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You are seeing a 3-year-old girl who has been potty trained for 4 months. She has been indicating that she has pain with urination. On exam, she is afebrile with normal other vital signs, has a soft nontender abdomen with no masses. Her genital exam shows Sexual Maturity Rating I, erythema of the labia majora and minora, and a small amount of milky discharge. Her point-of-care urinalysis is negative for leukocytes, nitrites, and blood.
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May 15, 2025 at 8:28 am
D) Advice to wear cotton underwear and avoid tight pants / leggings
The primary differential would be vaginitis (could be chemical due to e.g. bubble bath, or mechanical, due to e.g. excessive masturbation, which sometimes occurs in toddlers and preschoolers) and UTI. Lack of pyuria rules out UTI. The discharge described is physiologic; STI testing and DCFS reporting is not indicated. (STI testing should be considered for copious discharge or significant pyuria where no uropathogen is cultured). Recommendations for managing vaginitis in a prepubertal girl include: avoid tight pants / leggings, use cotton underwear, wear nightgowns instead of PJs, don’t sit in wet swimsuits for a long time, avoid bubble bath and soap to the genital area (use just warm water on the genital area and do not scrub), teach the child to wipe front to back and assist if needed until she is old enough to do it herself.