Young girl at the gynecologist. Gynecological problems in little girls. Preschool and elementary grades
Good day everyone!
Oddly enough, but many girls asked me to talk about such a seemingly simple issue as the first visit to the gynecologist...
It would seem that it is simpler? ... but a lot of questions arise:
- why examine a very young girl / girl?
- How is it prepared?
- what will the doctor do?
- how to climb on a chair?
- What will they do with me?
- Should I shave?
- What questions will be asked?
So, so that there are not so many questions, I will try to cover this topic in as much detail as possible today.
An examination by a gynecologist is as necessary and mandatory as an examination by other doctors and specialists for your health both today and for your future.
Let's start with the very first question.
1. When should I start seeing a gynecologist?
Or when is the age of the first examination by a gynecologist?
This question is different for everyone.
The most important thing you need to understand is that if you or your daughter has any complaints or questions....you should already make an appointment with a gynecologist!
As a standard, after the age of 18, a girl should visit a gynecologist 2 times a year.
As a rule, the first visit takes place in school age during medical examination - this is 15-16 years old ... this is a general examination ... so that you are not afraid! ... the doctor will only externally examine you and maybe ask something ... if he has questions for you or a desire to examine you, and you are not yet 18 years old .... then it is better to transfer the doctor’s request to your mother or your guardian, because the examination of girls under 18 years old should be carried out only with the consent of the mother or guardian and in his presence, if of course you want your mother I looked at it ... if you don’t want, mom will wait for you outside the office door ... but first she will give her consent to the gynecologist for your examination.
That is, if at school you do not want to look around or after the examination there are questions, ask the gynecologist to write a note to your mother or guardian stating that you need an examination by a gynecologist at your place of residence or registration ... And only then at home with Mom, you will discuss and plan your trip to the gynecologist. And remember, no one can force you to undergo an examination. Know your rights!
And of course, even if you are not yet 18 years old, but you have already started to lead sexual life you just need to visit a gynecologist.
2. If a very young girl (child) is forced to undergo a gynecologist, what should I do?
Yes, it also happens ... when, upon admission to some lyceums or gymnasiums, or even to some kindergartens, a certificate from a gynecologist is required.
Well, don't be scared...First of all, you should find out where in your area (at the place of residence) a CHILDREN'S gynecologist sees you.
It is he who examines children and girls under 18 years of age. It is his office that is equipped with a special children's gynecological chair ... for little girls.
You must be present at the reception with your daughter and, if she wishes, be with her at the time of the examination itself.
If the girl is very small ... then the whole point of the examination will be the external examination of your girl ... is it right is developing mammary and sex glands (no one will insert mirrors, and no one will conduct an anal examination in the absence of complaints).
The doctor will ask the girl if something hurts her? .. of course she will ask about menstruation, if any? .. and give you a certificate.
Perhaps the doctor can take a smear from your daughter with a special wand and only from the outer labia, he should not insert the wand inside!
3. What should I take with me to the gynecologist's appointment?
As a rule, good clinics already have everything you need for your examination and you don’t need to take anything ... but this is not everywhere, right? Many of them are serviced in ordinary city clinics. So, what you need:
- clean diaper or small towel to lay yourself under the ass on the gynecological chair.
- clean socks(when you undress at the gynecologist, take off your tights or socks, it will be very good if you quickly put on clean socks brought with you - the doctor will also like it, it will be more aesthetic than your bare feet and besides, you will it is more convenient to walk from the couch on which you undressed to the chair in socks than barefoot on the floor (it is not known who and with what feet walked on it before you).
- if you are already sexually active and do not want to be examined with instruments that are already available in the clinic, you can buy at any pharmacy disposable gynecological examination kit(there will be mirrors, and a diaper, and gloves for the doctor, and a special brush for your smear) Here's what it includes:
- if you are already on your period, do not forget your calendar where you mark your period.
- and of course you need your positive attitude - remember, the doctor will not bite you and does not dream of offending you or laughing at you. You are not the first patient at the gynecologist, he is used to everything .... do not be afraid to be frank with him about your intimate problems.
And believe me, he looked THERE many - many times .... and it only seems shameful or scary to you ... the gynecologist is used to this and no matter what, he will never offend you (according to at least I wish you this.)
