mom

I would strongly suggest you see a doctor to rule out any other issues. We have used cetaphil soap for our son who has very sensitive skin. We were told that the ''baby soaps'' actually have so many frangrances that they irritate the skin. You may also want to consider Aveeno products.

I don't think vaginas need to be washed with soap, just water.

You could try having her wash herself. 4 is old enough for that. Also, maybe don't use soap in those areas all the time. Just a nice long soak in the water that is probably full of soap from washing the other parts of her body would probably do the trick.
clean enough

I never washed my kids private parts with soap... or my own for that matter! This sounds unhealthy to me!
fresh and clean mamma

Plain water is best. Soap or cleanser of any kind can be very irritating to the female genital area at any age. At 4 years, she might also resist having parents too involved in her personal bathing ritual. Have you tried ''delegating'' and trusting her? She should well be able to simply pour water from the shower head to her privates, or to dab them front-to-back with a soft wet washcloth.
Don't obsess

I second everyone's advice that water is sufficient but wanted to add that using soap on female private parts can upset the natural bacterial balance and cause yeast infections.