MANY mothers bring their young daughters to the pediatrician because they have noticed a discharge on the child's underclothing. Most of such discharges are nothing more than desquamation of the epithelial cells at perhaps a more rapid pace than usual. Such a discharge, commonly referred to as "whites," occurs normally in the adult female. No pathologic process is involved in either the child or the woman and no treatment is indicated. On the other hand, a discharge which is irritating, malodorous, and provokes an inflammatory response, has a pathologic background. By far the greater number of such cases fall into one of the following categories:
(a) Nonspecific vaginitis which may be due to the presence of organisms which find their way into the vaginal canal either through insertion of the child's finger or some foreign object, or may appear for no apparent predisposing reasons. Among the organisms found are pneumococcus, streptococcus, staphylococcus, diphtheroids, colon bacillus, etc. The treatment consists primarily of removing or correcting the underlying factor and cleansing measures. Frequently, attention to the technique of cleansing the rectal area following a bowel movement, daily bathing and a pitcher douche with saline twice a day will clear up the discharge. Sulfonamides by mouth, locally, or both may be effective in some cases. In other cases, the local use of a specific antibiotic such as Terramycin® or Aureomycin® has been effective (a 50 mg. capsule may be inserted into the vaginal canal daily for 5 to 7 days).
(b) Another group of cases is due to the presence of foreign bodies in the vaginal canal. Any number and type of foreign bodies have been found in the vaginal canals of small children, such as safety pins, pencils, sticks, etc. The presence of a foreign body sets up an irritant reaction and causes a discharge, in most instances with a bloody component. The diagnosis may be made by inspection or by gentle rectal examination, pressing the vaginal wall through the rectum.
Pathologic Process
