Hygiene, puberty of girls and more. Answers from a pediatric gynecologist

Mothers of girls are concerned about many special issues, ranging from girls’ hygiene to issues of puberty and contraception. How to wash a newborn baby? When will synechiae stop bothering you? What is considered normal when girls begin menstruation?

Girls hygiene

— Please tell us about the hygiene of girls 1-3 years old, what can they wash with, etc.?

— S.V. : Hygiene for girls 1-3 years old consists of daily washing with a change of underwear; after defecation, we wash with soap and water or a special product with clean warm water, from front to back; if washing is impossible, treatment with wet wipes, sponges and washcloths is not needed! Panties should be loose and made of cotton.

— How to properly wash 3-month-old girls? Is it necessary to wash and clean something THERE every day? At the maternity hospital they said not to touch the “white” lubricant. And in general, is it worth washing baby girls every day?

— S.V. : Girls 3 months old should be properly washed with clean warm water from front to back after each urination and with soap after defecation.

— Which discharge from the genital tract in a teenager is considered normal and which is not.

— S.V. : In adolescents, discharge that is clear or whitish without a strong odor is considered normal.

— My daughter is 5 months old. At the maternity hospital they told me not to go there. But when I spread my labia, I saw a lot of white lubricant. Our pediatrician also says not to go in there. But I still periodically wipe with a cotton pad moistened with warm water, removing the grease, since it itself is not washed out when washed. Am I doing the right thing? And how should it be in your opinion?

— S.V. : You are doing everything right, well done!

— Pediatric gynecologists strongly advise the use of special gels for intimate hygiene for girls of preschool age, but what is worse than natural baby soap, which, unlike these gels, does not contain fragrances and dyes? Is it the influence of marketing and advertising?

— S.V. : The fact is that soap dries out the mucous membrane of the labia, and special gels for intimate hygiene, on the contrary, moisturize the sensitive mucous membrane of the genital organs of girls.

— A 3-year-old girl constantly accumulates white discharge between her labia in the evening, a little, but constantly. What to wipe them with? We had a smear and everything was fine. I'm interested in the issue of hygiene.

— S.V. : For small accumulations of discharge in 3-year-old girls, wash as usual twice a day, morning and evening, with clean warm water without washcloths. With a normal smear, there is no reason to worry.

— A boy and a girl, 5 months old, no problems, but my mother advises washing them at least once a week with water diluted with a decoction of nettle and chamomile. Is it worth doing?

— S.V. : In the absence of symptoms of inflammation, it is not necessary, but in order for the mother to be calm, you can wash it with a decoction of chamomile or nettle once a week.

- Child under one year old. What is better to wash with: solid baby soap, liquid soap, special gels for intimate hygiene, or just water? When you wash your child after taking off a full diaper (you went to the toilet in a big way), no matter how you look at it, you wash everything and everywhere with soap - how bad is this for the sensitive skin of the genitals.

— S.V. : For girls up to one year old, we wash them with clean warm water, from front to back, after each urination or diaper change, and with a special baby wash after defecation. You are right, too frequent use of soap dries out the sensitive skin of girls' genitals. Do not overdo it.

Vaginal discharge in teenage girls

Immediately before the onset of the first menstruation, a girl’s vaginal secretion changes. An important feature is the body's production of a hormone called estrogen, which stimulates the growth of cells in the lining of the vagina. The secretion of glycogen increases, which acts as a nutrient for lactic acid bacteria. As a result, the acidity of the internal genital organs decreases from approximately 5.5 to 3.5, i.e. the environment becomes acidic. Low pH levels act as protection against infections.

After the onset of the first menstruation in teenage girls, the leucorrhoea becomes more abundant, the consistency is thicker, it can be compared to egg white. Normally, discharge that does not have or has a barely perceptible sour odor is normal.

After ovulation in adolescents, the secretion of estrogen and progesterone occurs, the leucorrhoea may change, it turns yellow and becomes harder. Now their consistency can be compared to gelatin.

These changes are caused by the unstable hormonal status of adolescents. When menstruation is regular, provided the child is completely healthy, the color of the leucorrhoea will be milky or transparent white.

Health questions

— Girl, just turned 9 in October. About a month and a half ago, one breast became painful when touched, like a ball inside. The second one is unchanged. Now the ball seems to have disappeared, but the pain remains. Is this puberty? Should I run to the doctor? Or watch? There are no other signs.