4. How to prepare for the first visit to the gynecologist or just how to prepare for the next visit to the gynecologist?
- you should not go to the gynecologist if you are menstruating, because due to spotting, the doctor will not be able to get all the information he needs. the time when you definitely didn’t expect it - for example, between the expected menstruation - then it’s just a must to go to the gynecologist’s appointment!
- Before the examination, it is better to take a shower or bath and put on fresh clothes. At the same time, it is not worth rinsing especially carefully, since the doctor must see the vaginal microflora in a normal, “everyday” state. It is strictly forbidden to douche(to inject water, and even more so antiseptic substances into the vagina using a douche): firstly, douching will deprive the doctor of the opportunity to evaluate vaginal discharge, which is very informative for a specialist; secondly, a smear taken after douching will, to put it mildly, not be informative. It is not recommended to use special intimate deodorants or perfumes.
- You don't have to shave your pubis...only if you like it the most.
- Before you go to the gynecologist's office, you should go to the toilet and urinate, and it is also advisable to empty your intestines in advance at home.
- For a day or two, it is worth refusing to have sexual intercourse, since the sperm remaining in the vagina can interfere with the examination or distort the picture.
- Also, for a day or two, you should not insert any candles into the vagina!
5. What will they do in the office and what will they ask?
So you went into the office, do not be embarrassed, say hello to the doctor, as a rule, he will not be alone, but with a nurse.
Come in and sit on the chair next to the doctor. Wait until they start asking you.
The doctor will most likely ask you right away about the reason for your visit to him or about what worries you about women's problems. To relieve your tension, immediately say that this is your FIRST VISIT to the gynecologist ... the doctor will assist you and be more loyal.
At the appointment, the doctor will definitely ask about the age at which menstruation began, the regularity of the cycle, the duration of the menstrual cycle (the number of days from the first day of menstruation to the next first day of menstruation), the date of the last menstruation.
With a calendar handy, you can easily answer these questions.
Ask about your complaints, if any.
He will ask if you are sexually active ... answer boldly the truth, the quality of the examination depends on this. As a rule, the doctor asks questions related to sexual life: have you had or have not had sexual intercourse, the age of onset of sexual activity, the number of sexual partners, the presence of any diseases in sexual partners, etc.
He may ask if you have had gynecological problems before.
Next, you will be asked to go into the next room for inspection or just behind the screen. There will be either a chair or a couch where you must undress: take off everything to the waist, that is, pants / jeans / skirt / tights / panties, then remove everything from above to the bra or if you do not wear it, you can stay in the bottom T-shirt. Then turn to the gynecological chair.
Here's what it looks like:
It has a backrest, a seat and footrests on both sides, sometimes there are also two steps from the bottom, so that it is convenient to climb onto the seat.
Lay your towel or diaper on the seat.
Then lean back, and spread your legs wide apart and put on coasters:
From the doctor's point of view, your position should look like this:
Tell the doctor you're down and ready. The doctor will come over and put on disposable rubber gloves first.
Then, if you are still a virgin, then he will look at you through the hindgut, not through the vagina! But first he will examine your external genitalia - this is normal! Then he will lubricate his finger with special oil and gently insert it into your hindgut, and with his left hand he will feel your tummy.... this way he can examine your uterus and ovaries. It will be a little unpleasant, be patient, this will not last long .. Then the doctor will most likely take a swab from the outer labia with a special wand, it can be recognized in a couple of days.
If your doctor has questions, he may order a pelvic ultrasound for you.
If you have already been sexually active, then you will be examined through the vagina with special devices ... which are called mirrors, although they are not much like mirrors.
This is what reusable speculums look like, they must be sterilized after each use:
And this is how disposable gynecological mirrors look like, they are made of plastic, you can buy them for yourself at any pharmacy, as I wrote above.
So, after you lie down on the chair, the doctor will insert this mirror and examine what he needs there, you lie quietly, right at the moment of examination in the mirrors, the doctor will take a smear for cytology (cancer cells) and a simple smear for flora. The moment of insertion of the mirrors is a little unpleasant, but less painful than examination through the rectum.
Just try to relax and in no case do not squeeze the muscles there! Otherwise, you will be hurt.
