Review Article: Vulvitis and in the Child Population Atit Tajmiati, Indonesian Midwives Association (IBI),West java, Indonesia Email : [email protected]

Abstract

Vulvovaginitis is a gynecological problem that usually occurs in prepubertas girls. The presence of vulvitis and vaginitis in the child population can occur separately or a whole (vulvovaginitis). The symptoms and signs of vulvitis are the presence of itching, dysuria and erythema of the . The presence of discharge is an indication of vaginitis. Increased incidence of vulvovaginitis in children is a combination of anatomical and behavioral factors. Where, the anus is located closer to the vestibule / introitus, so poorer perineal hygiene causes bacterial contamination or irritation of the faecal material to become easier and more frequent. Keyword: Vulvitis, Vaginitis, Child, Factors

Introduction

The cause of vulvovaginitis in children is an infection (including sexually transmitted infections) or non infectious. The most common cause is infection. Various microorganisms have been reported as the cause of Haemophilus influenzae, Shigella, Eischeria coli, Streptococcus group A and B β hemolyticus, Neisseria gonorrhoeae, Chlamydia trachomatis, Candida fungus and parasite Trichomonas vaginalis, Oxyuris (Enterobius) vermicularis [1,6]. Another cause is a foreign object inside the vagina, but in some children there is no known cause. Candida infections are very rare in prepubertas-age girls when compared to adults. This is because Candida can not thrive in the vagina that is not estrogen [2]. Predisposing to such as the use of oral antibiotics, diabetes mellitus, immunodeficiency, immunosuppression treatment, the use of estrogen therapy and their underlying primary dermatosis should be sought in case of infection with Candida, especially in prepubertal age. The characteristic feature of diseases such as vulvovaginitis is that it occurs usually in girls up to eight years old and in older women. Women have different ages of the disease is very rare, but, after all, it is possible and such. Commonly known as vulvovaginal inflammation of the vaginal and vulval walls in girls. This contributes to the emergence of transmitted infections such as scarlet fever, measles. Some sources of vulvovaginitis in girls are divided into several groups: bacteria, viruses, trichomonas, mikotik [3]. Many parents are concerned about this topic as the cause of vulvovaginitis in children, a closer look at why this disease occurs in girls. Generally, inflammation arises in relation to the painful effects on the genital female pathogenic mucosa such as staphylococci, streptococcus, gonococcus and enterococci, chlamydia, E.coli and others [5]. The cause of inflammation in children should be known: First, it is a failure to comply with the basic norms of genital hygiene; Second, often inflammation can develop as a result of obesity and diaper rash. Third, a significant impact on the occurrence of inflammation can have eczema, psoriasis; Fourth, vulvovaginitis is able to develop in women in the presence of diseases such as hemorrhoids; Fifth, inflammation is a serious threat to various, thermal, mechanical methods of chemical influence, for example, a child can comb the genital area, receive minor injuries, abrasions, which may lead to the progression of the disease; Sixth, vulvovaginitis is able to develop on the background of various endocrine diseases, especially diabetes. In addition to the causes of the above graves can serve a variety of inflammatory processes in the perineum area. In addition, provoking factors to develop the disease are: 1. Uncontrolled use of antibiotics, as well as duration of intake may lead to the development of vulvovaginitis. 2. Provoke this inflammation capable of pregnancy. 3. Ovarian function triggers the disease. 4. Use of certain drugs can cause inflammation. 5. Because of injury and surgery there is an immune deficiency, which causes the onset of the disease. That is not a complete list of provoking vulvovaginitis in children and adult factors, but the most common cause of this disease is trichomoniasis, candidiasis and others. A leading role in the treatment of vulvovaginal girls to play a correct and timely diagnosis of disease. For effective medical treatment of this disease requires a diagnosis, which is done by a particular study with different methods, such as immunoassay, bacterioscopic, cytology, bacteriology. To do this, the patient is taken some type of vaginal pap, moreover, if it is suspected that vulvovaginitis is present, the doctor performs mandatory examination of the genital organs, with the greatest attention paid to the state of the vulva and urethra. In addition, if this disease doctors monitored the vaginal mucosal reaction, explore the nature of these emissions. Childhood vulvovaginitis expresses certain symptoms based on who goes to the doctor, who can diagnose and detect the cause of the disease. Vulvovaginal symptoms are itchy and burning in the genital area, and these symptoms are characterized by an increase in urination, walking. In addition, in the genital area is a strong discomfort, sometimes these feelings added purulent-mucus characters [4]. Quite rare, but there is a bloody and smelly discharge, which gives reason to believe about disease neglect and transition to chronic form. What threatens disease is possible to develop complications or other diseases The main threat in vulvovaginitis in girls a fusion of the minora, is called , and when circumstances of neglect, this phenomenon can cause urethral closure. In addition, without proper treatment and disease progression can cause warts, polyps, scars in the vagina. In the worst scenario, these complications can affect the reproductive ability and more complicated a woman's sexual life. Child vulvovaginitis is not a rare phenomenon, causing, in principle, obvious. It should be noted that the treatment of vulvovaginal should be done with the help of obstetricians, self- medication, especially children is unacceptable. Sometimes it happens that inflammation has arisen due to poor hygiene, can be cured with washing and ordinary body hygienic standards and genitals in particular. However, it is not always appealing to specialists deemed necessary. Doctors may prescribe antibacterial and antifungal drugs - it depends on The type of pathogen is the cause of inflammation. Patients with this disease are often advised to switch to a healthy diet that excludes large intakes of carbohydrates, dyes, preservatives. Increased dietary intake of vegetables, vegetables, fruit products, milk acids.You can not ignore the cleanliness of the body - children should be washed, especially for girls, it is important to keep the vulvar cleanliness.

