Obstetrics and Gynecology · MU Sofia

57. Gynecology of childhood and adolescence

Covers gynaecology from birth to the end of puberty, starting with the newborn's normal maternal-oestrogen effects and the thin, vulnerable childhood genital tract. A table lists childhood problems such as vulvovaginitis, labial adhesions, lichen sclerosus, foreign bodies and prepubertal bleeding, with features and management. It then describes the normal sequence of puberty, Tanner staging, and a table contrasting precocious and delayed puberty with their causes. Adolescent issues close the note, including irregular cycles, heavy menarcheal bleeding, dysmenorrhoea, and primary amenorrhoea with cyclical pain.

Inside: 4 sections · 2 tables · 16 flashcards · 2 min

Topic 57 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 4 sections, about 186 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Newborn and childhood
  3. Puberty
  4. Adolescent problems

Introduction

Paediatric and adolescent gynaecology covers the genital tract from birth to the end of puberty. Examination is gentle, with a parent present, usually without a speculum; ultrasound is the main imaging tool. Always keep sexual abuse in mind.

Newborn and childhood

  • Newborn: maternal oestrogen causes breast swelling, white discharge and sometimes a small withdrawal bleed in the first weeks (normal).
  • Childhood: low oestrogen, thin vulval and vaginal skin, neutral pH: prone to vulvovaginitis.

Puberty

Normal order in girls: thelarche (breast budding, average 10–11 years), then pubarche, growth spurt, and menarche (average 12–13 years, about 2–3 years after thelarche). Breast and pubic hair development are graded by Tanner stages 1–5.

Adolescent problems

  • Irregular cycles are common in the first 2–3 years (immature axis, anovulation).
  • Heavy bleeding at menarche: anovulation, but consider von Willebrand disease; treat with tranexamic acid or hormones.
  • Primary dysmenorrhoea: NSAIDs, combined pill; if resistant, think of endometriosis or an obstructive anomaly.
  • Primary amenorrhoea with cyclical pain: imperforate hymen or transverse septum (haematocolpos).
  • PCOS, eating disorders, contraception, STIs and confidentiality, HPV vaccination.

In a child with bloody vaginal discharge, think of a foreign body first, then abuse, precocious puberty and tumour.

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