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Wednesday, April 16, 2014
Urinary and Genital Disorders (Children)
External Vaginal Itch
I have a 6 year old daughter who was diagnosed with a bladder infection in early April 2009. Her symtoms were a vaginal itch that kept her up all night in tears and some pain on urination. She was put on a sulfa antibiotic and external vaginal cream...Things seemed to improve but a week later she was itching again...Her pediatrician thought perhaps a yeast infection...she`s been on two rounds of fluconazole and an abundance of topical creams--both steroid and non. The dermatologist we took her to has suggested Zyrtec with daily A/D cream application. Not working--she still needs to itch especially when up walking around. When sitting, it seems she sits on her foot to "accomodate" the itch or shifts position a lot. Strangely enough, she has no trouble sleeping and is not awakened at night with this problem (thankfully) and when she`s swimming (which is rarely) or in the bathtub/shower she doesn`t itch. We`ve done the whole no fabric softener, no soap in the bath, avoid irritants thing and it`s not working. It all goes back to this bladder infection with the severe itch. Any other ideas?
There are a few possibilities. Pinworms can cause significant itching, and she should probably be tested for this condition. In addition, girls who sit on their foot often have an overactive bladder, which can respond to an anticholinergic medication such as oxybutynin. Another possibility might be underlying constipation. If addressing these conditions is unsuccessful, then she might benefit from an appointment with a pediatric urologist or pediatric gynecologist. If you live in the Cleveland area, we can provide a name of a pediatric gynecologist.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University