A Trip To the Gynecologist For Your Preteen?

Also, Gynecological Care News That Could Affect Your Health

When Mary's daughter was just 9 years old, she came home with a note from the school nurse that stunned her mother.

"I couldn't believe what I was reading. It said, 'I think your daughter needs to see a gynecologist.' A gynecologist! She was 9 years old! I won't even tell you the horrible thoughts that went running through my mind," says Mary, a 42-year-old divorced, single mom who asked that she and her daughter not be further identified.

As it turns out, Mary's daughter had been suffering with a vaginal itch caused by an irritation from a new bath gel, and she was too embarrassed to share the details with her mother. When the itch became unbearable, the girl confided in the school nurse, who sent the note home.

"You just don't think of a 9-year-old needing a gynecologist—it just doesn't enter your mind," Mary says.

Indeed, most parents—particularly mothers—associate the need for gynecological care strictly with an active sex life. However, in reality, there are a variety of reasons why young girls may need this kind of medical attention.

Experts agree, if a female of any age is experiencing any problems that are breast- or vaginal-related, such as irritation, infection, bleeding, discharge, or pain, or if she experiences pelvic pain that does not appear to be related to any other cause, then she should be examined by a gynecologist, regardless of her age.

Reasons behind the problems can include something as simple as a new toilet tissue or bath gel to more serious issues such as a hormonal imbalance or, more rarely, a tumor. And any problem that can affect a woman has the potential to also affect a young girl, which is why gynecological care must be considered.

If you are not quite ready to have your daughter go from the playground to the gynecologist's office, you are not alone. Fortunately, it is not your only option.

Consider Adolescent Medicine

An increasingly popular alternative is a medical specialty called "adolescent medicine." Here, physicians who are schooled as pediatricians also receive training in adolescent gynecology. They are prepared to deal with any number of problems that befall young girls.

"We believe we play an important role in the lives of girls and young women by recognizing the need and providing care for a number of gynecological problems, but doing it with a decidedly pediatric slant," says Dr. Karen Soren, director of the Adolescent Medical Center of Children's Hospital of New York Presbyterian.

"We are more than a pediatrician, but not quite as much a gynecologist, and I think we bridge an important gap in a young woman's health care," Soren adds.

Among the most common gynecological problems Soren sees are menstrual and puberty-related issues—cropping up as early as age 10 or 12 or as late as age 19 or 20.

"Some girls are plagued with very severe cramping, dysfunctional bleeding—either too heavy or very light, highly irregular periods, or no periods at all," she explains.

Among the most prevalent gynecological problems being diagnosed in young women today, she says, is polycystic ovaries, a hormone-related condition that, if not treated early, can cause problems such as infertility.

Whether you choose a gynecologist or adolescent medicine specialist for your daughter, experts say it is important the physician have both the physical training and medical equipment to properly examine and treat a young woman—such as a small speculum and more slender instruments of all kinds.

Equally important, is that the physician has the proper "bedside manner" to reduce trauma and make the experience a positive one for the girl and her family.

Always consult your child's physician for more information.

In Other News About Your Gynecological Health:

Physicians Warn Against Douching

Gynecologists have spent decades telling their patients not to douche, but a new survey suggests many women—nearly 80 percent—have not been listening.

"It's very prevalent, even though most women have heard this may not be good for them," says Dr. M. Kim Oh, co-author of several studies on douching and professor of pediatrics at the University of Alabama at Birmingham.

Some health experts say douching, the flushing of the internal female genitals with a liquid, is dangerous because it washes away healthy bacteria.

The theory is that the flushing "changes the environment of the vagina, and makes the lower genital tract susceptible to infections," Oh says.

Another theory suggests that douching solutions push unhealthy bacteria higher into a woman's body.

"In the cervix, you normally have a barrier, a mucous plug, so you can't get things into the uterus very easily. Douching reduces that," says Dr. Jeanne Marrazzo, an assistant professor of medicine at the University of Washington at Seattle.

Studies have linked douching to pelvic inflammatory disease, chlamydia, and ectopic pregnancies. On the other hand, many women douche and appear to suffer no negative effects.

"Maybe it's not harmful to them. I don't know," Oh says. So, she set out to find out how many women douche and why. She released her findings at the recent annual National STD Prevention Conference, sponsored by the Centers for Disease Control and Prevention (CDC).

Oh and her fellow researchers surveyed 571 girls and women aged 14 to 63 in rural Alabama, urban Alabama, and urban Ohio. Seventy-seven percent said they had douched at least once in their lives—70 percent of those were under 30, and 90 percent were over 30.

Sixty percent of the women said they douched to feel fresh, 38 percent to get rid of odor, 36 percent to get rid of menstrual blood, 5 percent to please a partner and 1 percent to prevent pregnancy.

The researchers also found older women were more likely to think—incorrectly—that douching prevents pregnancy and kills germs that cause sexually transmitted diseases (STDs).

Oh says women appear to be willing to accept the risks of douching.

"I think it's a really small minority of women who have not heard anything about bad effects," she says. "With teen-agers, it may be different."

Indeed, women who began douching before age 15 were more likely to be misinformed about the hazards of douching. Also, the researchers found early use of douching products "is very related to sexual behavior, having multiple partners, starting intercourse very early," Oh says.

Always consult your physician for more information.