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Paediatric gynaecology

Early detection of gynaecological problems in adolescence prevents complications in adulthood

Most common problems for girls

Synechiae

These most often occur up to the age of 5 as adhesions of the mucous membranes at the entrance to the child’s genital tract, when the edges of the mucous membranes stick together. An adhesion then forms, initially as a thin membrane, but may gradually become leathery. A paediatrician will detect synechiae during regular check-ups. Parents may often notice a change in the flow of urine, including a burning sensation after urination. If merely stuck together, the synechiae can be simply separated by pulling the labia apart. Thicker membranous adhesions can be separated by agitation with tweezers, which is not painful for the patient. If the synechiae is thick and leathery, adhesions are separated under very short general anaesthesia using thermocautery. After separation, the genitalia are treated with epithelising cream. Synechiae can be prevented by proper genital hygiene and care.

Vaginal bleeding

During childhood any bleeding is pathological and the most common causes are: injury to the external genitalia and vagina, inflammation of the external genitalia and vagina, a foreign body in the vagina, which is not unusual, premature puberty, and in rare cases, malignant tumours. Vaginal bleeding during this period always needs to be investigated.

Tummy aches

Pain can signal inflammation of the internal genital tract, which is rare in girls at this age. However, this must be considered, especially when preceded by appendicitis. Inflammation of the ovaries and fallopian tubes can result in infertility. Yet, this can be prevented by considering the possibility of pelvic inflammation and referring the patient to gynaecology in time. In these cases, it is always better to examine the girl immediately to rule out appendicitis.

Problems in adolescence

Sexual adolescence is a crucial period in a girl’s life, which is associated with a number of significant physical and psychological changes. Pubic hair starts to grow from the age of 8 to 15, the hair in the armpits growing last. Girls experience their first “menarche” menstrual period most often between the ages of 11 and 13. The menstrual cycle is quite often irregular in the first years after menarche. This does not require treatment if these are simply longer pauses between menstrual cycles. However, if periods occur after less than 23 days, are very heavy or last longer than 7 days, the girl should see a paediatric gynaecologist. Nonetheless, girls most often come to see a doctor due to a discharge. This can be both physiological and pathological at puberty. Treatment is administered based on a determination of the type of bacteria, and this in the form of vaginal suppositories or creams. Recurring lower abdominal pain should not be underestimated, and could be a sign of congenital developmental defects, cysts or tumours, and chronic irritation of the appendix must also be considered. Girls should therefore undergo spa treatment after gynaecological surgery or an appendectomy to prevent future fertility disorders.

Vaginal discharge

This represents the most common gynecological problem at this age. Until about 8 years of age, in the pre-pubescent period, any vaginal discharge must be considered pathological. A common cause is poor hygiene after a bowel movement, sometimes intestinal parasites, pinworms, but other more serious causes are also possible. Mycotic inflammation – yeast infections are rare in this period. Treatment is mostly topical, in the form of creams or suppositories. The administration of antibiotics is usually an unnecessary burden for the child. Untreated discharge can lead to a chronic stage with urinary tract infection, inflammation of the internal genital tract and subsequent infertility.

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