Adolescent Gynaecology

Gynaecology can be a daunting process for adults, so when it comes to adolescent and paediatric gynaecology, you can only imagine how a child can feel. As an adolescent and paediatric specialist, Dr Peta Wright discusses how she approaches each consultation in a way that makes patients feel safe and comfortable.

For many girls, puberty is an awkward time of life and an uncomfortable subject. Couple this with unique anatomical conditions that only become apparent during teenage years and it’s easy to understand why girls may be apprehensive towards consultations.

In some cases there can be an obvious need to see a specialist like myself. Parents will often present girls from 18 months to four years with labial adhesion or vulvovaginitis, which are common conditions and easily treated; occasionally they even resolve themselves with time. For adolescents, I will often provide contraception advice, help ease heavy or painful periods and investigate primary or secondary amenorrhea, which is the absence of a period or when periods suddenly stop.

Sometimes I’m faced with more complex conditions such as precocious puberty, anatomical abnormality of the genital tract such as MRKH or disorders of sexual differentiation such as androgen insensitivity syndrome (AIS), Sywer syndrome or Turner syndrome. These conditions require great tact, knowledge and skill to treat, helping both patients and parents to be reassured their lives can be enjoyed and not hindered by the condition.

In some cases, I will be asked to stop periods completely in adolescents with developmental delay or complex conditions such as autism or cerebral palsy. This is done using reversible treatments such as a mirena IUCD or other medications until they are able to cope with periods, providing a reprieve for both the parents and the adolescent.

The first signs of a gynaecological problem maybe complaints of discharge or pain, especially with heavy periods or period pain that isn’t relieved with medication such as paracetamol and non-steroidal inflammatory, resulting in time away from school. Conversely, if your daughter hasn’t had her first period by 16, it could be a sign of a developmental issue.

Sometimes parents may be concerned about the development of pubic hair and breasts before the age of eight, or the absence of secondary sexual development by 14 years of age.

If your daughter is experiencing any of these symptoms, see your GP and they will refer you to a specialist for further investigation.

Should these symptoms not be addressed at an early age, young women miss the opportunity for counselling and being able to talk about their unique bodies. Without this counselling, girls may think they are not normal or that it will affect their fertility, which may not be the case at all. A possible outcome of excess pain, other than discomfort and the large impact on a young woman’s quality of life, is endometriosis, which can cause scarring and infertility. If treated early, endometriosis has a much better prognosis.

Whilst everyone is different and treatment will vary, it’s important to remember most conditions are treatable. Be open with your children about what’s happening to their bodies and make sure they feel comfortable talking to you about any of the common symptoms of conditions.

This post was written by Dr Peta Wright, an obstetrician and gynaecologist, specialising in adolescent and paediatric care at Eve Health.

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