Teenage gynecologist

Gynecology is the branch of medicine concerned with the health of the female reproductive system (vagina, uterus, and ovaries) and breasts. Outside of medicine, the term means “the science of women.” Accordingly, a gynecologist is a doctor who monitors the state of the female reproductive system, the presence of possible diseases of the genital organs, their timely treatment and is engaged in the prevention of the development of various complications.

The health of the female reproductive system largely depends on its condition in childhood and adolescence. The level of gynecological diseases among girls is constantly growing. Not all questions of parents related to female genital organs and developmental features can be answered by a pediatrician. Doctors of all specialties are faced with the need to address the specific issues of preventing reproductive dysfunction in women long before puberty. This is where a pediatric gynecologist comes to the rescue.

Features of the work of a pediatric gynecologist

Preventive examinations of girls by a gynecologist are provided at the age of 3, 6 and 14 years, from the age of 15 annually. Little girls come to the reception with their mother. Adolescents can visit the gynecologist on their own, but with the written consent of the legal representative of the child. From the age of 16, such consent is not required. At this age, the girl herself gives written consent to a gynecological examination. Regarding the provision of information about the health of a young patient, if the girl is less than 15 years old, then the mother’s doctor provides complete information, and after 15 years, the opinion of the girl should be taken into account, to what extent she wants to inform the mother about her condition.

The purpose of a gynecological examination is to determine both the physiological and pathological state of the genitals in different age periods. As with any appointment with any specialist, it all starts with a survey (anamnesis). The gynecologist asks the mother in detail about the health features of not only the child, but also herself, about how the pregnancy and childbirth proceeded, what developmental features she had. It is important for a gynecologist to know with what weight the girl was born, what she was sick with, in what conditions she lives, how hygiene procedures are carried out. Of course, not every teenager can answer all such questions. Therefore, the presence of a mother, even with older girls, is highly desirable.

On examination, a pediatric gynecologist evaluates the appearance, body weight, height, degree of sexual development, pays attention to the skin, the nature of hair growth, the development of subcutaneous fat and mammary glands. The degree of sexual development is expressed by the special formula MaPAxMe, where Ma is the mammary glands, P is pubic hair, Ax is axillary hair, Me is the age of menarche. For example, the formula Ma2Ax2P2Me1 – moderate axillary and pubic hair growth, cone-shaped mammary glands with a flat nipple, were the first menstruation. Such a formula can correspond to the age of 12-13 years. Then the gynecologist will write in the conclusion that sexual development corresponds to age. And if a 10-year-old girl has such a formula, then this is already premature sexual development, and this is a reason for an in-depth examination.

After examination, the gynecologist performs palpation of the abdomen and a special gynecological examination, which is carried out on a gynecological chair or changing table. The gynecologist evaluates the nature of hair growth (male or female type), the structure of the external genital organs, the hymen. He can take smears with special catheters, Volkmann’s spoon. After conducting a recto-abdominal examination: palpation of the pelvic organs through the anus and anterior abdominal wall. With the help of special mirrors, an examination of the vagina and the vaginal part of the cervix can be carried out. Girls often worry about the upcoming gynecological examination, are embarrassed and afraid of possible painful manipulations. Therefore, it is very important that such a visit be prepared in advance. It is useful for the girl to know that her mother also regularly visits the gynecologist. It’s good if a mother sometimes takes her child with her to a gynecological appointment, shows by personal example that it’s not scary, explains how important regular visits to such a doctor are for a future woman and mother.

Conditions that require a mandatory visit to the gynecologist

Below are the most common complaints of teenage girls:

• the appearance of secondary sexual characteristics (growth of the mammary glands, pubic hair) in a girl under 8 years old;
• lack of secondary sexual characteristics up to 12 years;
• lack of menstruation over the age of 15 years;
• violation of the menstrual cycle, a break in menstruation for more than 3 months;
• male pattern hair
• delayed physical development, short stature, high growth;
• obesity of 23 degrees or underweight of more than 10% during puberty;
• violation of the structure of the external genital organs;
• changes in the shape and size of the abdomen;
• abdominal pain at any age;
• injuries of the abdomen and external genital organs;
• pathological conditions of the mammary glands;
• itching, burning, pathological discharge from the genitals;
• painful periods;
• pathological urine tests;
• long-term non-gynecological diseases (endocrine, allergic, infectious, chronic tonsillitis);
• after the transferred operations;
• beginning of sexual activity.