By the way, a small digression, gynecological mirrors come in 3 sizes: 1,2,3.
So ask yourself for the first examination that the doctor examine you exactly in size No. 1 - these are the smallest. And remember that sometimes the doctor doesn’t care whether it hurts you or not, watch yourself and ask what he is doing.
Next, the doctor will get the mirrors ... do not immediately jump up from the chair !!! Lie down, the doctor should now examine you with his hands, the gynecologist will insert the right hand, namely 2 fingers into the vagina, put the left on the tummy and press on the stomach, so the doctor can examine what is not visible in the mirrors. Lie still and relaxed, it is almost painless.
Sometimes it is difficult for the doctor to see some points in the mirrors due to your anatomical features, then he may ask you: "Put your feet on your heels" ...
This means that you have to bend your knees even more, and put your heels in the place on the supports where your knees just lay, like this:
When the doctor is done, he will tell you to "get up" and you can get up.
6. When will the breasts (mammary glands) be examined?
Here, each gynecologist has his own turn, someone looks at the mammary glands before looking at you on the chair, someone looks at the chair, someone after the chair.
In a word - do not worry - he will tell you.
And if you didn't, remind him... ALWAYS!...because we have doctors who forget about it, and breast cancer is now far from uncommon even at a young age!
7. What kind of apparatus was it when they looked at you in the chair?
Now almost all gynecologist's offices should be equipped with a special device - a colposcope - this is such a special microscope in order to examine the cervix in the mirrors for the presence of pathology ... It usually stands next to the chair, and looks like this:
Do not be afraid of him, he does not bite, if necessary, the doctor will simply look into him at your neck for 3-4 minutes. It does not hurt.
8. What to do next?
Well, they examined you, took smears, now you have the right to ask the doctor everything you want to know about yourself. Sometimes, after an examination, doctors rest against your card and nervously scribble something there and are silent like partisans .... And you sit side by side and are afraid to breathe.
Do not be shy, ask if everything is fine with you. Do you need to take any additional tests, if so, which ones and why?
Ask when you can find out the result of your smear?
When do you need your next appointment?
Ask about contraception? Suddenly you are doing something, but it's wrong!
Do not be afraid to ask the doctor questions and do not be embarrassed that you do not know something or did not understand the first time.
Doctors undergo quite a long training and understand their specialty - their direct responsibility.
At the consultation, you have the right to count on a detailed and, most importantly, accessible explanation about your state of health, the planned examination, the diagnosis and the prescribed treatment.
Well, that's all I wanted to tell you, I hope this post will help you successfully pass your first visit to the gynecologist.
And of course I wish you to find YOUR competent and sensitive doctor!
Teenage girls should visit the gynecologist once a year after their period. The first examination may cause some psychological discomfort. That is why it is important to talk to your child. Conduct an educational program, tell us about how the doctor will conduct the examination.
How is a gynecological examination performed?
Examination of adolescents consists of several stages:
Identification of complaints;
- Examination of the external genital organs;
- inspection with a mirror;
- palpation of the abdomen;
- taking a smear.
Identification of complaints is a necessary step during the examination. The doctor may ask about general well-being, as well as about previous diseases. Also, the gynecologist should examine the mammary glands and body hair -.
Girls who are not yet sexually active do not need to be examined with mirrors. The procedure itself in the gynecological chair can last no more than five minutes, and a visit to the doctor usually fits in twenty minutes.
Often, a gynecological examination of adolescents is carried out even in high school. But this procedure is not mandatory, so you can write a letter of resignation if your daughter is not mentally ready for this.
You should be prepared for the fact that the doctor will visually examine the external genitalia for inflammation or discharge. Also, the gynecologist can take a smear for research.
For this, it is used special tool, similar to an ear stick. A pediatric gynecologist runs her along the vaginal mucosa.
Usually, immediately after the examination, the doctor asks a series of questions. For example, “When did menstruation first start?”, “What discharge is present?”. You need to answer these questions honestly.
Preparing for an inspection
You can agree in advance whether you need to accompany your daughter during a visit to the doctor. This will help relieve psychological discomfort.
You should stock up on everything you need. It is advisable to bring a diaper, rubber gloves, and a disposable plastic mirror.
