Childhood Gyn Concerns

Newborns and Children 

■ A variety of gynecologic problems commonly occur in young girls. Most of these problems can be evaluated and treated in the office. 

■ Gynecologists can work together with pediatricians to evaluate any concerning findings in the newborn. 

■ Any genital examination of young girls that may be required is discussed beforehand with parents and, if appropriate, with the child.  It is conducted carefully and gently to avoid fear or discomfort. Pelvic exams on prepubescent children are done without the use of a speculum. Most of the time this works well. If necessary, there is also the option of conducting exams and procedures at an Outpatient Surgery Center with the benefit of anesthesia. 

■ Vulvovaginitis is the most common gyn condition in prepubertal children. Symptoms include itching, rash, pain and discharge. Evaluation includes examination and sometimes microbial cultures. These symptoms may also point to a noninfectious condition, such as lichen sclerosis or psoriasis. 

■ Small children can sometimes have foreign bodies in the vagina. A child may present with foul-smelling or bloody discharge. Toilet tissue is the most common foreign body identified. Coins, marker caps, and small toys have been found as well. Sometimes these are embedded in the tissue and anesthesia is required for their removal.

■ Occasionally sport, play or accidents result in trauma to the genital area. Usually this results in bruising and can be managed conservatively with rest and ice packs. A gynecologist can be very helpful in the evaluation and treatment of these injuries. 

Abuse 

■ Concerns about sexual abuse of children are treated very carefully and seriously, usually with the assistance of other healthcare and social service providers. As a general rule, emergency rooms, rather than the offices, are properly equipped to handle the medical and forensic aspects of evaluation and treatment of possible sexual abuse. 

Puberty

■ Problems with puberty - Evaluations of these types of problems usually involve examination, imaging studies and blood work.

Stages in female pubertal development : 

thelarche = the beginning of breast development. This occurs at an average age of 10, with a range of 8-13, but later in whites; Thelarche is also referred to as the development of secondary sex characteristics.  Breast development before six or seven years of age or not until 13 years of age should be investigated by a physician.

adrenarche = roughly equates to the development of pubic hair growth. Average age is 11 to 12 years and takes a mean of 2.7 years. The presence of pubic hair in the absence of breast development may be a sign of hormone imbalance and should be evaluated. However, it may be normal for girls of African American descent to develop pubic hair before breast development. 

menarche =  the onset of menstrual periods. The mean age of menarche is approximately 12 1/2 years of age, with a range of about 11 to 14. Menarche typically occurs 2 to 3 years after thelarche after the breasts are fully developed. Ninety eight percent of females will have had menarche by age 15. Any adolescent girl who has not reached menarche by 15, or within 3 years of thelarche should be evaluated. Additionally, any vaginal bleeding before the age of 8 is a concern and should be evaluated by a a gynecologist. 

In summary, most of the time the stages of puberty development occur in fairly predictable stages. Discussing this affords an opportunity for parents and caregivers to give age appropriate explanations to children well in advance of these impactful events, thereby easing stress and promoting well-being.

We understand how much you care about your children. We welcome phone calls and appointments from concerned parents wanting to know more.

The above has been paraphrased from guidelines from the American College of Obstetricians and Gynecologists.