by Chiara Daina
Very young people may need specific tests and treatments, but it is not always clear who to trust. The pediatrician of free choice is the reference
Vaginal infections, precocious puberty, genital malformations, irregular or missing periods: these are some of the problems for which it is advisable to take your daughters or adolescents to the gynecologist. Normally the primary care pediatrician is the point of contact for the little ones. If you are unable to trace the cause of the symptom, in the presence of important anomalies it is best to contact a gynecology service for developmental age, says Francesca Pampaloni, who directs the hospital’s childhood and adolescent gynecology clinic. Careggi of Florence.
The centers are not in every region
Pediatric gynecology centers are not present in all regions. In the absence of a specific service, depending on the problem, the pediatrician will direct you to the pediatric endocrinologist, to the clinic, which can be accessed from 14 years of age, or to the hospital adult gynecologist, specifies Anna Maria Fulghesu, professor of Gynecology at the University of Cagliari. and president of the Italian Society of Childhood and Adolescent Gynecology (Sigia).
The most common problems in girls
Among the most common disorders before menarche are recurrent infections of the vulva, the external part of the female genitals, and of the vagina, the internal part – explains Pampaloni -. They cause burning, itching, redness, smelly secretions, sometimes bloody, mostly caused by fecal bacteria that reach the vulvar area through incorrect hygienic maneuvers or due to constipation: stagnant feces cause the bacteria that contaminate the vulva to proliferate. Infections may also depend on an alteration of the vaginal flora after the use of antibiotics.
The other reasons why a little girl should be seen by a pediatric gynecologist are synechiae of the labia minora, i.e. their partial or total fusion – he continues -. As well as trauma to the genitals, from falls or sexual abuse, and the appearance of secondary sexual characteristics (development of the mammary glands, pubic and axillary hair, more voluminous vulvar lips, ed.) under 8 years of age. In this case, the pharmacological block of pubertal development is evaluated, avoiding the arrival of menstruation, which is difficult to manage at that age. Two rarer causes requiring intervention are lichen, an autoimmune disease that mainly causes vulvar itching and dryness, and tumors of the genital system, which generally manifest themselves with blood loss.
The most frequent problems in adolescents
Among the disorders most often encountered in adolescence are ovarian cysts (which manifest themselves with discomfort in the pelvic area and possible bleeding between one cycle and another) and those linked to the menstrual cycle, which can hide more serious pathologies. Primary amenorrhea for example: The absence of menstruation in girls by the age of 15, in the presence of secondary sexual characteristics, must arouse attention – warns Pampaloni -. It can be a sign of a malformation syndrome, such as the lack of a uterus or vaginal septum and an imperforate hymen, which does not allow the menstrual flow to escape, causing abdominal pain.
Other symptoms that should be investigated: Abundant flow, which may result from hormonal changes or a fibroid, and dysmenorrhea, i.e. severe pain during menstruation that forces you to miss days of school and may indicate endometriosis, uterine or vaginal malformations and chronic inflammatory diseases intestinal. Suffering from a non-normal cycle – underlines Pampaloni -. In girls it is advisable not to underestimate even a small number of menstruations, less than 6 per year, or an excessive number of 14-15 per year. Scanty or prolonged periods, with excess hair on the face and body, obesity and baldness are signs of polycystic ovary syndrome.
When to have your first gynecological visit
Prevention of sexual and reproductive health must be learned from adolescence. The American College of Obstetricians and Gynecologists recommends the first gynecological visit between the ages of 13 and 15. An opportunity to teach the girl about breast self-examination, the first tool for preventing breast cancer, and the importance of recording the first day of the onset of the menstrual flow, which corresponds to the start of the cycle, to calculate its duration, says Maria Chiara Lucchetti, head of pediatric gynecology at the Bambino Ges hospital in Rome and vice-president of Sigia for childhood and adolescence. During the visit you are offered counseling on contraceptive methods that protect against unwanted pregnancies and sexually transmitted infections.
The family pediatrician also plays a fundamental role. It would be his responsibility to control the regular development of the external genitalia during health assessments, scheduled up to the age of 14, in which the child’s physical growth is evaluated, underlines Lucchetti. A normal menstrual cycle occurs on average every 28 days. But it should be considered normal between 21 and 35 days. In the first 2-3 years after menarche, a period of amenorrhea of up to 6 months is normal. If it persists, it is necessary to identify the cause, he recommends Lucchetti. When the girl begins to have sexual intercourse, an annual gynecological check-up is recommended. To exclude the presence of sexually transmitted infections, which in most cases are asymptomatic but can give rise to serious consequences, warns Lucchetti.
The clinic
The local counseling center represents a point of reference for this type of assistance. Access is available from 14 years of age and does not require a medical request or an accompanying adult. In case of more serious problems, which can also affect newborns and girls, it is best to contact a pediatric gynecology clinic, concludes the doctor. To access the service through the National Health Service, a prescription from your pediatrician is required.
The rules for correct intimate hygiene
Since childhood, it is important to observe the rules for correct intimate hygiene. Wash your hands before and after pee, wash your private parts using a delicate cleanser, moving from front to back to avoid contaminating the vaginal environment with intestinal bacteria. The same direction should be followed when cleaning yourself with toilet paper – recommends Maria Chiara Lucchetti, head of pediatric gynecology at the Bambino Ges hospital in Rome -. Use personal towels and cotton panties to allow the skin to breathe and not encourage material stagnation. Daily intimate hygiene prevents vulvovaginal infections. In most cases the inflammations are of a non-specific nature, as a consequence of poor hygiene practices, retention of urine or constipation – explains Lucchetti -. Avoid self-prescribing to your daughters swabs to search for the responsible pathogens. Too many are made and they are useless.
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January 9, 2024 (modified January 9, 2024 | 07:34)
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