— S.V. : During puberty, swelling and tenderness of one or both mammary glands may occur. Dynamic observation is carried out every six months; ultrasound of the mammary glands must be added to the examination.

— My 6-year-old daughter has single, dark, thick hairs on her labia. The labia themselves became darker in color (brown). Is this normal for this age?

— S.V. : Your six-year-old girl needs to be examined, because perineal hyperpigmentation may be a symptom of metabolic disorders. Come with your daughter to an appointment with a pediatric gynecologist.

— How is a rectovestibular fistula diagnosed in a child?

— S.V. : Diagnosis of rectovestibular fistula in a child - rectal-abdominal wall examination.

— My daughter is 6 years old and almost all this time we have been faced with the problem of synechiae in one way or another. Ovestin or Orniona is always in our medicine cabinet, we tried to smear it, and once a gynecologist friend visited and helped dilute it manually. After some time, everything grows together again. Is there any reason to panic and until what age does this problem usually persist? I'm worried that my daughter is growing up, she will soon begin to master washing and wiping herself, and it will be strange to go to her for an examination. And now it’s not particularly easy to smear.

— S.V. : Synechia can be present before puberty. More often observed in allergy sufferers, fair-skinned blondes and red-haired girls. Aggressive hygiene and chemicals in everyday life also provoke the appearance of fusion of the labia. Panties must be made of cotton, an individual towel. It is necessary to exclude helminthic infestation. Estrogen cream can be used twice a day for two weeks and once a day for a month.

— My 7-year-old daughter often has redness of the labia majora, but there is no discharge. When washing your face, intimate hygiene product sometimes hurts, should you go for a smear test or treat it with something? She sometimes sits in the toilet at school, out of habit from kindergarten, and cannot do otherwise. Could I have become infected with something?

— S.V. : In case of isolated redness of the labia majora, it is necessary to exclude vulvitis of allergic origin. If there is pain, wash with a special product for sensitive skin, infusion of chamomile, celandine, limit carbohydrates and allergenic foods. Try not to sit in a shared toilet. Panties should not be tight, the towel should be individual.

— My 5-year-old daughter visited the pediatric gynecologist once for a medical examination in kindergarten. How often should you visit a doctor at this age?

— S.V. : A medical examination by a pediatric gynecologist is carried out at the age of six; if there are complaints, a doctor’s consultation is required at any age.

— A 3-year-old girl often has vulvitis. The child is allergic and exacerbations happen often. Besides baths, is there any way to prevent redness, or what kind of examination should I undergo?

— S.V. : If there is an allergy, it is necessary to examine the child for parasites, consult an allergist, conduct tests for allergens, and exclude foods that cause allergies in the daughter.

— Good afternoon, my daughter is 15, according to ultrasound there is a cyst in the right ovary, the doctor said to observe. What can be done besides observation?

— S.V. : I can’t answer you in more detail, without having information about the ovarian cyst and its size, in any case, you will need to look at the dynamics of the ultrasound.

— Question about endometrial hyperplasia in teenage girls. Causes? Treatment? Will everything get better after stopping the pills (Duphaston)? Or the cycle will continue to jump. Do I need to take and monitor hormones for this disease? My daughter’s gynecologist says it’s not necessary yet. Control ultrasound and visit to the doctor only in November.

— S.V. : The causes of endometrial hyperplasia in teenage girls may be hormonal and metabolic disorders, inflammatory processes in the genitals caused by infections. The hereditary factor also plays a role. Treatment of hyperplasia in girls is aimed at strengthening the body as a whole: healthy eating, proper sleep, normal weight. Treatment is mainly carried out with hormonal drugs.

Prevention of pathological discharge

By adhering to certain recommendations, you will be able to reduce the risk of pathological leucorrhoea to a minimum:

1. Follow the rules of personal hygiene and wash yourself twice a day.
2. Use only your personal towel.
3. Perform hygiene procedures using boiled water.
4. Choose the right products to wash your genitals.
5. Avoid mechanical damage to the genitals.
6. Buy underwear made from natural fabrics.

Leucorrhoea in girls normally appears during puberty and can be observed in the first month of life. If they appear at a different age or are accompanied by additional symptoms, they indicate pathological changes. In this case, you should definitely consult a doctor.

Puberty and menstruation

— My daughter is 8 years old, she began to complain of pain near her nipples, her temperature rises in the evening - maybe these are signs of growing up?

