This review adopts a symptom-based approach to guide clinicians in the evaluation and management of common vulvar signs and symptoms in prepubertal girls. It integrates practical evidence-informed strategies and highlights conditions that warrant referral to pediatric dermatology or gynecology. While clinical evaluation is rooted in the child’s presenting symptoms, management must also account for contributing external factors, most notably, genital hygiene practices.

Despite limited literature on the specific impact of hygiene practices on vulvar physiology, clinical experience suggests that hygiene practices can significantly influence both the onset and persistence of vulvovaginal symptoms, regardless of the etiology. Genital care behaviors are shaped by personal preferences, cultural norms, religious beliefs, and guidance from health care providers.1 Notably, mothers’ histories surrounding their vulvar disorders, possible trauma, and learned care may influence their perceptions of their daughters’ symptoms and care they provide.1 Maternal history should be considered to inform parental concerns.1

Although the use of genital hygiene products has grown in popularity, such products are inappropriate for pre-pubertal girls due to fundamental anatomic and hormonal differences. There is a lack of research exploring how parents and girls understand the causes of vulvovaginal symptoms and their associations with common irritants. In a descriptive cross-sectional study, Delago et al.2 surveyed 191 pre-menarchal girls aged 6-12 and their parents during well-child visits. Forty percent (76/191) of parents reported their daughters had experienced symptoms, compared to 50% (95/191) of girls.2 While parents attributed symptoms to inadequate genital hygiene (22/76), most girls did not know the cause of their symptoms (50/95).2 The most common reported causes from mothers were exposure to soap on the genitalia and inadequate genital hygiene.1,3

Table 1 provides an overview of signs and symptoms along with the associated differential diagnoses discussed in this paper. The main diagnoses are reviewed and categorized according to the presenting signs and symptoms.