Pediatric and adolescent gynecology is a unique subspecialty of gynecology that encompasses reproductive health care of girls and young women under the age of 20 years, although some experts extend the age limit to 22 years.
This field has expanded greatly over the past decades, as increased attention has been directed to disorders of developmental physiology. The spectrum of gynecologic problems that a physician might encounter in young girls is age specific and involves different skills than those applied for adults. Currently, pediatric and adolescent gynecology includes a vast array of diagnoses and treatment modalities for these particular patients.
Pediatric and adolescent gynecology starts with an observation of abnormal external genitalia in a newborn. Later on in childhood, it involves early detection of infections, labial adhesions, congenital anomalies, and even genital tumors. With adolescents, normal pubertal development, evaluation of menstrual disorders, and treatment of genetic and hormonal ailments need to be addressed. Educational approach should be implemented for healthy lifestyle and issues of budding sexuality in teenagers. Concomitantly, counseling of proper use of contraceptives is imperative to lower the rates of teen pregnancies and sexually transmitted infections.
The American College of Obstetricians and Gynecologists recommends that adolescents should have their first visit to a gynecologist for health guidance, general physical screening, and the provision of preventive health care services at age 13–15 years. A pelvic examination of adolescents who are sexually active may be deferred until the age of 18 years, unless medically indicated. This first visit should provide an opportunity for the gynecologist to start the physician–patient relationship, recommend proper health behaviors, and dispel myths and fears.
The first gynecologic visit is of paramount importance in establishing a trustful relationship between the young woman and her health care provider for many years to come.
ANATOMIC & PHYSIOLOGIC CONSIDERATIONS
During the first few weeks after birth, follicle-stimulating hormone (FSH) rises in the newborn due to the abrupt withdrawal of placental and maternal sex steroid hormones, resulting in hyperestrogenic physiologic effect. Breast budding occurs in nearly all female infants born at term. In some cases, breast enlargement is marked, and there may be fluid discharge from the nipples. No treatment is indicated. The labia majora are bulbous, and the labia minora are thick and protruding (Fig. 38–1). The clitoris is relatively large, with a normal index of 0.6 cm2 or less.* The hymen initially is turgid, covering the external urethral orifice. Vaginal estrogenic discharge is common in some cases and can even be bloody for the first 2 weeks, and is composed mainly of cervical mucus and exfoliated vaginal cells. Endometrial cell shedding occur in 5% of neonates.
External genitalia of the neonate; notice the hyperestrogenic effect, including vaginal secretions.