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December 1, 2008

Diagnosis and Symptoms

Question from Lesotho:

My six-year-old daughter was diagnosed with diabetes after struggling with vaginal discharge for two years. Our doctor suspected it because of her low body weight but, recently, said her blood sugar level is normal. So, what could the problem be? The vaginal discharge is still there and she has never gained any weight. The last time we checked, she weighed 12.5 kg (27.5 pounds). Please help me. I am really confused.


From: DTeam Staff

I don’t know how much we can help, but I’ll try. I also do not know how easy it is for you to seek medical care in your part of Africa. I do know that there are some excellent medical facilities in South Africa.

Vaginal discharges have many causes. What helps to differentiate some of the causes includes the color of the discharge, the odor of the discharge, whether or not the girl has itching where the discharge is, and other considerations as well.

I presume that your little six-year-old daughter has no signs of puberty, such as breast swelling or hair in her vaginal area and that the discharge does not look like menstrual blood. Age six would be too soon for a girl for any of these. But, this is important because some of the causes of vaginal discharge in a teenage or adult female would not be expected in a six-year old pre-pubertal girl.

The common cause of vaginal discharge in a girl with diabetes would be due to a vaginal yeast infection. This typically is associated with extreme itchiness and redness to the girl’s vaginal area. The discharge is typically white and typically does not have a foul-smelling odor. One would expect the blood glucose or urine glucose to be higher than normal with normal being a fasting blood glucose less than 100 mg/dL [5.6 mmol/L] and there should be no glucose in the urine. If the discharge had a bad smell and/or if there were brownish or reddish discoloration, then I would be suspicious that perhaps there is a small foreign object inside the vagina that is causing irritation. This would have nothing to do with diabetes. It is not uncommon for little girls to stick things inside themselves (like a small pebble or the eraser top to a pencil); often, a small bit of toilet tissue gets inside and then leads to irritation. There are some not-too-worrisome germs that can infect and irritate the vagina, even in a pre-pubertal girl. These “non-specific” vaginal infections often are easily cleared up with special vaginal creams and/or medications that are taken by mouth. The correct medicine would depend on what germ or germs are identified. Unfortunately, these days, we also need to keep in mind the possibility that the little girl has caught some vaginal infection because of sexual abuse. Circumstances in her life can help you and her doctor decide how heavily to pursue this concern. A very smelly vaginal discharge that smells of bowel movement is not common, but might suggest a small connection between the rectum and the vagina.

Finally, diabetes mellitus typically is associated with obvious increased urinary and thirst habits, and you didn’t describe these.

So, I’d suggest the following, especially given the poor weight gain: Ask your doctor to measure a blood glucose and urine test from first thing in the morning before she has had anything to eat or drink. This would preferably be done by a needle poke from a vein (and not a little “finger poke”) that is analyzed in a hospital or clinic laboratory and not a bedside glucose monitor. Get more details of the vaginal discharge and explain them to your healthcare provider. Your little girl may need to have an exam from the inside of her vagina – not like an adult woman has…but similar. Commonly, little girls have to be significantly sedated or given anesthesia for this. This would be especially true to attempt to assess and remove any foreign body in the vagina.

Your doctor should try to obtain some of the discharge in a sterile manner so that it can be examined in the laboratory and under a microscope for specific types of germs.

This is a good start. Good luck. Please let us know what you learn.