Gynecology for Teenage Girls

Gynecology for Teenage Girls

Part of an adolescent girls growing up is to learn how to take care of their body. This means making smart choices. Seeing a gynecologist for their first visit, between the ages of 13 to 15, is a great start. Even if this first visit is to talk with their parents and physician about their menstrual period.

For many girls, their first visit to the gynecologist is an opportunity to discuss their questions about puberty, development, reproductive health and sexuality. It’s also a perfect time to educate them about when a pelvic or breast exam should be performed.A pelvic exam is usually not necessary before the age of 21. However, in some cases, a pelvic exam is advised because of certain symptoms or risk factors.
Here are some of the reasons why a teenage girl should come for a Gynecology visit:

Heavy, frequent or painful menstrual periods

A heavy period is a blood loss of 60-80 ml or more. This is about half a teacupful or more. However, it is difficult to measure the amount of blood that you lose during a period. For practical purposes, a period is probably heavy if it causes one or more of the following:
•    Flooding through to clothes or bedding.
•    You need frequent changes of sanitary napkins or tampons.
•    You need double sanitary protection (tampons and napkins).
•    You pass large blood clots.

Irregular or infrequent menstrual periods

Having an irregular cycle means that the interval between periods varies each month. That is, sometimes they come every 28 days, sometimes every 20, sometimes every 30. Having irregular periods is very common.  The causes can range from something insignificant to something that requires treatment. If you’re a teen, your body’s hormones can fluctuate and take some time until they find a balance. Therefore, it’s normal to have an irregular period during adolescence or, sometimes, for your period not to arrive in a given month.

Menstrual management for girls with physical and developmental challenges

Puberty and menstruation are difficult issues for teens with disabilities and for their families as well. Irregular bleeding, mood swings, and problems with hygiene often complicate the delicate balance in the lives of these adolescents. The care provider is asked to help with the pubertal transition and the issues surrounding menstruation. The impact of the menstrual cycle on teenagers with developmental disability, including hygiene issues, menstrual irregularities due to specific clinical circumstances, and treatment dilemmas associated with the use of hormonal medication need to be discussed for this special group of teens.

Signs of early sexual development

Breast development is the main sign that a girl is entering puberty. This will be followed by the first menstrual period. Before having the first menstrual period, a girl will normally have:
•    An increase in height
•    Pubic, armpit, and leg hair growth
•    Clear or whitish vaginal secretions
•    Increased hip size

Menstrual cycles occur over about one month (28 to 32 days). At first, the menstrual periods typically are irregular. The girl may go 2 months between periods, or may have two periods in 1 month. Over time, they become more regular.

Signs of delayed sexual development

For many teens, puberty just happens later. There’s no medical problem. Later puberty is normal in many families. Signs that the delay may be due to a disease include an abrupt change in growth or arrested development, in which puberty starts then stalls. Headaches, vision problems and other neurological symptoms might mean there’s a problem in the central nervous system. In case a medical condition is causing the delay, a teen that is late in experiencing puberty should see a doctor.

Breast abnormalities, including asymmetry or pain

  • One breast larger than the other (asymmetry): Girls commonly have one breast that develops faster than the other. It is also common and normal for girls and women to have one breast that is larger than the other. The difference can be as much as a bra cup size or more.
  • Small or large size: Breasts come in all shapes and sizes. There is almost no size that is considered abnormal. If breasts fail to develop at all, or if they are so large they are causing neck or back issues, talk to your daughter’s healthcare provider.
  • Breast pain around periods: It is common for breasts to become tender before or during menstrual periods. This is due to hormone changes and is not a cause for concern. If the pain is severe, your daughter’s healthcare provider can suggest treatment.

Chronic genital rashes or itching

Complaints of genital redness, itching, discharge, and/or bleeding are relatively common in young girls before the onset of puberty. Most of these problems have benign causes and respond to the removal of irritants.

Vaginal discharge, drainage or odor

Normal vaginal discharge has several purposes: cleaning and moistening the vagina, and helping to prevent and fight infections. Although it’s normal for the color, texture, and amount of vaginal fluids to vary throughout a girl’s menstrual cycle, some changes in discharge may indicate a problem

Unusual appearance of the genitals

Female genital abnormalities are uncommon and often do not present until, or well after, puberty. Although genital abnormalities may be isolated, careful assessment for possible underlying disorders, particularly chromosomal or metabolic, is essential.

Abdominal or pelvic pain

Pelvic pain can be a common complaint for adolescent girls. Pain can be acute (sudden and severe) or chronic (constant or continually comes and goes). Pelvic pain can be due to a number of factors including gynecological disorders, urologic disease, gastrointestinal problems, musculoskeletal abnormalities and psychosocial problems (such as stress, abuse, or eating disorders).

Ovarian cysts or pelvic masses

Ovarian masses are uncommon findings in adolescent females. Most of these masses are benign, but doctors should be aware of how they can present and should include ovarian masses in their differential diagnosis of lower abdominal pain, which is a common complaint in this patient population.


Endometriosis causes different symptoms in young women. Pelvic pain and/or severe period cramps are the most common symptoms.

There can be pain before, during or after your period. The pain may occur at regular times in your cycle or it may occur at any time during the month. It is often referred to as “chronic” pelvic pain. The location of the endometrial implants and the way in which the lesions affect the pelvic organs contribute to the symptoms teens may have.

Some teens may have pain with exercise, sex, and/or after a pelvic exam. Although not as common, some teens may have painful or frequent urination, diarrhea or constipation with pelvic pain. It’s important to remember that some teens have a lot of endometriosis and have very little pain, while others may have a small amount of endometriosis and severe pain.

Birth defects involving the reproductive organs

Birth defects of the reproductive system are common, occurring in approximately 1 in 400 women. The reproductive system is derived from two tubes (the Mullerian ducts) which fuse in the midline followed by absorption of the central portion. The upper portion forms the fallopian tubes and uterus, the lower portion forms the vagina. Defects in this developmental process may include absence of the structures (Mullerian agenesis) and abnormalities in fusion and absorption.

Injuries involving the reproductive organs

Injury to the genitals can be very painful. It may cause a lot of bleeding. Such injury can affect the reproductive organs, bladder and urethra. It may be caused by placing items into the vagina.

Contraception counseling

For sexually active adolescents who use contraception, the role of the health care professional is to educate and support compliance, to assist in managing adverse effects or, alternatively, to counsel the patient regarding a new contraceptive method as circumstances require and to provide referrals and follow-up with periodic screening for STIs.

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