What Do Teen Gynecologists Treat?

Gynecological problems can occur at any age from birth to adulthood:

• congenital defects and anomalies in the development of female genital organs (vagina, cervix and uterine body);
• menstrual disorders in adolescents (amenorrhea – absence of menstruation, juvenile bleeding, dysmenorrhea – painful, irregular periods);
• endometriosis – an often painful disease in which the inner functional layer – the endometrium – grows outside the uterus;
• inflammatory diseases of the reproductive system (specific vulvovaginitis caused by STIs, and non-specific; salpingoophoritis – inflammation of the appendages);
• genital tumors;
• anomalies of sexual development (premature sexual development, delayed sexual development, impaired sexual differentiation).

Congenital anomalies of the reproductive system

Anomalies in the development of the female genital organs include congenital disorders of the anatomical structure of the genitals and a delay in the development of properly formed genital organs (infantilism). They occur in the prenatal period, are associated with genetic causes or exposure to damaging factors (drugs, radiation, infection).

Atresia of the hymen, a frequent violation of the structure, is a continuous hymen that does not have an opening. Vaginal agenesis is the complete absence of the vagina. With such violations, menstrual blood, having no outflow, gradually fills the uterus and fallopian tubes, which causes severe pain. Such a pathology is usually diagnosed only in adolescence, when abdominal pains appear, menstruation is absent, sexual development corresponds to age. Rokitansky-Küster syndrome – the uterus and vagina are practically absent. Often there are malformations of the uterus:

• bicornuate uterus;
• uterus with rudimentary horn;
• complete doubling of the uterus.

Such diseases violate not only fertility, but also significantly reduce the quality of life of a girl in the future. Many problems can be solved with timely diagnosis through reconstructive surgery. Therefore, a preventive scheduled examination by a pediatric gynecologist is so important.

Violation of sexual development

Sexual development disorders include premature sexual development and delayed sexual development. The physiological process of sexual development proceeds in a specific, genetically encoded sequence, starting with adrenarche (activation of the adrenal cortex) at 6-9 years of age and ending at 16-17 years of age.

Violations of the puberty of girls consist in changing the timing of the appearance of menstruation, the time and sequence of development of secondary sexual characteristics. Precocious sexual development is said to occur when secondary sexual characteristics appear before the age of 8. The most common forms of PPR are incomplete. Isolated thelarche is an enlargement of the mammary glands, this condition has two age peaks: in the first two years of a child’s life and in the period from 6 to 8 years.

Isolated adrenarche/pubarche onset of pubic or axillary hair growth before age 8, more common in obese girls. Isolated menarche – the appearance of bleeding from the genitals without signs of puberty. Most often it is associated with inflammation, ovarian cysts. Incomplete forms of PPR in most cases are a variant of the norm, but require a detailed examination by a pediatric gynecologist.

Delayed puberty is understood as a delayed, complete or partial absence of signs of puberty in girls over 15 years of age. Often this pathology is associated with damage to the hypothalamic-pituitary region as a result of the influence of infections, intoxications, injuries, tumors or a decrease in the hormonal function of the ovaries caused by damage to the follicular apparatus during ovarian operations, infections (mumps, measles).

Recently, due to delayed sexual development, girls with a lack of body weight are often treated. During puberty, rapid loss of body weight due to adipose tissue causes the development of amenorrhea (menstruation stops or does not begin at all). The development of the mammary glands stops, the sexual hair grows poorer, the size of the uterus decreases.

Delayed sexual development may not be a manifestation of any pathology, but be hereditary. There are families in which the sexual development of girls began after the age of 15, but proceeded further without disturbance. But all such situations require mandatory consultation of a pediatric gynecologist.

Inflammatory diseases of the female genital organs in girls

Vulvovaginitis is an inflammation of the vagina and vulva caused by various specific and non-specific infectious agents, as well as other factors (traumatic, allergic, etc.). Girls are most often affected before puberty. This is due to the fact that under the influence of a sufficient level of female sex hormones, which increases starting from the puberty, a special environment is formed in the vagina, thanks to lactobacilli, that can protect against the effects of pathogens. Little girls do not have such a defense mechanism. The vagina has abundant folding, the reaction of the internal environment is neutral or alkaline, the flora is mixed, the large vestibular glands are poorly differentiated, their secretion is absent.