— S.V. : Swelling and tenderness of the mammary glands may occur, but it is still better to see a pediatric gynecologist to rule out mastitis and clarify the diagnosis.

— A 9.6-year-old girl in the spring began to notice breasts, hair growth in the armpits and labia majora. At the end of August, the first menstruation appeared... Those around me at this age have none of this. Is this premature or is this the norm. Physically, he’s also taller than anyone, height 155, weight 60. Now they’ve added sports and adjusted their diet, and the weight has dropped.

— S.V. : This is normal, don't worry. It’s good that you added sports and adjusted your diet! Since my daughter was overweight, this is not very good for further sexual development.

— My daughter (15 years old) has low hemoglobin (84), we were sent to an appointment with a gynecologist (in my opinion, she has very heavy periods, plus cycle instability), I was not able to go to the appointment with her. At the appointment, they took a smear, talked to her (according to her words), sent her for an ultrasound (we’ll definitely go) and prescribed Duphaston. I drank it in the early stages of pregnancy. What is this for? From the 16th day of the cycle. I'm afraid to give her hormones.

— S.V. : Do not be afraid to give hormones to regulate the cycle, since it is impossible to quickly cure a cycle disorder, and your daughter has very low hemoglobin. Be sure to do an ultrasound to clarify the diagnosis. We prescribe Duphaston from days 16 to 25 of the cycle for 3 months, plus your daughter needs an iron supplement to treat anemia. During menstruation, take Tranexam to reduce blood loss.

— My 12-year-old daughter started menstruation six months ago, but it is irregular, it can start after 20 days or in the summer, for example, it hasn’t happened for 2.5 months at all... and in terms of duration, it can last for 3 days, or it can actively go for 7 days. How normal is this at the moment, how long does it take to establish a regular cycle? Or should I see a doctor now and get examined? The pain is mild or moderate, there are no special complaints, height and weight are normal.

— S.V. : During the formation of the menstrual cycle, this is normal; regulation usually occurs within two to three years. You can come for a consultation about menstrual pain; the gynecologist will give recommendations.

— My daughter will turn 15 in a week, and she still hasn’t had her period. Our gynecologist says that signs of puberty are present (breasts, hair growth), but due to my low weight (37 kg), menstruation will come later. Does my daughter need drug stimulation?

— S.V. : Your daughter is underweight, which is why she does not menstruate. You need to consult an endocrinologist to correct the girl’s weight, since by replenishing the body weight deficit, the daughter’s menstrual cycle will also normalize.

- My daughter is 15 years old, she has been menstruating for 2.5 years, but she has a short cycle (on average 23 days) and irregular - from 20 to 24 days. We took 2 courses of Cyclovity, but the regularity did not improve. This year, 2 courses of Duphaston from days 16 to 25 of the cycle - on the tablets the cycle was normal for 28 days. As soon as we finished drinking, everything went wrong again. My daughter’s physique is asthenic; with a height of 163 cm, she weighs 45 kg. What would you recommend?

— S.V. : Your daughter is underweight, so the main recommendation for you is to gain weight; you can take duphaston from the 16th to the 25th days of the cycle for 3-6 months.

— My 9.5-year-old daughter has slightly swollen breasts and it hurts when accidentally touched. Has puberty started yet?

— S.V. : Yes, this is possible at your age.

— I’m very interested in the topic of a girl’s puberty, my 13-year-old daughter started having periods, but they come irregularly, sometimes they come, sometimes they don’t, sometimes 3 days, sometimes a week, sometimes heavy, sometimes a little. And discharge is present in the middle of the cycle. As far as this is normal at the moment, there are no special complaints, height and weight are normal. And which discharge is considered normal and which is not in a teenager.

— S.V. : During puberty, irregular menstruation is possible, but to exclude pathology of the reproductive system, I advise you to do an ultrasound of the pelvis. Normally, the volume of menstrual blood loss is 50-80 ml, the duration of menstruation is 4-6 days.

— My daughter has early puberty, at the age of 10 her periods came, and they are going steadily, all other signs of maturation also appeared. She's a big girl and overweight. With a height of 152 cm, now at 11 years old she weighs 58 kg. Already stretch marks. An endocrinologist checked my hormones, they are normal, it’s just wrong and he eats a lot, we need to correct this. An ultrasound of the pelvic organs diagnosed a “bicornuate uterus.” How dangerous is this for the reproductive system? Can the situation change as the girl grows up? How is it possible to correct this?