Can you go to private clinic or a youth medical center, and not to a regular antenatal clinic. Teenagers often try to put off seeing a doctor for a long time due to embarrassment, psychological discomfort, and a number of other reasons. In this case, it is important to have a conversation with your daughter.
In the event that you have signed a school screening waiver, you will need to select a qualified doctor. To do this, call private clinics, consult with friends.
When I was collecting my daughter for school, in the first grade, I was given a long “guidebook”: a list of doctors we need to go through in order to get the right to gnaw on the granite of science. Surgeon, ophthalmologist, ENT, endocrinologist - it's all clear. But a gynecologist?.. I don't really like going to this doctor myself, but I have to. But why would a six-year-old child need it?
Tatyana Butskaya:
- On the forums, I often come across questions, indignation and fears of mothers: “A pediatric gynecologist is nonsense”, “Why go if you can’t look at a child with instruments and nothing bothers the girl?”, “I myself see that my daughter has everything okay!”, “The daughter will still have time to visit the gynecologist”, “Examination by a pediatric gynecologist is harmful to the child’s psyche!” Someone really has a negative experience of visiting a pediatric gynecologist, and someone is simply not sufficiently informed about why this specialist is needed.
So, let's dispel some myths around the "adult" doctor and understand the situation.
Photo by GettyImages
Why is this needed?
Just because a girl isn't sexually active and doesn't have her period yet doesn't mean the gynecologist isn't her doctor. After all, she has female genital organs! They just develop and develop. And it is very important to follow how this happens. After all, problems with gynecology and reproductive function in a woman, when she begins to have sex and decides to have a baby, may be the result of untreated, neglected problems in childhood. What? For example, these:
- vulvovaginitis- Violations of the microflora of the vagina lead to it, as in a mature woman. It can even happen to a newborn girl. Often such a problem is encountered in the first two years of life, when there is an active use of diapers that create a greenhouse effect. Girls don't yet have enough lactobacilli in their vaginas to protect against infections like women do. Therefore, any decrease in immunity or improper hygiene can cause inflammation.
- congenital cysts or tumors of the ovaries, underdevelopment of the internal genital organs. This is very dangerous during puberty and can lead to irreversible consequences if the problem is not identified in time.
A common problem for little girls is synechia, or fusion of the labia minora. Because of this misfortune, it is difficult for a child to go to the toilet and not far from inflammation in the kidneys. Synechia can occur due to an allergic reaction, skin characteristics of the labia minora, or in the presence of an inflammatory process. The reason must be found out.
In addition, a pediatric gynecologist examines not only the genitals, but also the mammary glands, assesses the state of the girl's endocrine system, hair growth, which is especially important to exclude puberty disorders. A pediatric gynecologist is especially important for a girl who has just begun menstruation. He should talk about the rules of hygiene, about what signs and symptoms should and, conversely, should not embarrass the girl.
Mom's big delusion
Many believe that they can independently assess the condition of their daughter's genitals. And they are wrong.
Mom may think that outwardly everything is fine. But the absence of redness, discharge, itching, daughter's complaints is not a guarantee that there is no hidden inflammatory process or disease. For example, the same adhesions of the labia minora often do not manifest themselves in any way and are outwardly invisible. Moreover, the mother sees only the external genital organs of her daughter and, by the way, does not really know how they should normally look at each age of the girl, and the doctor will be able to delicately, through the stomach, probe the internal organs and determine their condition.
Photo by GettyImages
But what about the psyche?
The question is, of course, an important one. If the doctor is delicate, respectful of the child, the girl is prepared, and the mother is calm, then there will be no trauma to the psyche. There are a few rules for those who do not trust pediatric gynecologists.
1. Find your doctor
If, for example, we come across an indelicate dentist, we don’t stop treating a child’s teeth in principle, do we? We're just starting to look for another doctor. Also here. Remember how you were looking for the same gynecologist or other specialist for yourself, how many doctors you went through. It's really important to find a doctor that both you and your child can trust. Try to find a doctor through friends or look at the recommendations on the forums.
