About adolescent gynaecology
The focus of paediatric and adolescent gynaecology is addressing conditions that affect the vagina, vulva, uterus and ovaries. The goal is to provide comprehensive evaluation and specialised treatment for babies, children and teens. Teenagers in particular have specific risk factors and conditions that appear between puberty and late teens that may need specialised treatment and education.
Conditions that may affect an adolescent’s reproductive system
We care for teens and children who have a broad range of gynaecological concerns, including:
- Congenital anomalies of the reproductive system
- Skin conditions of the vulva
- Labial differences
- Abnormal vaginal discharge
- Vaginitis and vulvovaginitis
- Delayed puberty
- Menstrual problems
- Polycystic ovarian syndrome (PCOS)
- Ovarian cysts and tumours
- Sexually transmitted infections (STI’s)
Congenital anomalies of the reproductive system
Some children have differences in their reproductive system that occur as the organs form, and are present at birth, whether they are noticed or not. These differences are sometimes found at birth but may be missed later in life, such as puberty when symptoms such as pain, and a possible lack of sexual development or menstruation, may arise. The organs inside and outside the body can be affected by anatomical abnormalities.
Skin conditions of the vulva
Young women may have itching, pain, swelling or ulcers in the skin on the just outside of their genitals, known as the vulva. An irritation, infection or inflammatory disorder may be the trigger of these symptoms. Some skin conditions that are easy to recognise on the rest of the body such as eczema and allergic dermatitis, can be difficult to recognise on the vulva, particularly considering that usually a dermatologist would diagnose skin conditions, with a GP or gynaecologist generally assumed responsible for understanding vulvar health. External irritants or allergens can cause reactions, such as:
- Soaps, detergents, shampoos, bath salts, etc.
- Panty liners
- Certain scented oils and fragrances
- Douches, scented washes, and other unnecessary ‘feminine odour’ products
The labial skin around the outside of the vagina (the vulva) may grow together and be fused in some places, which is known as labial adhesion, though this typically disappears at puberty with the introduction of oestrogen to the body. Some teens have large or asymmetrical labia which can cause some discomfort, but is not considered a medical concern. Some problems may also arise after female circumcision, but this is rarely in Australia. Specific medicines or creams can be used to treat conditions affecting the labia, however surgery is sometimes needed. Many teenagers are now overly concerned with the size and shape of their inner labia, however it’s important to teach girls about what’s ‘normal’ and what’s not when it comes to labia size. Showing teens pictures of the wide variety of vulvas is a great way to help them feel normal – vulvas come in all shapes and sizes and that is normal and healthy.
Abnormal vaginal discharge
Fluid (mucous or discharge) produced in the vagina helps to clean and protect the delicate permeable mucosa from infection, while serving important roles in sexual arousal and fertility. If vaginal discharge is different from normal, it may be the sign of a problem, but understanding what is normal can be difficult, since discharge changes across a normal menstrual cycle. Some of the reasons abnormal discharge may occur include:
- A foreign object inside her vagina causing infection – in teens, a classic cause of this is a forgotten or lost tampon, but can include many small objects
- An irritant such as soap, bubble bath or shampoo in or around the vulva and vagina
- She may not have been taught the importance of front to back wiping, with mixed bacteria from the bowel entering the vagina, possibly contributing to infection and abnormal discharge
- Sexually transmitted infections such as chlamydia, gonorrhoea and trichomoniasis,
- Bacterial vaginosis (sometimes sexually transmitted) or a yeast infection
- Pregnancy can cause different types of discharge, which could be unusual if pregnancy was not understood to be the cause
Vaginitis and vulvovaginitis
Vaginitis is the infection or inflammation of the vagina, however if it involves the outside of the vulva, it is called vulvovaginitis. Vulvovaginitis can be caused by a sexually transmitted infection, yeast or other infection, or a form of dermatitis. It can also be caused as a result of the skin being irritated by bath products or laundry soap. Young girls may get vaginitis if they are not big enough to fit properly on the toilet seat, causing urine to enter their vagina when the urinate.
Infections and inflammation can also occur when there is a lack of protective bacteria. Because teenagers are less likely to talk about what’s wrong, you’ll need to be able to offer them resources and the option to talk over any concerning symptoms. They will be able to tell something is wrong if, for example:
- The vaginal or vulvar area becomes red, dry, itchy or sore
- Walking may cause irritation and cause an abnormal walk (which they may try to hide)
- The vulva becomes red, hot and possibly swollen
- There is white, brown, yellow, green, thick, thin, odorous or bloody discharge
- Painful urination
- There may be dry, white itchy patches on her vulva
The signs of puberty, such as starting menstrual periods and developing breasts, usually begin in the early teen years but that age will vary between young women. There are many reasons why development may be delayed, such as medical problems or a lack of body fat. There are treatments that can help in these cases, but accurate initial diagnosis is important.
There may be a range of problems teens experience with their periods. Periods may be painful, too heavy, hard to predict, too frequent, or they may not get a period at all. These problems are often symptoms of another condition.
Polycystic ovary syndrome (PCOS)
In PCOS, the ovaries produce and respond to an abnormal balance of hormones such as androgens and estrogen. A person who has PCOS may not get their period every cycle, and may grow more hair or have more acne on their body than usual. Medication can sometimes be used to treat the hormone imbalance and control menstrual periods, but there are many other factors involved in PCOS that must be discussed and addressed, like insulin resistance. PCOS is a complex syndrome that requires education and lifestyle adjustments to successfully manage.
Ovarian cysts and tumours
Ovarian cysts tend to develop when the ovaries are making an egg, from a follicle. Surgery may be needed if an adolescent has cysts that are painful, large, limit blood flow or might be tumours. Most ovarian tumours are benign and not cancerous. Cysts can be removed with surgery by using small incisions that allow the ovaries and fallopian tubes – thus fertility – to be preserved. Most ovarian cysts, however, are completely normal and benign, and no need for concern.
Sexually transmitted infections (STI’s)
STI’s are spread through close contact, and without treatment can cause lasting damage to the reproductive tract of women and men. Some of the most common STI’s include gonorrhoea, chlamydia and genital herpes. Educating teenagers on sexual health remains a critical element in keeping teenagers safe into the future, and preserving fertility
We have a range of helpful medical treatments and services for teens available at our clinic.