Vulvovaginal complaints account for 80–90% of outpatient pediatric gynecologic visits . Most cases may be attributed to vulvovaginitis but other less common conditions, such as vulvar diseases or vulvar manifestations of systemic disease, should be taken into account. Rare causes of vulvovaginitis have to be considered especially when symptoms are recurrent or not responsive to standard treatment. In this chapter, the causes, manifestations, and management options of vulvovaginitis in childhood will be reviewed. Furthermore, common vulvar diseases affecting children were outlined, since their knowledge is essential for differential diagnosis. The prepubertal child is particularly susceptible to vulvovaginitis for anatomic, physiologic, and behavioral factors: absence of hair and minimal labial development; close oximity of the vagina to the anus; physiological hypoestrogenism which causes atrophic genital mucosa; neutral pH and unbalanced vaginal flora; absence of cervical mucus; and lack of antibodies ; furthermore, children’s tendency to have poor local hygiene and to explore their bodies increases the risk of developing this conditions. Germs may easily reach the genital area as a result of contiguity from the rectum, urethra, or the surrounding skin. Diffusion of bacteria from the upper airways is also possible through autoinoculation and occasionally hematic spread . Obesity, diabetes, anatomic anomalies, and use of antibiotics may play a role in facilitating vulvovaginitis.