Gynecological problems in children

Gynecological problems are uncommon in pre-pubertal girls. And if they occur, there is often a blur about which specialist to consult, a Paediatrician or a Gynecologist?For most parents, the likely initial consultation is either with a General Practitioner or a Paediatrician. Some rare problems however mandate referral to a Gynecologist.Most problems that raise concerns are minor and do not have long term consequences. Vaginal discharge and irritation in children is often a result of poor perineal hygiene.

Children must be guided on proper toilet hygiene till the point when they can be safely left unsupervised. It is worthwhile checking on them frequently to ensure they have mustered hygienic techniques of wiping themselves.

Most vaginal infections in children will resolve on hygienic measures alone, but rarely antibiotics or anti-fungals may be required. If the infection is recurrent, a Gynecological review is necessary to exclude the likelihood of a foreign body in the vagina. The possibility of sexual abuse must always be considered, and if this the case, remedial measures must involve the relevant legal authorities.

Vaginal bleeding is rare in pre-pubertal girls, but is a cause for worry when it happens. Some girls may simply have stumbled upon their mother’s contraceptive pills and swallowed a few, which is usually followed by some bleeding. Some cases may be due to puberty setting in early. Again, sexual abuse must be excluded. Ovarian tumors may also occur in children, more commonly detected as abdominal swellings, but may also cause vaginal bleeding. Any vaginal bleeding in a pre-pubertal girl warrants Gynecological assessment.

Some girls may appear not to have a vagina. In such cases, Gynecological referral should be prompt as the possible causes are varied. In the simplest of cases the labia are simply fused together, a condition called labial adhesions. This is self-resolving, but estrogen creams can be given to enhance separation of the fused labia. More serious causes of an absent vagina could be due to developmental abnormalities of the female reproductive system.

Such cases range from a vaginal hymen that is simply occluded (called imperforate hymen); to complex problems where the vagina or the uterus may be completely missing. In some cases, a child reared as a girl may actually have the genetic component of a boy. Such cases often only become apparent when puberty appears to be delayed. Due to long term implications of such developmental abnormalities, early referral to a Gynecologist is advised.

Parents should always be present when girls are being medically assessed to avoid unnecessary psychological trauma to the child. Painful assessments are usually done under sedation. Some treatments, especially if developmental, may be delayed till around puberty. And if long term reproductive consequences are expected, psychological support must be availed.