GENITALIA - GIRLS

Newborn Girls and Hormonal Effects:

Newborn girls often experience a mucous-like, white vaginal discharge due to the effect of maternal hormones during pregnancy. This is normal and requires no treatment. In addition, a small amount of menstrual vaginal bleeding may also occur in the first few days of life in an infant girl. This will resolve on its own without intervention, although it is often shocking to see blood in the diaper of a baby girl.

Vulvovaginitis in Young Girls: 

Vulvovaginitis is an inflammation or irritation of the vaginal area. One of the primary causes of vulvovaginitis is inadequate hygiene. For instance, failing to wipe correctly can lead to bacteria from the feces coming into contact with the vaginal area, causing irritation. Children should be taught to wipe from front to back once and then discard the tissue, to minimize this risk. Other contributors include irritants such as soapy water, bubble baths, and certain laundry detergents, which can all irritate the sensitive skin of the genital area. In some cases, infections due to yeast or bacteria can also lead to vulvovaginitis.

Fortunately, most cases of vulvovaginitis can be managed effectively at home with a few straightforward steps.

1. Educating your child about the importance of good hygiene practices is crucial. Encourage your child to wipe correctly and change underwear daily, opting for breathable cotton materials that allow air circulation and reduce irritation.
2. Sitz baths: the child soaks in warm water for 10 to 15 minutes twice a day over several days. This can provide soothing relief.
3. Additionally, applying a topical mixture of half water and half white vinegar or using mild ointments like Neosporin or Vaseline can help soothe the irritated skin.

While vulvovaginitis usually isn't usually a severe condition, there are specific circumstances where medical attention becomes necessary. If symptoms such as redness, itching, or discomfort persist despite home treatment or if there is burning on urination, or sores in the genital area, you should make an appointment for a regular office visit.

Labial Adhesion:

In infants and young girls, typically between the ages of 6 months and 6 years, the labia minora may fuse together at the mid-line, partially closing off the entrance to the vagina. This condition, known as labial adhesions, does not affect the urethral opening, so urination remains normal. Labial adhesions are most often asymptomatic and usually do not require treatment. As a girl matures and her natural estrogen levels increase, the adhesions typically resolve on their own within a few years.

It is important to ensure that any labial adhesion has resolved before menstruation begins. Regular monitoring is recommended over time until the labial adhesion has resolved.

Rarely, if a labial adhesion develops a small tear, it can lead to painful urination as the salty urine contacts the torn labial area. In such instances, treatment with an estrogen cream can help resolve the issue. If a girl with labial adhesion experiences painful urination, it is advisable to come in for an office visit to obtain this prescription.

Puberty: 

For detailed guidance on puberty, resources such as The Care and Keeping of You Vol. 1 and 2 by the American Girl Series are helpful for girls aged 9-12 and teenaged girls respectively. We will deal briefly with the topic of puberty.

Normal pubertal development in young girls occurs in a well-established sequence marked by various physical, emotional, and social changes, typically commencing between the ages of 8 to 13. One of the earliest visible signs is the development of breast buds, usually starting around the age of 9 to 10, though it can begin as early as seven years in some cases. This phase is often followed by the growth of pubic hair and a significant growth spurt, characterized by a rapid increase in height and weight. As development progresses, girls begin menstruating, usually two years after the onset of breast budding. Skeletal growth typically concludes about two years after menarche, marking the end of this transformative developmental stage.

These physical changes are often accompanied by fluctuations in emotions and mood, influenced by the rise in hormones such as estrogen and progesterone. While these changes are universal in girls, they unfold at their own pace for each individual, with some girls maturing in the 5th to 6th grade and others not maturing until later in Jr. High school. These developments are natural aspects of growing up into adulthood. Education about these facts can help girls navigate this transitional stage with confidence and a sense of normalcy.

Abnormal pubertal development such as early breast bud development (before age 7) or early development of hair in the genital region (before age 7 or 8) should prompt an office visit to discuss this. Also, delayed pubertal development should prompt an office visit. We would define delayed pubertal development as no breast development by age 14 or no menstrual cycles despite one to two years of mature sexual development.

Abnormal Vaginal Discharge: 

 Abnormal vaginal discharge in girls can vary in color, consistency, and odor from normal vaginal mucous that serves to keep the vagina clean and free from infections. Typically, a normal vaginal discharge is clear or milky white and has a mild odor. However, abnormal discharge might appear yellow, green, gray, or even brown and may be accompanied by a fishy or foul smell. The texture can change as well, appearing thick and lumpy rath- er than the usual smooth consistency. Other symptoms, such as itching, irritation, or pain, may also accompany the discharge. Such abnormalities may be indicative of infections like bacterial vaginosis, yeast infections, or sexually transmitted infections (STIs) such as gonorrhea, chlamydia or trichomoniasis.

Treatment of abnormal vaginal discharge depends on the underlying cause which needs to be identified. If a bacterial infection like bacterial vaginosis is diagnosed, antibiotics such as metronidazole or clindamycin may be prescribed. For yeast infections, antifungal treatments like fluconazole or topical antifungal creams may be effective. In the case of STIs, appropriate antibiotics or antiviral medications will be used according to the specific infection. 

