When a pre-pubertal girl presents with an itchy or sore vulval rash, she is usually assumed to have thrush or a urinary tract infection. Poor hygiene or sexual abuse may also be considered. In fact, none of these are likely to be true.

For a patient to experience symptoms from candidiasis, the vagina must be oestrogenised. It therefore does not occur in pre-pubertal girls. Urinary tract infections do not result in rashes unless prolonged incontinence is present (although contact of urine with inflamed skin may cause stinging), sexually abused children rarely have physical signs and over-zealous hygiene is more likely to produce a rash than lack of hygiene.

Vulval disease in children is less common than in adults. In both adults and children, dermatitis, psoriasis and lichen sclerosus (LS) are the most common dermatoses that cause a chronic vulval rash. Infective vaginitis is rare in children.