2. Learn how a girl should be examined
The examination of a girl is not at all the same as that of a mature woman. Under no circumstances should any mirrors or instruments be inserted into the girl's vagina. It's really redundant. Examination by a pediatric gynecologist is a delicate external examination and superficial palpation of the abdomen in order to understand how the internal genital organs develop, whether there are cysts, tumors, or inflammations.
3. Prepare and set up the daughter
Tell your daughter that there is such a doctor, why he is needed and what he will do at the reception. Explanations, of course, should be chosen according to the age of the child. Tell that you and other women also go to such a doctor - this will definitely inspire confidence in your daughter. If you understand why an examination is needed, if you trust the doctor, then you will be able to explain everything to your daughter so that she is not afraid. Otherwise, the child may be afraid only because you yourself are tense.
When a pediatrician advises parents to show a very tiny girl to a gynecologist, they are often perplexed. It is believed that a doctor of this specialty is needed only adult woman. However, the causes of "women's" health problems can often be found in early childhood, and in some cases even in the prenatal period.
The first time a newborn girl is examined by a neonatologist while still in the maternity hospital. The doctor draws attention to the external genital organs, ascertains their correct development. In the future, an examination by a pediatric gynecologist is recommended for all girls during the first year of life, although a doctor in this specialty is not included in the list of specialists required to visit.
When consultation is required
It is highly advisable to contact a pediatric gynecologist if the girl suffers from allergic diseases, infections of the urinary tract and kidneys, respiratory organs, diseases of the thyroid gland and adrenal glands. Also, the girl should be taken to the gynecologist if there were complications during pregnancy and childbirth. Such pathological conditions pregnancy, as oxygen starvation of the fetus () during pregnancy and childbirth, birth trauma, can provoke premature sexual development. Chlamydia, ureaplasma, mycoplasma and other sexually transmitted infections that a pregnant woman had, require additional examination of the girl, since the possibility of their transmission to the child is not ruled out. The mother should be alerted by the presence of various kinds of discharge (from mucous to purulent and bloody) from the girl's genital tract, redness and itching of the vulva, enlargement of the clitoris, engorgement of the nipples of the mammary glands, the appearance of hemorrhages and spotting in the vulva.
How is a gynecological examination
The maximum that may be needed at the appointment with a pediatric gynecologist is a clean diaper. Mom herself needs to behave calmly, she should not be afraid that the child will be hurt. In children of the first year, the examination is carried out on the changing table. For an older girl, it is better if during the examination she sits on her mother's lap: this way the baby will feel more protected.
The examination is completely painless for the child. If manipulations such as examination of the vagina and cervix, removal of a foreign body are necessary, then they are performed under general anesthesia.
What can a doctor find?
sexual crisis
After the mother and baby are discharged from the postpartum department, some girls develop quite abundant mucous, and sometimes bloody discharge from the genital tract, and the nipples of the mammary glands swell. So the reproductive system of the girl reacts to the mother's sex hormones that came to the fetus through the placenta, and later to the child with breast milk. Normally, by the end of the first month of life, the discharge from the genital tract completely disappears. The swelling of the mammary glands may persist for some time, disappearing in some girls by the end of the breastfeeding period. If this symptom persists, the mother is recommended to change the nature of the diet: exclude broiler chicken meat from her (and later from the baby’s diet) (it may contain hormonally active additives), give the child fruits grown in season in vivo(from the garden).
precocious puberty
This is the name of the condition in which secondary sexual characteristics (growth of the mammary glands, the appearance of pubic hair) and menstruation appear in girls up to 8 years of age. Distinguish precocious maturation by female and male types.
Hygiene girls
The issue of caring for girls is extremely important in the prevention of inflammatory diseases of the genital organs.
In the first year of a child's life, when he still cannot take care of himself, mothers, as a rule, carefully monitor the cleanliness of the baby's body. However, as soon as the girl grows up, the frequency of washing is often reduced. It is necessary to take care of the external genital organs of the girl daily. Due to the peculiarities of the structure of the mucous membrane of the vulva, the composition of microorganisms and the alkaline reaction of the environment, it is better to wash it with plain water or decoctions of herbs (melissa, succession, chamomile), alternating them alternately. It is desirable to use soap pH-neutral.
It is important to teach the girl to wash properly: the movement of the hand comes from the womb back. The child should be washed with warm water. After completing the procedure, be sure to thoroughly blot the genitals with a towel: a constantly humid environment favors the development of fungal flora.
