Vaginal Odor

Dear Lisa,

My daughter is almost 2 years old and today for the first time she had this really bad odor coming from her vagina. I tried looking it up online thinking its a yeast infection but there is no discharge and she gets a bath(she's not dirty or anything) What could this be? I can't seem to find an answer to make me feel better.

“Two year old with odor”,

Dear “Two year old with odor”,

Malodorous urine or foul smelling urine can be a sign of a Urinary Tract Infection in a young child. Therefore if the odor you are smelling is really an odor from your daughter’s urine, or her diaper filled with urine, a visit to the Doctor would be necessary in order to rule out a Urinary Tract Infection. Symptoms of a Urinary Tract infection in young children do not necessarily present the way that Urinary Tract Infections do in older children or adults. The typical urinary symptoms such as burning with urination or urinary frequency may not be present.

Instead infants and toddlers can develop non-specific symptoms such as a fever, vomiting, diarrhea, decrease appetite, weight loss, abdominal pain, pale grey skin color, lethargy, irritability or respiratory distress.(1) Older children are more likely to have the classic symptoms or other symptoms such as dribbling, incontinence, abdominal pain, decreased appetite, urinary urgency, blood in the urine or vomiting.

If the odor that your are smelling is from the vagina this may be normal. Many parents are surprised to find that girls as young as two can develop an odor in their private area the same way that adults do. Normal bathing should keep this odor under control. Although, a vaginal odor can be particularly noticeable in a child who still wears diapers.

Wearing a diaper traps moisture and provides a breeding ground for Candida albicans which is the microorganism responsible for yeast infections. Young girls can develop a yeast infection of the skin in the diaper area as well as in their vagina. Those children at risk for developing a Candia Yeast infection include children in diapers, children treated with antibiotics, children with Diabetes Mellitus and children treated with steroids. (2)

A child with a vaginal yeast infection does not display the same symptoms as an adult with this type of infection. The typical symptoms of a vaginal yeast infection in a child include vaginal discomfort, itching, redness, urinary frequency, or burning with urination. Sometimes children can be found rubbing thier private area on furniture. (3) From my experience, most young girls (including toddlers) with a vaginal yeast infection do not have a discharge coming from their vagina. Typically young girls do not develop an odor from a vaginal yeast infection.

The treatment for a vaginal yeast infection in a young child includes baking soda baths, exposing the area to air and the application of anti-fungal crèmes. Over-the counter antifungal crèmes such as Monistat or Lotrimin are used to treat yeast infections. In some cases a prescription antifungal crème may need to be prescribed.

Candida albicans is not the only cause of Vaginitis in a young girl. Vaginitis or the inflammation of the vaginal area can be caused by other infectious agents, irritation, or emotional stress.(4) Normal anatomical variations such as a high or microperforate hymen put some young girls more at risk for developing Vaginitis than others.(4)

Young girls with a high or microperforate hymen are more likely to trap urine or mucus in the area. The pooling of secretions in this area provides a good environment for microorganisms to grow. This cause should be considered in young girls who experience recurrent Vaginitis.

Irritation is a very common cause of Vaginitis in young girls. Items such as scented soap or lotions, bubble baths, tight fitting clothing, stockings and dyes in colored toilet paper or diapers can cause irritation and inflammation of the vaginal area that lead to symptoms. (4) Improper wiping of the female genital area after toileting is a common cause of vaginal irritation and subsequent Vaginitis.

Special care needs to be given to the cleansing of a young girl after toileting, always wiping from front to back, not back to front. Wiping from front to back prevents stool from being pushed into the vagina and contaminating the area. Sometimes a small piece of toilet paper or piece of stool can become trapped in the vaginal area which can cause irritation and in some cases an infection.(4)

As a part of normal development, toddlers and preschoolers learn about and explore their genital area through touching.(4) Frequent touching and playing with the genitals is another potential cause of Vaginitis in young girls. A tiny vaginal laceration may result if the child touches themsleves with sharp, untrimmed nails. The signs of a vaginal laceration include vaginal discomfort, burning with urination or bleeding.

In some cases a child’s natural exploring may lead to the insertion of a foreign body into the vagina. Items such a bead or a part from a small toy can become accidentally lodged in the area. (3) Symptoms of a foreign body in the vagina include vaginal discomfort, vaginal bleeding, a toddler who points to the area or an older child who says something is stuck.

Many times children will not tell a parent or even remember that they put something in one of their orifices. If a foreign body remains in the vagina for a length of time an infection can develop which can lead to odor and in some cases a discharge.

Symptoms of Vaginitis can mimic many disorders; therefore it is important to have a child who has vaginal symptoms evaluated by a Doctor or Nurse Practitioner. Urinary frequency and burning with urination can be caused by a Urinary Tract Infection. Redness and excessive itching of the vaginal area can be due to a vaginal strep infection. Pinworms, a common childhood infestation may also present with Vaginitis.(5)

If your daughter’s vaginal odor is relieved with bathing and only worsened after prolonged periods in her diaper this may be normal. If the odor is quite noticeable, not relieved by bathing or associated with fever, discharge or discomfort an evaluation by your Doctor or Nurse Practitioner is warranted. If you have noticed that your daughter has recently been touching and exploring her genital area and are not sure whether or not she placed a foreign body in her vagina, an evaluation would also be necessary.

I hope this answers your questions.

If you are interested in reading other Pediatric Advice Stories about topics discussed:

Burning with Urination

Candida Diaper Rash

Oral Candida Infection

Toddler Swallowed Paper Clips

Pinworms

Vaginal Strep

References:
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:532.
(2)Goldstein SM. Advances in the treatment of superficial candida infections. Semin Dermatol. 1993;12:315-330.
(3)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:832-833.
(4)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994: 1711-1714,209-210.
(5) Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:489.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Childhood Illnesses