Only for girls. When the pediatrician advises the first visit to the gynecologist of
to parents to show absolutely still the tiny girl to the gynecologist, they often are perplexed. It is considered that the doctor of this specialty is necessary only to the adult woman. However the reasons of problems with “female“ health can quite often be found in the early childhood, and in certain cases - even in the pre-natal period.
the First time the newborn girl looks round neonatology in maternity hospital. The doctor pays attention to genitalia, states their correct development. Further survey of the children`s gynecologist is recommended to all girls within the first year of life though the doctor of this specialty is not included also into the list of the experts obligatory for visit.When consultation is obligatory for
is Extremely desirable to address the children`s gynecologist if the girl has allergic diseases, infections of urinary tract and kidneys, respiratory organs, diseases of a thyroid gland and adrenal glands. Also the girl needs to be taken away to the gynecologist if there were complications during pregnancy and childbirth. Such pathological conditions of pregnancy as oxygen starvation of a fruit (hypoxia) at pregnancy and in labor, a patrimonial trauma, can provoke premature sexual development. Being available for the pregnant woman chlamydial, ureaplazmenny, mikoplazmenny and other infections, sexually transmitted, demand additional inspection of the girl as the possibility of their transfer to the child is not excluded. Different existence of allocations (from mucous to putreform and bloody) from a genital tract of the girl, reddening and an itch of a vulva, increase in a clitoris, nagrubany nipples of mammary glands, emergence of hemorrhages and bloody allocations in genitalia has to guard mother.
As there takes place survey
At most that can be necessary on reception at the children`s gynecologist, it is a pure diaper. Mother most needs to behave quietly, she should not be afraid that the child will be hurt. At children of the first year inspection is performed on a pelenalny table. For the girl is more senior better if during survey she sits at mother on a lap: so the baby will feel more protected.Survey is absolutely painless
for the child. If such manipulations as survey of a vagina and neck of a uterus, extraction of a foreign matter are necessary, then they are carried out under the general anesthesia.
That the doctorcan find
After mother`s extract with the kid from postnatal office in some girls bloody allocations from a genital tract appear rather plentiful mucous, and sometimes, nipples of mammary glands bulk up. So the reproductive system of the girl reacts to the sex hormones of mother arriving to a fruit through a placenta, and later to the child with breast milk. Normal by the end of the first month of life of allocation from a genital tract completely disappear. Swelling of mammary glands can remain still some time, disappearing at some girls to the end of the period of breastfeeding. At preservation of this symptom mother is recommended to change nature of food: to exclude from the (and later - and from a diet of the baby) meat of broiler chickens (it can contain gormonalno active additives), to give to the child the fruit which are grown up during a season under natural conditions (from a bed).
So call a state at which secondary sexual characteristics (growth of mammary glands, emergence of hair on a pubis) and periods appear at girls to 8 - summer age. Distinguish premature maturing on female and man`s types.Hygiene of the girl
the Question of care of girls is extremely important
On the first year of life of the child when it cannot independently serve itself(himself) yet, mothers, as a rule, carefully watch purity of a body of the kid. However, as soon as the girl grows up, quite often frequency rate of podmyvaniye is reduced. It is necessary to look after genitalia of the girl daily. In view of features of a structure of a mucous vulva, structure of microorganisms and alkaline reaction of the environment it is better to wash away its simple water or broths of herbs (a melissa, turns, camomiles), alternately alternating them. It is desirable to use soap rn - neutral. > it is important to br to teach the girl to be washed away correctly: the movement of a hand goes from a bosom back. It is necessary to wash away the child warm water. After completion of procedure it is obligatory to blot genitals with a towel carefully: constantly damp environment favors to development of fungal flora.
Elementary measures of hygiene will help to impart to the girl skills of personal care and to avoid many problems with health in the future.
Premature sexual development in female type can be caused by a set of the reasons: pathology of the central nervous system of an organic origin (tumor) or functional character (activity change); gormonalno - an active tumor of ovaries or adrenal glands; follicular cysts of ovaries; dysfunction of a thyroid gland.
At a full form (when there are all signs) premature puberty on female type symptoms can arise at girls till 2 years. At the isolated increase in mammary glands it appears since the birth and, increasing, decreasing, takes place without special treatment by 2 - 4 years. Such children to majority are under supervision of the children`s gynecologist. At them more often than healthy girls, have violations from reproductive system. > it is correct to p to make to
the diagnosis of premature sexual development in female type and the timely inspection of the child including besides survey of the doctor, ultrasonic research of bodies of a small pelvis, determination of level of sex hormones and hormones of a hypophysis, a brain X-ray analysis, survey of the neuropathologist and endocrinologist will help to pick up the corresponding treatment.
At detection gormonalno - active tumors and follicular cysts of ovaries tactics of treatment in each case is chosen individually.
hormones for the purpose of suppression of development of secondary sexual characteristics and periods resort To treatment in case of the full form of premature sexual development in female type arising at the girl till 3 years.
