Understanding Gynecological Issues in Adolescents
The gynecological problems that affect teenagers have distinctive characteristics based on their age and development. It is crucial to consider these factors when diagnosing any relevant symptoms. Notably, if a young girl presents with unusual gynecological symptoms or a vaginal infection, the possibility of sexual abuse or the presence of foreign bodies in the vagina due to masturbation should be taken into account.
1. Premenstrual Syndrome (PMS)
Many women, including adolescent girls, experience discomfort in the premenstrual phase. However, most of their symptoms are mild, often leading them not to seek help. Young girls requesting medical attention for PMS typically complain of swelling or rapid acne development. Keeping a menstrual diary for at least one cycle can help in identifying the relationship between symptoms and the menstrual cycle, allowing for the further categorization of PMS. For some, symptoms may persist throughout the entire cycle, indicating that a diagnosis of PMS may not be appropriate. It is essential to differentiate between anxiety-related PMS, characterized by elevated estrogen and decreased progesterone during the luteal phase, and the depressive variant, where estrogen decreases and progesterone increases.
2. Dysmenorrhea
Adolescents under the age of 15 rarely experience dysmenorrhea since primary dysmenorrhea typically occurs in ovulatory cycles. Many girls may have 6 to 18 anovulatory cycles following menarche. Secondary dysmenorrhea and other abnormalities might signal organic damage. Therefore, any patient complaining of genital or lower abdominal pain should undergo a gynecological examination, regardless of age or sexual history. In young girls, this examination is often conducted via a rectal digital examination.
3. Abdominal Pain
Lower abdominal pain due to reproductive issues is uncommon in adolescents. The most frequent causes of lower abdominal pain in this group are menstrual cramps and atypical dysmenorrhea. However, it is vital to consider the potential for organic damage, such as ovarian tumors or sudden changes in existing tumors (torsion or hemorrhaging), which can also lead to abdominal pain. Therefore, any young girl presenting with lower abdominal pain should undergo a thorough gynecological examination, including a rectal digital examination and abdominal bimanual examination, to rule out any serious conditions.
4. Vaginal Discharge
The skin around the vulva in girls is delicate and lacks protection, making them more susceptible to injury and infections. Occasionally, mothers may bring their daughters to the doctor due to increased vaginal discharge. Many teenagers worry about changes in the color, consistency, or volume of their discharge, particularly those who have engaged in sexual activity, fearing they may have contracted a sexually transmitted infection (STI). However, it is common for vaginal discharge to fluctuate based on several factors, such as bathing. The discharge, often resulting from estrogen stimulation of the vaginal epithelium, commonly consists of a proteinaceous, viscous, and transparent fluid. When a patient has a history of unclean intercourse and presents abnormal discharge, it is prudent to conduct vaginal secretions testing to rule out STIs. Additionally, variations in discharge and intermenstrual bleeding may occur due to in-utero exposure to diethylstilbestrol (DES) if the mother took this medication to prevent recurrent miscarriages during pregnancy. If such symptoms arise, regular follow-up and appropriate examinations are advised to eliminate various infection possibilities.
Young women aged 18 to 20 typically report issues that are more akin to those of adult women. Their menstrual cycles are predominantly ovulatory and tend to be more regular compared to their younger counterparts. However, the incidence of dysmenorrhea increases significantly during this period. If they experience lower abdominal pain, the likelihood of gynecological disorders is notably higher than in younger adolescents. Additionally, abnormalities in vaginal discharge may raise concerns about sexually transmitted infections. Some young women may develop a form of "STD anxiety" following a rushed sexual encounter, especially if they feel emotionally exploited. This anxiety can lead them to obsessively seek medical advice, even falling prey to dubious practitioners, in hopes of alleviating their fears. Even when tests return negative, they may struggle with persistent worry and emotional turmoil.Providing appropriate psychological support during such distressing times often yields positive results.