In gynecology of children and adolescents, the following age periods are distinguished: fetal development, newborn, early childhood, neutral (up to 7 years), prepubertal (from 7 years to a year of menarche), puberty (from the onset of menarche to 16 years) and adolescence (from 16 to 18 years old). The sex organs of the newborn girl are highly differentiated. The vagina of a newborn has its own mechanisms of protection against infection; a feature of the ovaries at this age is the presence of primordial follicles, the number of which is in the range of 500,000-700,000 in each.
The development process of the girl on anatomical changes can be represented as follows: 8-9 years – a rapid increase in the circumference of the pelvis, the appearance of adipose tissue on the thighs. 9-10 years old – the beginning of the growth of the mammary glands, 11 years old – the growth of pubic hair, 12-13 years- pigmentation of the nipples, an increase in the mammary glands, the appearance of menarche, 13–14 years old – hair growth in the armpits, 15–15 years – the establishment of two-phase menstrual cycles, 16–18 years of skeletal growth, however, all these signs are subject to significant individual fluctuations and wear usually inherited Gov. character. The physiological age for the occurrence of menarche at this time is considered to be from 9 to 15 years.
Gynecological diseases of children and adolescents are divided into several groups:
- Inflammatory diseases
- Dysfunctional diseases of puberty
- Disorders of sexual development
- Abnormalities of genital organs
- Genital tumors and trauma
Inflammatory diseases of the genitals in girls account for about 90% in children’s practice and 35% in adolescents.
Classification of inflammatory urogenital diseases in girls (VF Kokolina, OV Zubakova, 1998)
- nonspecific bacterial vulvovaginitis
- bacterial vaginosis
- diphtheria vulvovaginitis
- genital tuberculosis
- candidal vulvovaginitis
- viral vulvovaginitis (cytomegalovirus,condylomatous virus, herpes virus)
- Primary infectious.
- foreign body of the vagina.
- worm infestation.
- changes in the body’s reactivity (metabolic disorders, dysmetabolic nephropathy, allergic diseases, intestinal dysbiosis, urinary tract diseases, acute viral diseases, children’s infections).
Classification of the inflammatory process by localization consists in the allocation of the following forms: vestibulitis, vulvitis, vulvovaginitis, coleitis (these forms are most common), endocervicitis, endometritis, salpingitis, oophoritis (these forms are less common), perimetric, parametritis, pelvioperitonitis (very rarely). Treatment of inflammatory processes is complex. The first group of drugs consists of vitamins, adaptogens, and immunostimulants. Eubiotics are used to prevent dysbiosis. During a long, chronic, torpid, or specific process, etiotropic antibiotic therapy is prescribed. Local treatment consists of three successive stages: etiotropic treatment, stimulation of the repair processes, correction of the vaginal microbiocenosis. Treatment of vulvovaginitis of gonorrheal or tuberculous etiology is carried out in specialized institutions with triple monitoring of cure.
Dysfunctional uterine bleeding
Depending on the clinical and morphological features, DMK is divided into ovulatory and anovulatory, and in puberty mainly anovulatory acyclic hemorrhages of the type of persistence or atresia of the follicles occur. In all cases of adolescent, DMC are the result of dysfunction of the hypothalamus-pituitary-ovary-uterus system. Treatment of DMK complex, etiopathogenetic and individual, consists of general therapy, the use of reducing and hemostatic agents, hormone therapy, and surgical intervention. After stopping bleeding for three cycles, anti-relapse and supportive therapy is necessary.
VIOLATION OF SEXUAL DEVELOPMENT.
Premature sexual development (CPD). The main manifestations are: isosexual PPR, PPR with a violation of the sequence of the appearance of secondary sexual characteristics, transient forms of PPR, heterosexual PPR.
Violation of sexual development at puberty (by the type of erased virilization). The pathological process is localized in the central nervous system, ovaries, adrenal glands. The nature of the manifestations depending on the level of the pathological process is diencephalic disorders, ovarian dysfunction (hyperandrogeny), adrenal dysfunction (puberty AGS). Clinical manifestations consist in metabolic and vegetative disorders, disorders of the menstrual cycle, signs of erased virilization. This also includes Stein-Leventhal syndrome.
Delayed puberty. Localization process: central nervous system, ovaries. The main clinical manifestations: underdevelopment of secondary sexual characteristics, amenorrhea, or hypomenstrual syndrome, primary amenorrhea. Lack of puberty. The basis of the pathological process is aplasia of the ovaries (chromosome abnormalities). This group includes Turner syndrome, pure and mixed forms of gonadal dysgenesis. The diagnosis of these diseases is carried out in a multistep with the involvement of endocrinologists, geneticists and other specialists. Treatment of each form of the disease, depending on the severity of the individual, long-term, multi-level. In all cases, children and their parents also need the help of a psychologist.
Abnormal development of the uterus:
- Uterus didelphys – doubling of the uterus and vagina with their separate arrangement.
- Uterus duplex et vagina duplex – the formations in contact or are combined fibrous-muscular layer.
- Uterus bicornis bicollis is the common vagina, and the rest of the divisions are split.
- Uterus bicornis with a rudimentary horn.
- Uterus unicornis. In this case, as a rule, there is one kidney and one ovary, but the uterus is functional.
- Rokitansky-Kyustera syndrome. The vagina and uterus are represented by thin connective tissue cords.
Anomalies of vaginal development.
Vaginal ages – the primary absence of the vagina. Secondary absence of the vagina – atresia – complete or partial fusion of the vagina, associated with the inflammatory process related to the prenatal period.
- Anomalies of development of the hymen, vulva, external genital organs.
- Atresia of the hymen – is detected with the onset of menarche.
- Deformation of the vulva – can be caused by epi- and hypospadias in hermaphroditism.
- Congenital hyperplasia or hypertrophy of the external genital organs.
- Anomalies of ovarian development.
- Monovarius with a horned uterus.
- Anovariya – is very rare.
- Additional ovary for uterine doubling.
- Ovarian hypoplasia in various types of gonadal dysgenesis.
The prognosis for genital anomalies depends on the degree and level of the disorder.