Discussion Candidiasis is a fungal disease that is acute or subacute caused by candida species, usually by candida albicans species and to the mouth, vagina, skin, nails, bronchi or lungs, sometimes causing septicemia, endocarditis or meningitis. Disease there are in the world, Can attack all ages, both male and female. The fungi are present in healthy people as saprofit [6]. The clinical picture can vary so it is the exact data dissemination [1]. Vulvovaginitis candidiasis is a fungal disease that affects candida vaginal mucosa and vulva. The cause of most common usually is candida albicans. Other names of this disease are vulvovaginitis candididosis or Mycotic vulvovaginitis. Vulvovaginitis candidiasis may occur if there is a predisposing factor endogen. Factors of both exogenous and exogenous to the onset of candidiasis vulvovaginitis are obesity, diabetes, pregnancy, and chronic infections in the or vagina. While the exogenous factors of climate, heat and humidity are increased as well as bad higyeni [1,2]. The pathogenesis of candidiasis vulvovaginitis starts from the presence of predisposing factors to facilitate pseudohifa candida attached to mucosal epithelial cells and to form colonization. Then candida will release keratolitik (phospholipase) that hydrolyze phospholopid membrane epithelial cells, thus facilitating the invasion of fungus to the tissue. In the candida tissue, neutrophil chemotactic factors will emerge which will lead to acute inflammatory ractions that will manifest as hyperemic or erythema areas of the vulva and vaginal mucosa. Keratolytic substances released by candida will continue to damage the mucosal epithelium resulting in superficial ulcers. Which increases weight with scratching so that erosion arises. The rest of the necrotic tissue, epithelial cells and fungus will form white colored clumps over an erythema region called flour albus [3,5]. Clinical symptoms of candidiasis vulvovaginitis comprised of subjective symptoms and objective symptoms can be mild to subjective berat. Symptoms of his main field area vulvar itching, and there is also a severe burning sensation, pain after micturition and objective dispaneuria. Symtoms of mild lesions of erythema and dilabia hyperemia of the labia, vagina and vaginal lower introitus bawah. On heavy 1/3 and minora edema with small ulcers red colored with erosion and often worsened by scratching and the presence of secondary infections. Distinctive sign is a yellowish white colored flour albus with clots as cream [1]. diagnosis is based on history is obtained and heat their itching of the vulva is sometimes followed by pain after micturition and dispaneuria and their predisposis factors such as obesity, diabetes, pregnancy , Infection in the cervix and vagina, increased humidity and poor higyeni. Clinical features of erythema and hyperemia can be accompanied by edema of the labia majora and minora, the presence of ulcers and erosions and yellowish-colored flour albus. Diagnosis is also accompanied by investigations including skin scrap or mucosal swabs examined with 10% KOH solution or by gram staining. In gram staining looks more cells, blastospores and false hyphae. It could also be a culture examination using a medium for sabaroud glucose dextrose overgrown with antibiotics (chloramphenicol) [1,2,3].

In addition to the treatment provided by doctors, for areas that have many medicinal plants, herbal treatment is one alternative [7]

References :

1. Casari, E. (2010). Gardnerella, Trichomonas vaginalis, Candida. 2. Discipline of Gynecology and Obstetrics,Faculdade de Medicina,Brazil. (n.d.). Incidence of Gardnerella vaginalis, Candida sp and human paviloma virus n cytological smears. 3. Gispen, W. (2007). Leiden Cytologi and pathology Laboratory Leiden Netherland. Vulvovaginal Candida, 41-60. 4. Kelestemur, N. (2012). Department of Parasitology, Faculty of Medicine, Fırat University. The Frequency of Trichomonas vaginalis, Gardnarella vaginalis and Candida ssp. Among Infertile Men and Women with Vaginitis, 5. Melbourne Sexual Health Centre. (2010, July). RECURRENT VULVO VAGINAL CANDIDIASIS. 6. Karo, Marni, et al. "Effects of ethanolic extract of Miana (Coleus scutellariodes [L] Benth) leaf on IgM profile in Balb/c mice with systemic of vulvovaginal candidiasis." 7. Karo, Marni Br, et al. "Effects of Herbal Plants on Candidiasis Vulvovaginalis Therapy." American Journal of Laboratory Medicine 1.3 (2016): 65-68.