Elementary hygiene measures will help to instill in the girl self-care skills and avoid many health problems in the future.
Premature sexual development according to the female type can be caused by many reasons: pathology of the central nervous system organic origin (tumors) or functional nature (change in activity); hormonally active tumor of the ovaries or adrenal glands; follicular ovarian cysts; dysfunction of the thyroid gland.
In the full form (when all signs are present) of female-type precocious puberty, symptoms can occur in girls under 2 years of age. With an isolated increase in the mammary glands, it appears from birth and, either increasing or decreasing, disappears without special treatment by 2-4 years. Such children until the age of majority are under the supervision of a pediatric gynecologist. They are more likely than healthy girls, there are violations of the reproductive system.
Correctly diagnosing precocious sexual development according to the female type and choosing the appropriate treatment will help timely examination of the child, which, in addition to examining a doctor, includes an ultrasound examination of the pelvic organs, determining the level of sex hormones and pituitary hormones, radiography of the brain, examination by a neuropathologist and endocrinologist.
When hormonally active tumors and follicular ovarian cysts are detected, the treatment tactics in each case are chosen individually.
Hormone treatment in order to suppress the development of secondary sexual characteristics and menstruation is resorted to in the case of a complete form of premature sexual development of the female type, which occurs in a girl under 3 years old.
Treatment for a hormonally active tumor is surgical and consists in its removal. If a girl has a follicular ovarian cyst, she is monitored by ultrasound, since the cysts usually disappear on their own within 3-6 months. Girls with various variants of deviations of sexual development are observed until the end of puberty for the timely detection and correction of violations that have arisen.
The cause of premature sexual development according to the male type is a genetically determined enzyme deficiency, as a result of which there is an increase in the level of male sex hormones - androgens.
Premature puberty according to the male type, the so-called adrenogenital syndrome, is characterized by increased function of the adrenal cortex and an increased content of androgens (male sex hormones) in the body. Pathology manifests itself in the form of an abnormal structure of the external genital organs, in particular, an increase in the clitoris, the presence of a urogenital sinus (a single urogenital opening), early pubic hair growth. Changes in the structure of the external genitalia in a newborn girl can be so significant that the sex of the child can be determined as male. Treatment is carried out with drugs of glucocorticoid hormones (cortisone, prednisolone, dexamethasone). Their introduction normalizes the synthesis of hormones by the adrenal cortex and the function of the hypothalamus - pituitary - ovaries (the appearance of secondary sexual characteristics of the female type, the formation of a normal menstrual cycle). Timely treatment of adrenogenital syndrome with hormones of the adrenal cortex (glucocorticoids) makes it possible to direct the sexual development of girls according to the female type.
With congenital adrenogenital syndrome, the clitoris is amputated and an artificial entrance to the vagina is formed.
Anomalies in the development of the genital organs
Atresia - complete infection of the hymen (a fold of mucous membrane that closes the entrance to the vagina, it has one or more holes through which menstrual blood flows). Although a hymen infection is a congenital condition and does not appear during a child's life, in rare cases it may not be noticed in the hospital. Girls with such an anomaly can live in peace, without contacting doctors about this, until the onset of menstruation. The blood accumulating in the lumen of the vagina and finding no way out will in this case cause a feeling of pressure in the small pelvis and difficulty urinating. Treatment of atresia is operational and consists in dissection of the hymen.
Doubling of the uterus, vagina. These congenital features development does not appear until pregnancy occurs. A pediatric gynecologist can diagnose defects much earlier with the help of an examination and ultrasound.
Inflammatory diseases of the vulva (vulvitis) and vagina (vaginitis)
These diseases are the most common gynecological diseases among girls early age. This is due to the fact that in children, unlike adult women, the cells of the vagina do not contain glycogen, which helps maintain an acidic environment in it and is a protective barrier against infection. In addition, girls have very few lactobacilli in their vagina, which are also a normal protective factor. The girl's vagina is alkaline. Therefore, any reduction defensive forces organism can lead to vulvovaginitis.
