Toilet Habits

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Maintaining proper toilet habits and perineal hygiene in young girls can be a challenge when parental supervision is first withdrawn. To avoid vulvar contamination with fecal material, young girls should be taught to consistently wipe from front to back after toileting.

Common sense dictates that establishing good hygiene habits is desirable and healthful, but research on the contribution of hygiene to premenarchal vulvo-vaginitis has produced mixed results. A case study of 54 patients, drawn from a North American population of low socioeconomic background, concluded that most noninfectious cases of vulvitis in young girls were caused by improper

Bathroom Habits Female

Figure 2 Changes in diaper rash severity before and after the introduction of superabsorbent disposable diapers. Note: Data represent the aggregate rash frequency and severity from (i) six clinical studies conducted between 1984 and 1988, involving 1850 infants (prior to the introduction of superabsorbents) and (ii) six clinical studies conducted between 1988 and 1995, involving 1975 children (after the introduction of superabsorbents). Source: Adapted from Ref. 15.

Figure 2 Changes in diaper rash severity before and after the introduction of superabsorbent disposable diapers. Note: Data represent the aggregate rash frequency and severity from (i) six clinical studies conducted between 1984 and 1988, involving 1850 infants (prior to the introduction of superabsorbents) and (ii) six clinical studies conducted between 1988 and 1995, involving 1975 children (after the introduction of superabsorbents). Source: Adapted from Ref. 15.

perineal hygiene (25). Only cases with visible inflammation and discharge were confirmed to be of infectious origin. Complaints of vulvitis with no infectious cause were judged to be hygiene-related based either on the clinical observation of stool or smegma or on the resolution of symptoms with improved hygiene and toilet practices.

Conversely, an Australian case-control study of pediatric vulvovaginitis (50 per group) found no difference in personal hygiene habits, consistent with these researchers' empirical experience that most premenarchal girls with vulvovaginitis exhibit good hygiene (26). Because most cases of pediatric vulvitis in this study were neither infectious nor attributable to improper hygiene, the investigators postulated that vulvitis of nonspecific etiology may be common in early childhood.

An alternative hypothesis was proposed by a different group of Australian investigators, who examined 130 young girls with vulvar complaints and determined that the majority had a dermatologic condition of the vulva (irritant or atopic dermatitis, psoriasis, or lichen sclerosus) (27). Poor hygiene was infrequently causative. These researchers proposed that most pediatric vulvar complaints of "nonspecific" etiology may be the result of undiagnosed dermato-logical conditions (28).

These disparate conclusions probably reflect the demographic differences in the populations from which the study participants were drawn. Inadequate hygiene may contribute to pediatric vulvovaginitis in some groups of patients, whereas when hygiene practices are adequate, other factors may predominate among those with vulvar complaints.

Fecal contamination of the vulva and perineum in young children is not always due to improper hygiene, but can result from fecal overflow around rectal blockage caused by constipation. This often unrecognized cause of fecal soiling is a precipitating or perpetuating factor in recurrent urinary tract infections (UTIs) in young girls. Because the anus and the urethra are closer in preme-narchal girls than in mature women, poor hygiene and toilet practices are often emphasized as a primary contributing factor. However, vulvar hygiene does not play a singular role. The most important risk factors for recurrent UTIs unrelated to physical abnormalities are a combination of:

1. Infrequent voiding

2. Inadequate fluid intake

3. Stool retention due to constipation

Inadequate hygiene and toilet habits usually coexist with these variables (29).

Vaginal foreign bodies, a relatively uncommon result of improper toilet practices by the young girls, cause a foul-smelling, occasionally brown or blood-tinged discharge. Bits of cloth or toilet paper, deposited when the child wipes herself after urinating, are the most common culprits. These can be removed with cotton swabs or by vaginal irrigation.

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Constipation Prescription

Constipation Prescription

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