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Pediatric and Adolescent Gynecology

What is the difference between Pediatric and Adolescent Gynecology, and Gynecology?

Pediatric and Adolescent Gynecology deals with the special gynecological problems affecting girls from infancy through puberty to the age of 18 years.  These examinations are performed by either gynecologists or pediatricians who have obtained this as their second degree.   Very young girls and/or teenagers with sexual problems and disorders should be treated gently, as befits their age.

When should a pediatric and adolescent gynecologist be consulted?                                   

Menstruation may cause problems if it begins too early, under the age of 10 years, but also if it is unusually late, above the age of 15 years.  In all events, if the bleeding is unusually strong, with a great amount of blood loss, or is accompanied by intense pain, or not feeling well so much so that it interferes with her usual life style, is not able to go to school and must remain in bed during her bleeding period, the cause should definitely be examined.  Besides menstruation, the most common reason for contacting a pediatric and adolescent gynecologist is inflammation of the genitalia.  Before becoming sexual active, girls would be well advised to go see their pediatric and adolescent gynecologist for advice regarding contraception.

What happens during the examination?

The first visit will commence with a conversation wherein the adolescent girl and the parent or guardian will be reassured and their worries regarding the unusual happenings put to rest.  In addition, preconditions and possible earlier illnesses may be discussed as well as medications used, hygiene habits, menstruation, bleeding character, problems and the best protection available in the event the adolescent is sexually active.

Physical examination follows which includes weight and height measurement, breast examination followed by examination of the genitalia.  Should there be inflammation and/or excessive vaginal discharge, a vaginal sample will be taken with the help of a speculum.  If necessary, laboratory tests and urinalysis may be ordered, ultrasound recommended, medications prescribed and discussion regarding to further steps to be taken.

How are girls that are still virgins examined?
There is no need to worry:  the vagina of small children or girls that are still virgins may be examined rectally, through palpation with a finger, with the thin vaginal mirror or the speculum without damaging the hymen.

Is the examination painful?

The examination of the female organs (the vagina, palpation of the stomach and biopsy) is not painful, at most, unpleasant.  It is well worth giving the child as much information regarding the examination as befits her age and the reason for its necessity.  If she knows what to expect ahead of time, she will not be afraid and will soon be over the “ordeal”.

Are there any preparations required?

No special preparations are required, but, the following advice and suggestions kept in mind.   When setting up an appointment for an adolescent, make sure that it not falls on a menstruating day; clothes that are easily taken off and on should be worn; no talcum powder, creams or cosmetics should be applied near the vaginal opening before the examination since these could affect the outcome of the diagnosis.  It would be very helpful if the menstruating adolescent girls kept a diary annotating the day bleeding starts, how long it lasts and its character.  All this would be very helpful and important information to the examining doctor.  As a reminder, a list of questions to be asked should be made so that none are forgotten in the heat of the moment.  
 
At what age does menstruation usually start?

The first menstruation usually begins between the ages of 11 and 14 years, however, it may occur earlier. It is not considered a pathological occurrence even between the ages of 9 and 11 years, but, a pediatric gynecologist should definitely be consulted if bleeding begins at any earlier age.

At what age should the cervical cancer vaccine be given?

The vaccine is not tied to a specific age but, rather, to sexual activity.  It would be best given beforehand.