Common Gynaecology Problems Of Adolescence
Paediatric and adolescent gynaecology focuses on a special subset of gynaecology where problems happening at this particular age is addressed and which needs special handling by an expert. In the paediatric population, the most common are vulval or vaginal problems whereas, adolescent girls usually have abdomino-pelvic pain or abnormal uterine bleeding problems. Here are some common gynaecological problems lace by young girls.
Inflammation of vulva or vagina resulting in discharge, is a very common complaint in this age group. Before puberty, girls are deficient in oestrogen and this makes them prone to infection. This hypo estrogenic state increase their chances of getting super-infection following inflammation.
A child may experience burning, redness, itching, urinary symptoms and a bad smell from the vulva. However, with puberty and hormonal changes, the vulval lesions are less common and adolescents are more afflicted with vaginitis, cervicitis and salpingitis rather than vulvitis. Also, various infective causes may be there such as candida, neisseria, and chiamydia.
This vaginal infection may be brought on by antiseptics, soap solutions. bubble baths, and cosmetics. Hence, proper hygiene has to be taught to prevent this.
Some conditions such as lichen planus, lichen simplex chronicus and lichen sclerosis can present as vu)vovaginitis with red and erythematous skin lesions.
These can present as vaginal discharge or malodourous discharge. Taking proper note of the case history and conducting a thorough examination is very important to rule out any kind of foreign body in the private parts.
Mullerian an abnormalities is usually present with abdomen pain when girls start menstwating and the blood does not come out in such cases as an imperforate hymen, didelphys uterus or obstructed vaginal canal. MRI is needed to rule out these kinds of lesions and surgical correction may be required for some of the mullerian abnormalities.
This is another common problem encountered at this age. Straddle injuries usually happens by cycling and by engaging in other sports. Abrasions, contusions and hematoma all can occur with the most common cause being straddle injury. However, most straddle injuries are non-penetrative and usually present as superficial wounds as echymoses and hematoma.
Defined as piercing injuries of the genitourinary tract, these types of injuries are usually more extensive and involve trauma to the hymen or vagina. They can present with hematuria, discharge or pain and rectal bleeding.
This condition is most common in a pre-pubertal girl with straddle injury being the most common, Usually surgical intervention is not needed but In penetrative injuries, it may be needed. Sexual abuse should always be considered in the case of genital trauma in a pre-pubertal girl.
Menorrhagia in Adolescents: DUB/ AUB (Abnormal Uterine Bleeding)
This is a very normal problem faced by adolescents when they start menstwatlng at puberty. It Is usually present with heavy, prolonged, and irregular bleeding and happens mostly because of immaturity of the hypothalamo-pituitary axis and also due to ovulation in the first two years of puberty.
If adolescents are afflicted with menorhhagia, it’s very important to rule out an underlying coagulation disorder such as Von Willebrand disease, which is the most common cause of bleeding disorder in adolescents as it accounts for five to thirty six per cent cases of AUB in this age group.
Pregnancy And Infection
Other causes of heavy bleeding such as pregnancy and infection must always be considered in adolescents. Infection such as chlamydia can present as heavy menses, Also, for adolescents looking for contraception and those experiencing heavy bleeding – ruling out pregnancy is a must.
Adolescent girls are also plagued with one more condition, called endometnosis usually accompanied by painful periods and chronic pelvic pain. Endometriosis is defined by the presence of endometrial glands and stroma outside the uterine cavity.
The incidence of endometriosis in adolescents is usually 25-30 per cent. When adolescents present with endometnosis, mullenan abnormalities should always be ruled out as compared to adults, it’s unlikely to be associated. Endometriosis or pelvic pain is managed conservatively by medicines, but ititis refractory to medical management, laparoscopy may be required for the pelvic pain.
Adolescents may also be troubled with some emergency conditions. If they have an ovarian cyst and it undergoes torsion or twisting, acute abdomen pain will be experienced and to take care of this problem, emergency laparoscopy is required.
Though rarely, adolescents may also get a huge lump in the abdomen which on investigation, turns out to be a huge ovarian tumour, which can be germ cell tumours, common in the younger age group.