identifiable cause Genital discomfort, discharge, itchiness, and dysuria are relatively common childhood complaints In a reported series of premenarcheal girls with vaginitis who have been systematically evaluated, between 25% and 75% are ultimately categorized as having nonspecific vaginitis The diagnosis should not be made until other entities have been excluded through examination and testing if indicated Clinical Assessment When a prepubertal girl with vaginitis symptoms has either a normal vulva and vagina or only mild vulvar inflammation on physical examination, a specific vaginal infection is unlikely, and other possible explanations for the complaint— smegma, pinworms, urinary tract infection, a local chemical irritant, or sexual abuse, for example—should be sought with appropriate questions and laboratory tests (It should be noted that commercially available bubble bath is not often the culprit.) If, however, a vaginal discharge is present on physical examination, the specific vaginal infections discussed in this chapter are diagnostic possibilities and cultures or other specific testing should be obtained Management General measures to promote cleanliness and comfort should be initiated for the girl with nonspecific vaginitis Daily soaking in a bath of warm water, either plain or with some baking soda added, gentle perineal cleaning with a soft washcloth, and the use of cotton underwear can be recommended The girl should be taught to wipe toilet paper anteroposteriorly Using these suggestions, most girls with perineal irritation will show improvement within weeks The remaining patients should be reevaluated to exclude any specific but previously unrecognized disorder If none is found, these girls may benefit from a brief course of topical estrogen cream (a small amount dabbed onto the vulva nightly for to weeks) to stimulate thickening of the vaginal mucosa so that it is more resistant to local irritation Parents should be cautioned that estrogen cream is capable of producing breast growth and tenderness if it is used for a prolonged period of time CERVICITIS Goals of Treatment To identify the causative agent and treat with antibiotics or removal of offending agent as appropriate, patients should also be screened for other sexually