Causes. Most often, inflammation occurs after a cold and other respiratory diseases, which is associated with a decrease in the protective forces of the child's body. In this case, bacterial vulvovaginitis occurs. In babies with frequent diseases of the respiratory system, kidneys, requiring the use of antibiotics, as well as with dysbacteriosis, a violation of the vaginal microflora develops with the development of the so-called bacterial vaginosis. Taking antibiotics also provokes an increased growth of fungal flora with the development of fungal (mycotic) vulvovaginitis. Often, vulvovaginitis accompanies childhood infections such as chicken pox, measles, rubella, since inflammation affects not only the skin, but also the mucous membranes of the vulva and vagina.
IN last years vulvovaginitis, the causative agents of which are chlamydia, mycoplasma, virus types I and II, is becoming increasingly important. This is due to the prevalence of these infections among adult women. Although pregnant women undergo a comprehensive examination and treatment of detected infections in antenatal clinics, intrauterine infection of the fetus or infection during childbirth is possible. It is possible to become infected through household contact with close prolonged contact, non-compliance with the rules of personal hygiene. In the spread of herpetic infection, self-infection of a girl plays an important role, when with her hands she transfers the virus from the lips, face to the external genitalia.
In little girls, there are also cases of vulvovaginitis caused by Trichomonas. Transmission of infection occurs, as a rule, during childbirth.
Often, vulvovaginitis is accompanied by allergies. The so-called atopic vulvovaginitis that occurs in this case takes, as a rule, a protracted character with frequent exacerbations.
Vulvovaginitis, especially caused by the growth of fungal flora, may be the first manifestation of diabetes.
Inflammation of the vagina also occurs if a foreign body enters it. During the game, some small object(a piece of cotton wool, a small toy, etc.). Moreover, parents may not notice this.
A very common cause that causes inflammation of the external genitalia is, most often pinworms.
Inflammation of the genital organs in babies may be the result of non-compliance with the rules of hygiene, when the microorganisms that cause the inflammatory process can get there with dirty hands.
Symptoms. Manifestations on the basis of which an inflammatory process can be suspected are discharge from the genital tract, itching and redness of the vulva. The nature of the discharge depends on the cause that caused the disease of the genital organs. In the presence of a foreign body, discharge with an unpleasant odor appears, sometimes with streaks of blood. Trichomonas vulvovaginitis is accompanied by abundant foamy discharge from the genital tract and their redness. With mycotic (fungal) vulvovaginitis, parents note the appearance of cheesy secretions on the mucous membrane of the external genitalia and panties, the child's anxiety and constant combing of the vulva. With inflammation that occurs against the background of childhood infections, children may be disturbed by itching and pain in the vulva. Severe itching and redness against the background of mild discharge make one suspect a helminthic invasion.
Manifestations of herpetic vulvovaginitis in most cases are pronounced: on the mucosa of the external genital organs, either transparent vesicles with liquid contents are visible, or ulcers that appear after the opening of the vesicles. There is redness, soreness of the vulva, because of which the kids are restless and capricious. In some cases, there is an atypical course of the disease, in which the child periodically appears scanty discharge and slight reddening of the external genitalia. In such a situation, a thorough questioning of the mother, the presence of her manifestations of herpes, frequent colds and herpetic eruptions on the face of the child helps. This allows you to purposefully examine the girl for the presence of this infection.
Bacterial vulvovaginitis is accompanied by a yellowish discharge, redness, and often itching of the vulva. Clinical manifestations of chlamydial, ureaplasmic and mycoplasmal infections are very scarce. In girls, in this case, slight mucous discharge from the genital tract appears against the background of a pale or slightly reddened vulva. Often there is a frequent exacerbation of urinary tract and kidney infections in a child.
With vulvovaginitis of an allergic nature, parents note recurrent scanty discharge from the genital tract, thinning of the mucosa. Bacterial vaginosis, which is based on a violation of the vaginal microflora, is characterized by the absence of inflammatory changes in the mucous membrane of the vulva and vagina and the appearance of milky or gray liquid secretions with the smell of rotten fish.