Beside medical treatments, maintaining good hygiene practices and wearing breathable, cotton underwear can help prevent recurrent infections. If your girl experiences an abnormal vaginal discharge, an office visit during regular office hours is needed. Accurate diagnosis and appropriate management, can prevent serious reproductive health issues which might happen if the discharge is not managed properly.

Dysmenorrhea (menstrual cramps):

Menstrual cramps, common among menstruating individuals, often im- prove with age. These cramps typically begin 1-2 days before menstruation, affect the lower abdomen and back, and last 12-72 hours.

Menstruation marks the onset of a girl's reproductive years, usually occurring between ages 9 and 16. The menstrual cycle involves several stages that prepare the body for potential pregnancy. As hormone levels of estrogen and progesterone rise, the uterine lining thickens. If the released egg during ovulation is not fertilized, hormone levels fall, causing the uterine lining to shed and discharge as menstrual blood. This flow lasts about three to seven days and varies widely among individuals in terms of flow, duration, and accompanying symptoms.

Many girls experience symptoms like cramps, bloating, mood swings, and fatigue, collectively known as premenstrual syndrome (PMS). The uterus, a muscular organ, contracts during menstruation due to prostaglandin, causing cramps. Menstrual cramps, prevalent after menarche (the first period), start 1-2 days prior to bleeding and are usually felt in the lower abdomen and back. Symptoms can range from mild to severe, lasting 12-72 hours, and may include nausea, vomiting, fatigue, and diarrhea. Of- ten, cramps become less severe with age and may resolve after childbirth. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can effectively alleviate the pain. Use the package instructions for dose.

In rare cases, severe menstrual cramps might indicate underlying conditions such as polycystic ovarian syndrome (PCOS), endometriosis, adenomyosis, uterine fibroids, or infections. This secondary dysmenorrhea begins earlier in the menstrual cycle and persists longer than regular cramps, needing medical attention.

For girls with heavy or irregular periods, hormonal treatments like birth control pills may help regulate the cycle. Maintaining a healthy diet and lifestyle, including regular exercise and stress management techniques, positively impacts menstrual health. Additional strategies for managing menstrual pain include rest, avoiding caffeine, alcohol, and tobacco, and regular exercise.

In cases where menstrual issues are severe or disrupt daily activities, it is advisable to make an appointment for a regular office visit with one of our physicians.

Polycystic Ovary Syndrome (PCOS): 

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age. It is characterized by the presence of multiple small cysts on the ovaries, although not all women with PCOS have cysts. PCOS is primarily a condition involving irregular or absent menstrual cycles, elevated levels of male hormones (androgens), and ovulatory dysfunction. The exact cause of PCOS is unclear, but it is believed to involve a combination of genetic and environmental factors, often related to excess insulin production or insulin resistance, which stimulates the ovaries to produce more androgens.

Symptoms of PCOS can vary, but the most common include irregular menstrual periods, excessive hair growth on the face and body (hirsutism), acne, and obesity. These symptoms are due to elevated androgens and can lead to further complications like infertility, an increased risk of developing type 2 diabetes, cardiovascular issues, cholesterol abnormalities, and metabolic syndrome. The clinical evaluation for PCOS typically involves a medical history, physical examination, and lab tests to measure hormone levels. An ultrasound may also be conducted to inspect the appearance of the ovaries for cysts and the thickness of the endometrial lining.

Treatment for PCOS is tailored to the individual's symptoms and concerns. Lifestyle modifications such as weight loss and regular exercise are often recommended as they can significantly improve symptoms and reduce the risk of associated complications. For those struggling with menstrual irregularities, hormonal birth control can regulate the cycle and reduce androgen levels. Anti-androgen medications might be prescribed to manage excessive hair growth and acne. Additionally, managing insulin resistance with medications such as metformin can be beneficial. Regular monitoring and follow-up with healthcare providers are needed to manage this chronic condition effectively.

First pelvic exam: 

Parents and caregivers often inquire about the appropriate timing for a girl’s first pelvic examination. It is advised for the following circumstances:

• Upon reaching the age of 21
• Initiation of sexual activity
• Delayed pubertal development
• Absence of breast development by age 14
• Absence of menstruation despite developments in other secondary sexual characteristics
• Menstrual disorders, such as excessive bleeding and pain
• Persistent, unexplained pelvic or lower abdominal pain
• Abnormal vaginal discharge

Abnormal vaginal discharge 

Abnormal vaginal discharge in a girl of any age warrants a medical examination. In adolescent girls, it is normal for the vagina to produce a very small amount of thin, clear to white mucus. Prepubescent girls rarely have any vaginal mucus secretion. An abnormal discharge is typically identified by an increase in the amount of discharge and changes in its color or consistency. This may include a yellow or green discharge with a pus-like consistency, or a white discharge resembling cottage cheese. Abnormal discharge might also have an unpleasant odor.

In adolescent girls, abnormal vaginal discharge can indicate an infection that requires treatment. Ignoring such symptoms can lead to serious complications, including infertility and pelvic inflammatory disease.

Moreover, sores and blisters on the external genitalia are significant and should be evaluated in adolescent girls if they occur. Sexual activity prior to marriage during the teenage years is fraught with complications and is discouraged. If any of these symptoms are present, it is important to seek medical at our office to ensure proper diagnosis and treatment.