When should you have your first gynecological visit? How to recognize disorders, who to contact

Vaginal infections, precocious puberty, genital malformations, irregular or missing periods: these are some of the problems for which it is advisable to take your daughters or adolescents to the gynecologist. Normally the primary care pediatrician is the point of contact for the little ones. If you are unable to trace the cause of the symptom, in the presence of important anomalies it is best to contact a developmental gynecology service, he says. Francesca Pampaloniwho directs the childhood and adolescent gynecology clinic at the Careggi hospital in Florence.

The centers are not in every region

Pediatric gynecology centers are not present in all regions. In the absence of a specific service, the pediatrician will orient you depending on the problem to the pediatric endocrinologistat the clinic, which can be accessed from 14 years of ageor to the hospital gynecologist for adults specifies Anna Maria Fulghesu, professor of Gynecology at the University of Cagliari and president of the Italian Society of Childhood and Adolescent Gynecology (Sigia).

The most common problems in girls

Among the most common disorders before menarche are recurrent infections of the vulva, the external part of the female genitals, and of the vagina, the internal part – explains Pampaloni -. They cause burning, itching, redness, smelly secretions, sometimes bloody, mostly caused by fecal bacteria that reach the vulvar area through incorrect hygienic maneuvers or due to constipation: stagnant feces cause the bacteria that contaminate the vulva to proliferate. Infections can also depend on an alteration of the vaginal flora after the use of antibiotics.

The other reasons why a little girl should be seen by a pediatric gynecologist are the synechiae of the labia minora, that is, their partial or total fusion – he continues -. As it is trauma to the genitalsfrom falling or sexual abuse, e the appearance of secondary sexual characteristics (development of the mammary glands, pubic and axillary hair, more voluminous vulvar lips, ed) under 8 years. In this case it is evaluated the pharmacological block of development pubertal avoiding the arrival of menstruation, difficult to manage at that age. Two rarer causes requiring intervention are lichen, an autoimmune disease that mainly causes vulvar itching and dryness, and tumors of the genital system, which generally manifest themselves with blood loss.

The most frequent problems in adolescents

Among the disorders most often encountered in adolescence are ovarian cysts (which manifest themselves with discomfort in the pelvic area and possible bleeding between one cycle and another) and those linked to the menstrual cycle, which can hide more serious pathologies. Primary amenorrhea for example: The absence of menstruation in girls by the age of 15, in the presence of secondary sexual characteristics, must arouse attention – warns Pampaloni -. It could be a sign of a malformation syndrome, such as lack of uterus or vaginal septum and imperforate hymenwhich does not allow the menstrual flow to escape, causing abdominal pain.

Other symptoms that should be investigated: An abundant flowwhich can result from hormonal alterations or a fibroid, and dysmenorrhea, i.e. severe pain during menstruation which forces you to miss days of school and can indicate endometriosis, uterine or vaginal malformations and chronic inflammatory intestinal diseases. Suffering from abnormal periods – underlines Pampaloni -. In girls it is advisable not to underestimate even a small number of menstruations, less than 6 per year, or an excessive number of 14-15 per year. Scanty or prolonged periods, with excess hair on the face and body, obesity and baldness are signs of polycystic ovary syndrome.

When to have your first gynecological visit

Prevention of sexual and reproductive health must be learned from adolescence. The American College of Obstetricians and Gynecologists recommends the first gynecological visit between the ages of 13 and 15. An opportunity forTeach the girl how to self-examine her breaststhe first tool for breast cancer prevention, and the importance of recording the first day of the onset of menstrual flow, which corresponds to the start of the cycle, to calculate its duration, he states Maria Chiara Lucchetti, head of pediatric gynecology at the Bambino Ges hospital in Rome and vice-president of Sigia for childhood and adolescence. During the visit, counseling is offered on contraceptive methods that protect against unwanted pregnancies and sexually transmitted infections.

The family pediatrician also plays a fundamental role. It would be his responsibility il control the regular development of the external genitalia during health assessments, scheduled up to the age of 14, in which the child's physical growth is evaluated, underlines Lucchetti. A normal menstrual cycle occurs on average every 28 days. But it should be considered normal between 21 and 35 days. In the first 2-3 years after menarche, a period of amenorrhea of ​​up to 6 months is normal. If it persists, it is necessary to identify the cause, he recommends Lucchetti. When the girl begins to have sexual intercourse, an annual gynecological check-up is recommended. To exclude the presence of sexually transmitted infections, which in most cases are asymptomatic but can give rise to serious consequences, warns Lucchetti.

The clinic

The local counseling center represents a point of reference for this type of assistance. Access from the age of 14 and no medical request is required, nor that an adult accompanies. In case of more serious problems, which can also affect newborns and girls, it is best to contact a pediatric gynecology clinic, concludes the doctor. To access the service through the National Health Service a prescription from your pediatrician of free choice is required.

The rules for correct intimate hygiene

Since childhood, it is important to observe the rules for correct intimate hygiene. Wash your hands before and after pee, wash your private parts using a delicate cleanser, moving from front to back to avoid contaminating the vaginal environment with intestinal bacteria. The same direction should be followed when cleaning yourself with toilet paper – recommends Maria Chiara Lucchetti, head of pediatric gynecology at the Bambino Ges hospital in Rome -. Use personal towels and cotton panties to allow the skin to breathe and not encourage material stagnation. Daily intimate hygiene prevents vulvovaginal infections. In most cases the inflammations are of a non-specific nature, as a consequence of poor hygiene practices, retention of urine or constipation – explains Lucchetti -. Avoid self-prescribing tampons to your daughters in search of the responsible pathogens. Too many are made and they are useless.

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