Treatment at gormonalno - an active tumor - quick also consists in its removal. In the presence at the girl of a follicular cyst of an ovary watch it by means of ultrasonography as cysts, as a rule, independently disappear within 3 - 6 months. Watch girls with various options of deviations of sexual development before the end of the period of puberty for timely identification and correction of the arisen violations.
genetically caused fermental insufficiency is the Reason of premature sexual development in man`s type owing to what there is an increase of level of male sex hormones - androgens.
Premature puberty on man`s type, the so-called adrenogenital syndrome, is characterized by the increased function of bark of adrenal glands and the increased maintenance of androgens (male sex hormones) in an organism. Pathology is shown in the form of the wrong structure of genitalia, in particular increase in a clitoris, existence of an urogenital sine (a uniform urinogenital opening), early pilosis of a pubis. The newborn girl can have so considerable changes in a structure of genitalia that the sex of the child can be defined as man`s. Treatment is carried out by preparations of glucocorticoid hormones (a cortisone, Prednisolonum, dexamethasone). Their introduction normalizes synthesis of hormones bark of adrenal glands and function of system gipatalamus - a hypophysis - ovaries (emergence of secondary sexual characteristics on female type, formation of a normal menstrual cycle). In due time begun treatment of an adrenogenital syndrome hormones of bark of adrenal glands (glucocorticoids) allows to direct sexual development of girls in female type.
At a congenital adrenogenital syndrome make amputation of a clitoris and formation of an artificial entrance to a vagina.
of Anomaly of development of genitals
the Atresia - a full zarashcheniye of a virgin pleva (the fold of a mucous membrane closing an entrance to a vagina in it is available one or several openings through which menstrual blood expires). Though the zarashcheniye of a virgin pleva is a congenital state and does not appear in the course of the child`s life, it can be in rare instances not noticed in maternity hospital. Girls with such anomaly can quietly live, without seeing about it doctors, until emergence of periods. The blood accumulating in a gleam of a vagina and not finding a way out will cause in that case pressure sense in a small pelvis and difficulty of an urination. Treatment of an atresia quick also consists in a section of a virgin pleva.
Doubling of a uterus, vagina. These congenital features of development are not shown until there comes pregnancy. The children`s gynecologist can diagnose defects by means of survey and ultrasound much earlier.
Inflammatory diseases of a vulva (vulvita) and a vagina (vaginita)
These diseases are the most widespread gynecologic diseases among girls of early age. It is connected with the fact that at children, unlike adult women, cells of a vagina do not contain a glycogen which promotes maintenance in it acidic environment and is a protective barrier on the way of an infection. Besides, girls in a vagina have very few lactobacilli which are also a normal protective factor. The vagina of the girl has alkaline reaction. Therefore any decrease in protective forces of an organism can lead to emergence of a vulvovaginit.
of the Reason. Most often the inflammation arises after the postponed cold, quinsy and other diseases of respiratory organs that is connected with decrease in protective forces of a children`s organism. In this case there are bacterial vulvovaginita. At babies with the frequent diseases of respiratory organs, kidneys demanding use of antibiotics and also at dysbacterioses violation of microflora of a vagina with development of a so-called bacterial vaginosis develops. Reception of antibiotics provokes also the strengthened growth of fungal flora with development of a fungal (mikotichesky) vulvovaginit. Quite often vulvovaginita accompany such children`s infections as chicken pox, measles, a rubella as the inflammation mentions not only skin, but also mucous membranes of a vulva and a vagina.
in recent years the increasing relevance is acquired by vulvovaginita which activators are hlamidiya, ureaplasmas, mycoplasmas, a virus of herpes of I and II types. It is connected with prevalence of these infections among adult women. Though pregnant women pass comprehensive inspection and treatment of the revealed infections, perhaps pre-natal infection of a fruit or infection in female consultations at the time of delivery. Infection with a household way at close long contact, non-compliance with rules of personal hygiene is possible. In distribution of a herpetic infection the large role is played by self-infection of the girl when the handles it transfers a virus from area of lips, faces to genitalia.
cases of the vulvovaginit caused by trichomonads also occur At little girls. The transmission of infection at the same time occurs, as a rule, at the time of delivery.
Quite often vulvovaginita accompany an allergy. The so-called atopic vulvovaginita arising at the same time accept, as a rule, long character with frequent aggravations.Vulvovaginita`s
, especially caused by growth of fungal flora, can be the first display of diabetes.
the Inflammation of a vagina arises also in case of hit in it a foreign matter. During game some small subject can get into a vagina of the child (a cotton wool piece, a small toy, etc.) . And parents can not notice it.
Very common cause causing an inflammation of genitalia are worms, most often pinworms.
the Inflammation of genitals at kids can be a consequence of non-compliance with rules of hygiene when a mikroor? the ganizm causing inflammatory process can get with dirty hands there.
