Because of the effect of mother’s hormones, newborn girls often have a considerable amount of mucousy, white vaginal discharge. This is normal and requires no treatment. In addition, sometimes a small amount of vaginal bleeding can occur during the first few days of life, again due to the mother’s hormones. This menstrual bleeding will stop spontaneously and also requires no treatment.
Vulvovaginitis is an irritation of the external genitalia usually occurring in young girls. It is generally caused by decreased attention to proper hygiene. Bacteria that are present in feces can irritate the external genitalia. Thus good hygienic practice are important. Bathing in bubble bath or soapy water can also cause vulvovaginitis. Other causes of this are infections with yeast and certain types of bacteria. Treatment for this problem includes:
- Improved hygiene -teach your child to wipe from front to back and have her put on a clean pair of cotton underwear daily.
- A Sitz bath in warm tap water for 10 to 15 minutes twice daily for four to five days is often helpful. One-half strength white vinegar (one-half water plus one-half white vinegar) can be a applied to the irritated genitalia to help resolve the vulvovaginitis.
- Neosporin ointment or Vaseline can be applied to the area.
If the above measures are not helping the child, she should have an appointment. A small amount of bleeding in this area with vulvovaginitis should not alarm you, but should prompt an office visit.
Labial adhesion: In infant and young girls, usually between the ages of 6 months and 6 years, the labia minora may fuse together in the mid-line and close off the entrance to the vagina. The urethral opening is not affected by this process, so urination is normal. Labial adhesions are usually asymptomatic and no treatment is needed. With time, as a girl matures and natural estrogens increase, the labial adhesions naturally separate. If your little girl has a labial adhesion, it is important to know that the adhesion has resolved before menstruation begins. We generally follow this over time. Rarely, if a labial adhesion develops a small tear, this can cause painful urination as salt rich urine touches the torn area of the adhesion. Treatment with an estrogen cream can resolve this. Consult your doctor if painful urination develops in the presence of a labial adhesion.
Puberty: The topic of explaining all the information that is needed for the child who is going through the passage of puberty is beyond the scope of this handbook. We have literature in our office to help with explaining pubertal changes to your children. A very good resource is the American Girl Series: The Care and Keeping of You. This is great for 9 to 12 year old girls.
In way of a brief explanation, on average, most girls begin the breast budding stage of puberty at about 9 – 10 years of age, although there is wide variation to this. Some girls can begin puberty as early as seven years of age normally. Generally, menses begin two years after the onset of breast budding. Skeletal growth generally stops about two years after menarche (the beginning of menses).
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 in a girl of any age is a reason for an examination. Normally in adolescent girls, the vagina secretes a very small amount of thin, clear to white mucous. Prepubertal girls rarely secrete any mucous from the vagina. An abnormal discharge would be characterized by an increase in the amount of material produced as well as color and consistency changes. The abnormal discharge could have a yellow or green color with a “pus” type consistency, or a white cottage cheese like color and consistency. An abnormal discharge can also be associated with an unpleasant odor. Particularly in adolescent girls, an abnormal vaginal discharge may be a sign of an infection that needs treatment. Ignoring such a discharge may have devastating complications such as infertility problems and pelvic inflammatory disease.
Like an abnormal vaginal discharge, sores and blisters on the external genitalia are significant in adolescent girls. If these should appear, an examination during regular office hours is appropriate. Sexual activity prior to marriage during the teenage years is fraught with complications and is discouraged.
Dysmenorrhea (menstrual cramps): menstrual cramps can be a problem, especially soon after menarche (first period). The cramps and pain usually begin 1 or 2 days before, or when menstrual bleeding starts, and is felt in the lower abdomen and back. The pain can be mild to severe. It usually lasts between 12 to 72 hours. Nausea, vomiting, fatigue, and even diarrhea can occur. Menstrual cramps usually become less painful as a woman ages and may stop entirely if the woman has a baby.
What causes menstrual cramps? The uterus, where a baby grows during pregnancy, is a muscular organ. Muscles can contract and cramp. Menstrual cramps (uterine contractions) are caused by contractions of the muscles of the uterus. The contractions are stimulated by a chemical called prostaglandin. Ibuprofen and naproxen inhibit the production of prostaglandins and are the main treatment of menstrual cramps. The uterus contracts throughout a woman’s monthly menstrual cycle. During menstruation, the uterus contracts more strongly. The tight constricted muscles can press against nearby blood vessels, cutting off the supply of oxygen to the uterus. Pain results when part of the uterine muscle briefly loses its supply of oxygen. This is a painful process, but not a serious one.
You can minimize menstrual cramps by taking ibuprofen or naproxen. Make sure to begin these medications at the first indication of menstrual period and take it regularly as directed on the bottle. Rest also helps to manage the pain. You should avoid foods that contain caffeine. Don’t smoke or drink alcohol during menstrual periods. Exercise can help.
Uncommonly, severe menstrual cramps and pain can be due to more serious gynecological problems such as endometriosis, adenomyosis, uterine fibroids, or infection. This type of dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. The pain is not typically accompanied by nausea, vomiting, fatigue, or diarrhea.
We are asked many times about when a girl should have her first pelvic examination. This should be done with any of the following:
- At the age of 21 years
- Delayed pubertal development (no breast development by 14 years and no no menstrual periods despite mature sexual development.)
- Initiation of sexual activity
- Menstrual Disorders, such as excessive bleeding and pain
- Unexplained abdominal pain
- Abnormal Vaginal Discharge