兒童也會得陰道炎？

經常穿漂亮裙子和時髦牛仔褲的小公主們，常有小屁股癢的情況，媽媽看見她們又抓又撓的可心煩了。今天和大家討論下青春期前兒童常見的外陰陰道疾病：非特異性陰道炎。兒童群體是存在若干增加外陰陰道炎風險潛在因素：陰唇未發育、未雌激素化的薄弱黏膜、比月經初潮后女孩/女性的陰道pH值偏鹼性(pH7)、衛生狀況不佳、泡沫浴、洗髮劑、除臭皂、肥胖、異物以及選擇的衣物(緊身連衣褲、緊身褲襪、牛仔褲)。

Nonspecific vulvovaginitis is the commonest gynecological problem in prepubertal girls. There are a number of potential factors in children that increase their risk of vulvovaginitis, including lack of labial development, unestrogenized thin mucosa, more alkaline pH (pH 7) than postmenarchal girls/women, poor hygiene, bubble baths, shampoos, deodorant soaps, or other irritants, obesity, foreign bodies, and choice of clothing (leotards, tights, and blue jeans).

●避免連身睡衣，穿睡袍需保證空氣流通。

●採用棉質內褲。內衣物在洗滌后應多次漂洗以免刺激物殘留，應避免將織物柔軟劑用於內衣物或泳衣。

●避免穿緊身褲襪、緊身連衣褲和綁腿褲。選擇裙裝和寬鬆的褲子以利於空氣流通。

●每日溫水沐浴也有幫助，如下：

• 讓兒童泡在清潔水中(無肥皂)10-15分鐘。尚未有人專門對在水中加入醋或小蘇打進行研究，但是根據我們的經驗，該方法並不比僅用清水更有效。

• 在兒童離開盆浴前使用肥皂清洗除生殖器區以外的區域，生殖器區限制使用任何肥皂。

• 充分沖洗生殖器區並輕柔拍干。

• 冷風模式的吹風機可能有助於乾燥生殖器區。

●不要使用泡沫浴或香皂。

●如果外陰部觸痛或腫脹，冷敷可緩解不適。擦拭時可使用濕巾代替廁紙，潤膚劑可能有助於保護皮膚。

●檢查兒童的衛生習慣。強調排便后從前往後擦拭，讓其在坐下時分開雙膝以減少尿液反流進入陰道。如果由於其體型小而難以保持該姿勢，則可以使用較小的可拆卸坐便椅或向後坐在坐便器上(面對坐便器)，應當指導或幫助5歲以下兒童的如廁衛生。

●避免讓兒童在游泳后穿著濕的游泳衣坐較長時間。

The following techniques and tips for parents may be of help to improving vulvovaginitis:

●Avoid sleeper pajamas. Nightgowns allow air to circulate.

●Cotton underpants. Double-rinse underwear after washing to avoid residual irritants. Do not use fabric softeners for underwear and swimsuits.

●Avoid tights, leotards, and leggings. Skirts and loose-fitting pants allow air to circulate.

●Daily warm bathing is helpful as follows:

• Allow the child to soak in clean water (no soap) for 10 to 15 minutes. Adding vinegar or baking soda to the water has not been specifically studied but from our experience is not more efficacious than clean water alone.

• Use soap to wash regions other than the genital area just before taking the child out of the tub. Limit use of any soap on genital areas.

• Rinse the genital area well and gently pat dry.

• A hair dryer on the cool setting may be helpful to assist with drying the genital region.

●Do not use bubble baths or perfumed soaps.

●If the vulvar area is tender or swollen, cool compresses may relieve the discomfort. Wet wipes can be used instead of toilet paper for wiping. Emollients may help protect skin.

●Review hygiene with the child. Emphasize wiping front-to-back after bowel movements. Have her sit with knees apart to reduce reflux of urine into the vagina. If she has trouble with this position because of small size, she can use a smaller detachable seat or sit backwards on the toilet (facing the toilet). Children younger than five should be supervised or assisted in toilet hygiene.

●Avoid letting children sit in wet swimsuits for long periods of time after swimming.

這些方法通常可以使非特異性黏液樣分泌物和/或氣味在2-3周內消失。如果癥狀持續存在或複發，則應當考慮異物或特異性感染的可能，家長需就醫解決問題。

These techniques usually result in resolution of nonspecific mucoid discharge and /or odor within two to three weeks. If symptoms persist or recur, the possibility of a foreign body or specific infection should be considered. See your paediatrician for consultation.

作者：上海沃德醫療中心兒科主治醫師 袁方