Gynaecological Problems Affecting Young Girls
Young girls are more prone to infection because of poor hygiene, handwashing and poor perineal hygiene
In paedeatric patients, gynaecological problems are confined only to the vulva and vagina, but in the adolescent age group, mostly abdomino-pelvic mass and menstrual irregularities are the main complaints. But the two most common vulvovaginal problems in children are vulvovaginitis and genital trauma.
Common Gynaecological Problems In Childhood And Adolescence
- FusIon of labia
- Genital crisis
- Precocious puberty
- Menstrual disturbances In adolescence
- Abdominal pain
- Abdomino-pelvic lump
Inflammation of the vulva and vagina are common problems seen in children. The hypoestrogenic state of the vagina contributes to the vaginal susceptibility to infection as the vaginal mucosa is thin and has alkaline pH, making it different from the adolescent and adult vagina. Children are more prone to infection because of poor hygiene, handwashing and poor perineal hygiene.
Also, some of the common problems faced by children include pruritus, irritation, unusual odour, discharge or erythema of the vulva, Vulvovaginitis in children is usually non-specific and needs only symptomatic treatment with warm water wash and the application of a barrier cream. If symptoms do not subside in 48-72 hours, specific causes should be ruled out and infectious causes too should be ruled out.
Genital trauma is also a common presentation in children. Sexual abuse should always be ruled out, if the child has vaginal bleeding, pain or discharge.
Labial adhesion Is a condition wherein the inner lips of the labia fuse together, leaving a small gap. It usually happens because of oestrogen deficiency in pre-pubertal girls and is usually self- correctable, but in some cases, it needs separation where there is difficulty in passing urine, recurrent urinary tract infections and pain. Manual separation followed by local oestrogen is the treatment of choice for labial fusion.
This is also known as small puberty’ wherein vaginal bleeding occurs in girls and there is secretion and swelling of the mammary glands. It occurs in both males and females and is the manifestation of hormonal changes at birth.
This is a condition in which a child s body undergoes changes of an adult, too soon. Puberty before the age of eight in girls and nine, in boys is known as precocious. Puberty is a phase of life where rapid growth of the muscles and bones occur, along with the ability to reproduce. Certain conditions such as tumours, hormone abnormalities, infections may be the cause of precocious puberty. Treatment aims at delaying further development and treating the specific cause.
When a baby is born, the first question asked by the mother is: ‘is it a boy or a girl?’ Hence, after a look at the genitals, the sex is assigned. But in two in 10000 neonates, the genitals are ambiguous and this is known as intersex. Most commonly this condition is congenital adrenal hyperplasia. The other kinds of intersex are recognized at puberty, when they fail to develop secondary sexual characters or when they fail to menstruate.
Menstrual Disturbances In Adolescence
When girls hit puberty, they start menstruating. However, in the initial years, there are irregularities of the menstrual cycle, as the hypothalamic- pituitary axis takes time to develop completely. Also, they may experience a condition called oligomenorrhea, as ovulation is not regular. Further, sometimes, there may be other causes for irregular cycles like hormonal imbalance, hormone secreting ovarian tumours and rarely, fibroids.
Painful periods in adolescence is a very common cause of abdominal pain. Primary dysmenorrhea has no specific cause, but secondary dysmenorrhea is due to endometriosis, pelvic infection, f ibroids or ovarian tumours.
Thus, secondary dysmenorrhea needs evaluation and treatment. Endometriosis is treated both medically and surgically, pelvic infection needs treatment with analgesics and antibiotics and for fibroids usually symptomatic treatment or surgical treatment is recommended.
Swelling in the abdomen is a very common presentation in the adolescent age group and most commonly lumps are due to ovarian tumours, endometriosis (chocolate cyst) or tibroids. However, if a lump is present, it needs to be diagnosed and specifically treated.
Ovarian tumours may also be a cause of irregular bleeding, amenorrhea or menorrhagia. Additionally, though rarely, but ovarian tumours may be malignant in this age group, especially germ cell tumours. Hence, any unusual symptoms should not be ignored in children and adolescents and a gynaecologist’s opinion should be sought immediately.