Inflammation of the genitals in girls can begin as non-infectious, aseptic. Often the cause is a foreign body that is in the vagina. It can be small objects (beads, buttons), helminths. Girls with allergies tend to have occasional flare-ups of vulvovaginitis. But infectious factors are in the first place. In most cases, parents cannot cope with such manifestations of inflammation, despite careful hygiene care. It is very important to teach the mother first, and then the girl herself, proper intimate hygiene. A young mother, caring for a baby, should pay attention to the condition of her genitals, if problems arise, visit a pediatric gynecologist.

A fairly common disease in girls 2-5 years old is synechia of the labia minora. This disease is formed on the basis of intensive desquamation of the epithelium of the labia minora, which can occur with atopic vulvitis and vulvovaginitis due to exposure to tight or coarse clothing. During the healing process, the epithelium of the labia minora grows together, forming an epithelial bridge that covers the vulva, the entrance to the vagina and the external opening of the urethra. This can make it difficult to urinate. The treatment is to separate the synechiae. Preliminary treatment with estrogens is carried out: the adhesion sites are lubricated daily with creams containing estriol, and after separation of the synechiae – for another week.

Gynecological care for adolescents and contraception

Perhaps the most problematic for a pediatric gynecologist is working with adolescents who have begun sexual activity. Here are the features of the psyche of adolescents and upbringing in the family, which do not allow the girl to have a trusting relationship with her parents, and the absence of clear moral principles in society, insufficient orientation towards family values. The sexual activity of young people is growing, and the age of initiation of relationships is decreasing. Adolescents are characterized by the random nature of sexual relations, illiteracy in matters of contraception and the prevention of STIs. The contradictions arising from the interaction of a doctor, a girl, her parents, law enforcement agencies and even the administration of a medical institution, various social services, make it difficult to achieve mutual understanding and trust between a teenager and a pediatric gynecologist, especially for young pregnant women.

Teenage girls are most often concerned about two issues – leucorrhea and menstruation. Even if a girl does not live sexually, she often asks herself the question: “Do I have normal discharge, maybe this is a disease?” In childhood, there is no vaginal discharge. The older the girl becomes, the more abundant the discharge appears. They are of a different nature: sometimes mucous, sometimes white thick. This is normal, but you can talk about this with a pediatric gynecologist. During a routine examination, even without taking a smear, the gynecologist can resolve all doubts. And if a teenager has sexual relations, then you can’t do without a gynecologist. Inspection, of course, is not the most pleasant procedure, but not as terrible as the girls imagine it to be. Menstruation in adolescence is most often irregular, often painful, and may be accompanied by a deterioration in the general condition.

Many mothers and grandmothers sincerely believe that this is normal, that we must be patient, no treatment is required, because they also had it. To understand how everything is normal, whether there are any serious diseases, a pediatric gynecologist will help the girl to calmly endure critical days.

It is important for a young patient to get basic knowledge about sexually transmitted infections, methods of protection, methods of early diagnosis in time.

Of course, early sexual relations that occurred before the completion of puberty have an extremely negative impact on reproductive health in the future. This is especially true for unwanted pregnancies. There are various methods of contraception hormonal and non-hormonal. The doctor selects contraception taking into account the age, health of the patient, the length of the period during which it is needed, the cost, the need for protection against STIs, taking into account the side effects of the methods.

For most adolescents, the best method of contraception is the use of condoms, which can prevent sexually transmitted infections. But the effectiveness of this method is not 100%. The additional use of oral contraceptives with a low content of hormones increases the reliability of the method by a lot. A girl, together with a gynecologist, can choose pills with which she will not only protect herself from unwanted pregnancy, but also solve other problems, for example, cosmetic or associated with the menstrual cycle, painful menstruation. The gynecologist will tell you how to use emergency contraception if necessary, about methods of emergency prevention of infections.

Thus, a pediatric gynecologist is a very important specialist who helps young girls and adolescents to maintain women’s health and give birth to healthy children in the future.