— S.V. : It’s good that your daughter has a stable cycle. You wrote absolutely correctly that you need to adjust your weight and nutrition. A bicornuate uterus is a congenital malformation of the uterus, it occurs quite often, it can be complete or incomplete, and the prognosis of pregnancy will depend on this, of course, there are features of the course of pregnancy and childbirth, but modern technologies, if necessary, make it possible to correct a bicornuate uterus surgically, I would advise you to repeat an ultrasound of the pelvic organs at an older age for your daughter to clarify the diagnosis.

— My daughter is 10 years old. In the summer, before washing, I saw a stain on her panties with a little blood, more like ichor. There were and are no other changes (no menstruation either). My stomach didn't hurt. She asked if she touched her, but she said no. Is this normal or should I go straight to the appointment?

— S.V. : In girls 10 years old, bloody discharge on panties can be caused not only by menstruation, but also by diseases of the intestines and urinary tract. Try to examine the girl.

— My daughter is almost 12 years old, 5 months old. I started my period ago, the cycle is immediately constant, my stomach does not hurt at this time. What worries me is that the periods themselves are very heavy and last for 7-8 days. There are also pink stretch marks on the hips.

— S.V. : Stretch marks may indicate a girl’s sudden growth and weight gain, and the abundance and duration of menstruation must be adjusted, as this can lead to anemia in the daughter. Be sure to do an ultrasound of your daughter’s pelvis.

If your period has already started

The onset of menstruation between the ages of 11 and 14 is considered normal. Possible diseases found in a little girl in childhood, hereditary factors, nutrition, amount of stressful situations and emotional health affect the onset of menstruation.

In some cases, girls begin to experience menstruation at the age of 9. The reason for this may be a hormonal imbalance; sometimes in such cases the help of an endocrinologist and the prescription of hormonal therapy are required. If by the age of 15 a girl does not have her period, this is a reason to contact a pediatric gynecologist. Perhaps the cause of this pathology is ovarian dysfunction, emotional overload, disruption of the thyroid gland, heavy physical activity, anorexia, and poor environmental situation in the place of residence.

If a girl begins menstruation, the further appearance of discharge will depend on the phase of the cycle.

Start

Usually the menstrual cycle lasts almost 1 month, namely 28 days. This period begins on the first day after the end of menstruation and lasts from two to three weeks. These days there is a fairly small amount of leucorrhoea; normally the volume is up to two milliliters per day. The consistency is homogeneous and watery, the color can range from white to beige.

Ovulation

In the middle of the cycle, the volume of leucorrhoea may increase to four milliliters per day. The consistency changes and the mucus becomes more viscous.

Second half of the cycle

At the end of the cycle, the amount of leucorrhoea becomes smaller, the consistency resembles a cream, or is similar to snot.

Just before your period

Before the onset of menstruation, the volume of secretion increases, the consistency resembles that of the discharge that was in the middle of the cycle.

HPV vaccination

— My daughter is 10 years old, I want to vaccinate her against cervical cancer. What vaccine do you recommend?

— S.V. : Today we have at our disposal only two vaccines against HPV - Gardasil (4 types of viruses and Cervarix (2 types of viruses).

— The doctor suggests getting vaccinated against HPV (11 year old girl). He says it is very important to do this before starting sexual activity to avoid HPV infection. What do you recommend? I can't find any clear recommendations on the Internet.

— S.V. : Indeed, it is better to get vaccinated against HPV before starting sexual activity. Up to 13 years of age, vaccination is possible using a shortened schedule twice (instead of 3 vaccinations).

— How do you feel about the HPV vaccine? At what age do you recommend putting it on? My daughter is 12 years old and has not had her period yet.

— S.V. : The HPV vaccine can be given from the age of nine, but it is better to wait until the start of menstruation.

Contraception

— My daughter is 16 years old. Started having sex. Is it possible to put a spiral on her? Or is it only given to those giving birth? He has also been drinking Regulon for 3 months (it was recommended). Plus they are protected by condoms. Haven't been to the doctor yet. Menstruation begins at age 12. What other contraceptive measures can you take?

— S.V. : IUD is not recommended for nulliparous girls. It is advisable for adolescents to use a dual method of contraception - condoms and birth control pills.

THERE ARE CONTRAINDICATIONS. SPECIALIST CONSULTATION IS REQUIRED.