Symptoms. Manifestations on the basis of which it is possible to suspect inflammatory process are allocations from a genital tract, an itch and reddening of a vulva. Nature of allocations depends on the reason which caused a disease of genitals. In the presence of a foreign matter allocations with an unpleasant smell, sometimes with blood streaks appear. Trikhomonadny vulvovaginit is followed by plentiful foamy allocations from a genital tract and their reddening. At a mikotichesky (fungal) vulvovaginit parents note emergence on mucous genitalia and shorts of curdled allocations, concern of the child and continuous combing of a vulva by it. At the inflammation arising against children`s infections, kids the itch and pains in genitalia can disturb. The severe itch and reddening against not plentiful allocations force to suspect a helminthic invasion.are in most cases brightly expressed to
of Manifestation of a herpetic vulvovaginit: on mucous genitalia the yazvochka which appeared after opening of bubbles are visible or transparent bubbles with liquid contents, or. Reddening, morbidity of a vulva is noted, from - for what kids are uneasy and whimsical. In certain cases there is an atypical course of a disease at which the child periodically has poor allocations and insignificant reddening of genitalia. Careful poll of mother, presence of displays of herpes at it, frequent catarrhal diseases and herpetic rashes on a face at the child helps with such situation. It allows to examine purposefully the girl on existence of this infection.Bacterial vulvovaginit
is followed by emergence of yellowish allocations, reddening and frequent an itch of genitalia. Clinical displays of chlamydial, ureaplazmenny and mikoplazmenny infections are very poor. Girls in this case have insignificant mucous allocations from a genital tract against the pale or slightly reddened vulva. The frequent aggravation at the child of an infection of urinary tract and kidneys is quite often noted.
At vulvovaginita of the allergic nature parents note periodically arising poor allocations from a genital tract, thinning of mucous. Lack of inflammatory changes of a mucous vulva and vagina and emergence of liquid allocations of dairy or gray color with a smell of rotten fish is characteristic of a bacterial vaginosis which cornerstone violation of microflora of a vagina is.
Diagnostics. For the purpose of identification of the reason which caused an inflammation of a vulva and vagina carry out bacterial crops of flora. To find hlamidiya, ureaplasmas, mycoplasmas it is possible by means of a method of the polimerazny chain reaction (PCR), immunofluorescence reaction (REEF), the immunofermental analysis (IFA). The virus of herpes is allocated or directly from the defeat center, or indirectly - by definition in blood of antibodies of a sharp and chronic phase of an inflammation. Capture of a soskob and a calla on eggs of helminths is obligatory. At suspicion on violation of intestinal microflora carry out the analysis a calla on dysbacteriosis. Vaginoskopiya (survey of walls of a vagina and neck of a uterus by means of the special device - a vaginoskop) is applied in case of suspicion on existence of a foreign matter in a vagina or for the purpose of diagnosis of a tumor of a vagina which are followed by purulent allocations. The increased blood glucose level along with persistently current fungal vulvovaginit allows to direct the girl to the endocrinologist for her additional examination concerning diabetes in time. As additional methods of inspection capture of the general blood test and urine is possible.
Treatment. Treatment of a vulvovaginit depends first of all on the reason which caused it. At the allergic nature of a disease appoint antiallergic therapy and a low allergy diet, at a helminthic invasion hold antivermicular events. Chlamydial, ureaplazmenny, mikoplazmenny, trikhomonadny vulvovaginita demand prescription of antibiotics, herpetic - antiviral preparations, and fungal - antifungal means. At the same time at all types of inflammatory diseases of genitalia carry out local treatment in the form of trays with herbs, washings of a vagina solutions of anti-septic tanks and introductions of the ointments possessing anti-inflammatory action. Drugs are injected by means of the small syringe, or through a catheter of small diameter, or by means of the syringe without needle. At the second stage carry out restoration of microflora of a vagina and normalization of local immunity. The parents who are previously trained in these manipulations can carry out their houses independently. If these procedures cause in them difficulty or they are afraid to do them, manipulations are carried out by the doctor.Sinekhiya`s
the Widespread disease among girls since the birth to 5 - 6 - summer age are sinekhiya - unions of small vulvar lips. As a rule, they are a consequence of the postponed inflammation of a vulva and a vagina as a result of which the external layer of cells of one small vulvar lip accrues on edge another.Quite often sinekhiya can be formed by
also at the wrong care of the girl when parents excessively often (several times a day) use soap or daily during the long period do trays with potassium permanganate solution at care of the child. They delete with this a natural protective secret, overdry mucous genitals and do it more susceptible to any infection.by
At an union of vulvar lips among themselves form additional “pocket“ through which there passes urine at an urination. Besides, in it microorganisms accumulate, creating additional conditions for maintenance of an inflammation.
sinekhiya by their cultivation Treat (divisions in a junction of one small vulvar lip with another) - before cultivation within several days vulvar lips grease with estrogensoderzhashchy ointment, they are softened, and unions divide in not surgical way. The effect is consolidated short, no more than 7 days, by greasing of small vulvar lips estrogensoderzhashchy ointment thanks to which on their edges full-fledged layers of an epithelium are formed. Then after inspection start treatment of the main disease which caused adhesion of vulvar lips.
of the Injury of genitals
during games kids can get injured on genitalia which will be shown in the form of hypostasis mucous, emergence of cyanosis, bloody allocations. In this case the girl surely looks round the doctor. During survey the doctor defines whether there is no rupture of vulvar lips, walls of a vagina, an anus. If necessary gaps are taken in in the conditions of a hospital.