What causes vulvovaginitis?

Vulvovaginitis in girls develops due to overstrain of the protective systems of the child's body, mediated by a number of factors:

• oppression of immunity;
• dysbiosis of the mother's birth canal;
• violation of the normal period of adaptation of the newborn;
• violation of the development of microbiocenoses of the mucous membranes of the child:
• frequent ARVI;
• hypertrophy of the elements of the lymphoid apparatus of the nasopharynx.

To a large extent, the health of the child is affected by environmental problems, changes in the quality of food containing an increasing number of substances of non-natural origin (synthetic components).

Relapses of nonspecific bacterial vulvovaginitis in girls in 82% of cases occur against the background of exacerbation of extragenital pathology, which is one of the leading causative risk factors for vulvovaginitis, a powerful source of infection. In the history of patients with vulvovaginitis with the same frequency there are systemic blood diseases, exudative diathesis, glomerulonephritis, cystitis, pyelitis, enterobiasis. In 5-8% of cases, vulvovaginitis in girls is associated with diabetes mellitus, thyrotoxicosis, endogenous obesity.

It has been established that vulvovaginitis is more common in children with chronic nasopharyngeal diseases, as in children with respiratory diseases, depression of cellular immunity occurs and the frequency of hypersensitivity reactions of delayed type increases.

Before birth and in the period of the newborn, the girl's vaginal mucosa mainly consists of 3-4 layers of flat epithelium of intermediate type. However, under the influence of estrogens and progesterone, which came from the maternal-placental blood flow or with the mother's milk, epithelial cells have the ability to produce glycogen and thereby maintain the vital activity of lactic acid bacteria. Only after 3-4 hours of the neonatal period, when the process of desquamation of the epithelium intensifies and cervical mucus becomes cloudy, lactobacilli, bifido- and corynebacteria, a single coccal flora can be found in the vagina.

Accumulation in the process of vital activity lactoflora lactic acid causes a shift in the acid-base balance of the vaginal environment of the newborn girl in the acidic side (pH 4,0-4,5). Bifidobacteria, like lactobacilli, protect the mucous membrane of the vagina from the effects of not only pathogenic but also conditionally pathogenic microorganisms and their toxins, inhibit the disintegration of secretory immunoglobulin (IgA), stimulate the formation of interferon and lysozyme. The body's resistance to a newborn girl is promoted by a high content of IgG, which is transmitted through the placenta from the mother. A significant drop in the level of estrogen occurs within 10 days from the moment of birth. It is during this period that the elimination of estrogens determines the so-called "sexual crisis" and the appearance of menstrual-like secretions in about 10% of newborns. Epithelial cells lose the ability to proliferate and synthesize glycogen. By the end of the first month of a girl's life, a thin and easily vulnerable vaginal epithelium is represented only by basal and parabasal cells. The reaction of the vaginal contents becomes alkaline, the pH rises to 7.0-8.0. Lacto- and bifidobacteria disappear.

How is vulvovaginitis classified?

The classification of vulvovaginitis is based on various principles. Depending on the patient's age,

• vulvovaginitis during the infancy (0-12 months);
• vulvovaginitis during childhood (1-8 years);
• vulvovaginitis of the prepubertal period (from 8 years to menarche);
• vulvovaginitis puberty period (with menarche). According to the clinical course, there are:
• acute vulvovaginitis;
• chronic vulvovaginitis:
  • in the stage of exacerbation;
  • in the stage of remission.

The specific composition and pathogenicity of microorganisms are:

• nonspecific vulvovaginitis (bacterial, caused by conditionally pathogenic microorganisms) against a background of chronic inflammatory diseases of the ear, throat, nose, respiratory and urinary systems, intestinal dysbacteriosis;
• atopic vulvovaginitis (allergic genesis);
• on the background of systemic extragenital diseases (diabetes mellitus, hepatocholecystitis, leukemia, hypercorticism;
• against the background of loss or decrease in the function of the ovaries;
• bacterial vaginosis (nonspecific vaginitis);
• against the background of mechanical, chemical and thermal damage to the vulva and vagina;
• against the background of helminthic invasion;
• against the background of a foreign body;
• on a background of red flat lichen;
• against scleroderma or dystrophy of the vulva (sclerotrophic lichen).

Specific vulvovaginitis in girls can occur with the following diseases:

• gonorrhea;
• urogenital trichomoniasis;
• urogenital chlamydia;
• urogenital mycoplasmosis;
• tuberculosis;
• fungal infections (fungi of the genus Candida);
• genital herpes;
• papillomavirus infection;
• children's viral infections (measles, scarlet fever, diphtheria, chicken pox).