Tackling Early-Onset Gynecological Problems

A woman’s first visit with a gynecologist often takes place when she is still a girl. That’s perfectly normal, but for some, that first visit needs to occur when the girl is a young child. That’s because there are, unfortunately, gynecological issues that can arise in girls so young they aren’t even in school yet.

Parents of children born female need to be aware of them.

“I’ve seen girls as young as 4 and 5,” says Emily Brophy, MD, gynecologist with LVPG Obstetrics and Gynecology. More typically, Dr. Brophy wouldn’t see a girl until after she had started her period, but that can also be surprisingly early.

“I’ve seen a 7-year-old with her period,” she says.

With such early onset of menses, the child’s diagnosis is probably precocious puberty, but there are several other issues and concerns that deserve a gynecologist’s attention sooner than you might think. For the youngest girls, it’s most likely to be vaginal discharge, itching or a concern about anatomical abnormalities. These patients will typically be referred to a gynecologist by their pediatrician. For older girls, painful periods are the leading complaint.

“In some young women, period pain is so severe that it limits their activity. So we talk about how to manage that,” Dr. Brophy says.

The most complex or concerning cases that Dr. Brophy sees have to do with precocious or delayed puberty.

“In such cases, we frequently rely on the support of a pediatric endocrinologist,” she says.

When should a parent or guardian be concerned that something is not “normal?”

“Any discharge that is smelly. Any itching or burning. These things should be evaluated,” Dr. Brophy says. “Also, bleeding that is so heavy a girl needs to change her pad or tampon every hour or so. And periods that are too painful for the girl to attend school.”

In such cases, and in the case of any matter that concerns you as a parent or guardian, Dr. Brophy recommends talking to the child’s pediatrician. When you have that conversation, “be open about everything,” she says.

If the gynecologist is concerned after examining your child, expect him or her to order lab work, or even an abdominal ultrasound.

“Note that we would not do a vaginal ultrasound on a child,” Dr. Brophy adds. “Abdominal only.”

Girls with no health concerns might wait until adulthood to make their first visit to a gynecologist.

“In the absence of any issues, 21 is fine,” Dr. Brophy says. “Of course if she’s sexually active, then earlier. She should come in at least to talk.”

In fact, it’s never too early to establish a relationship with a gynecologist, according to Dr. Brophy. “The goal is that a girl will feel comfortable discussing it if she ever does have an issue.”

Irregular Menstrual Cycles

While irregular periods can be worrisome for teens, they are common. But after two years of menstruating, a girl’s periods should have established a pattern.

Sexually Transmitted Diseases (STD)

Studies have shown that one in every four girls between the ages of 14 and 19 will contract an STD or sexually transmitted infection (STI) after becoming sexually active.

The most common in teenage girls are human papillomavirus (HPV), trichomoniasis and chlamydia.

Ovarian Cysts

Ovarian cysts are fairly common in teens. While most are harmless, should one rupture it can cause severe pain and internal bleeding.

Endometriosis

Endometriosis occurs when tissue that normally lines the uterus grows outside of it. Symptoms can include heavy periods, pelvic or back pain, bowel problems, and pain when urinating. There is no cure for the condition, but the symptoms can be addressed.