Diagnostics. In order to identify the cause that caused inflammation of the vulva and vagina, a bacterial culture of the flora is carried out. It is possible to detect chlamydia, ureaplasma, mycoplasma using the polymerase chain reaction (PCR), immunofluorescence reaction (RIF), enzyme immunoassay (ELISA). The herpes virus is isolated either directly from the lesion, or indirectly - by determining the antibodies in the blood of the acute and chronic phases of inflammation. It is obligatory to take scrapings and feces on helminth eggs. If a violation of the intestinal microflora is suspected, a fecal analysis for dysbacteriosis is performed. Vaginoscopy (examination of the walls of the vagina and cervix using a special apparatus - a vaginoscope) is used in case of suspected presence of a foreign body in the vagina or in order to diagnose a tumor of the vagina, which is accompanied by purulent discharge. An elevated blood glucose level, along with persistent fungal vulvovaginitis, allows the girl to be referred to an endocrinologist in time for her additional examination for diabetes. As additional methods examinations, it is possible to take a general and urine sample.
Treatment. Treatment of vulvovaginitis depends primarily on the cause that caused it. In the allergic nature of the disease, antiallergic therapy and a low-allergenic diet are prescribed, and in case of helminthic invasion, antihelminthic measures are taken. Chlamydia, ureaplasma, mycoplasma, trichomonas vulvovaginitis require antibiotics, herpetic - antiviral drugs, and fungal - antifungal agents. At the same time, for all types of inflammatory diseases of the external genital organs, local treatment is carried out in the form of baths with herbs, vaginal lavages with antiseptic solutions and the introduction of ointments with anti-inflammatory effects. Drugs are administered using a small syringe, either through a small-diameter catheter, or using a syringe without a needle. At the second stage, the vaginal microflora is restored and local immunity is normalized. Parents who have been previously trained in these manipulations can perform them at home on their own. If these procedures cause them difficulty or they are afraid to do them, the doctor performs the manipulations.
Synechia
A widespread disease among girls from birth to 5-6 years of age is synechia - fusion of the labia minora. As a rule, they are the result of inflammation of the vulva and vagina, as a result of which the outer layer of cells of one labia minora grows on the edge of the other.
Often, synechia can also form with improper care of the girl, when parents use soap too often (several times a day) or make baths with a potassium permanganate solution daily for a long period when caring for a child. By doing this, they remove the natural protective secret, dry out the genital mucosa and make it more susceptible to any infection.
When the labia is fused together, an additional “pocket” is formed through which urine passes during urination. In addition, microorganisms accumulate in it, creating additional conditions for maintaining inflammation.
Synechia is treated by dilution (separation at the junction of one labia minora with another) - before dilution, the labia is smeared with an estrogen-containing ointment for several days, they soften, and the adhesions are separated non-surgically. The effect is fixed by a short, no more than 7 days, lubrication of the labia minora with an estrogen-containing ointment, due to which full-fledged layers of the epithelium are formed along their edges. Then, after the examination, they begin to treat the underlying disease, which caused the adhesion of the labia.
Genital injuries
During games, children can get injured in the external genitalia, which will manifest itself in the form of swelling of the mucous membrane, the appearance of cyanosis, bloody discharge. In this case, the girl must be examined by a doctor. During the examination, the doctor determines if there is a rupture of the labia, vaginal walls, anus. If necessary, the gaps are sutured in a hospital.
My daughter was shown to a pediatric gynecologist a year, along with other specialists. The appointment did not last long, the child was on my lap, they felt the stomach and took a swab, everything is fine. The daughter did not even notice the manipulations, other doctors were perceived worse. Better to make sure everything is ok. True, examinations by various specialists once a year, and the gynecologist only once. After a year, problems can also arise, and parents do not always notice this. At the clinic, a nurse told a terrible story about how a 5-year-old girl died of uterine cancer (!). It is believed that such problems occur only in adults, but all diseases are now rapidly getting younger, not only gynecological. And the wrong arrangement of the internal organs was also encountered in our childhood, only then they were taken to the doctor at the age of 13. By this time, many problems could already have accumulated, for example, infections that have become chronic.
I am categorically against any examination of my daughter by a gynecologist.
I've read research on the subject and it says that
1 is the worst stress for a child
2 - drawing too much attention to this place(it is believed that a child under 6 years old does not identify himself with a man or a woman, he is, as it were, "genderless")
3 - this contributes to the early onset of sexual activity.
c@t