Abstract
Gynecological examination of children is not by far so common, as in adult women. That's why some doctors - pediatricians and sometimes even gynecologists - refuse it as traumatizing, with possible psychical consequences in adulthood.
History of pediatric gynecology (PG) as a substantial sub-specialisation of gynecology started with Professor Rudolf PETER (1900-1966), who opened in Prague in 1940 the first independent outpatient unit for PG in the world. Peter is therefore internationally called father and pioneer of PG.
Since Peterœ time, PG has in Czech Republic its tradition. Our pediatricians knows very well what this discipline brings them, and therefore they require services and help of PG.
Czech Republic is divided into 100 Districts: in each of them works minimally one doctor (usually lady-doctor), who is trained and skilled in PG. Gynecological examination in children in our country is considered neither as inappropriate nor as harmful or detrimental.
On the contrary, we can document by examples its benefits and well-groundness. Erudition in PG requires first the knowledge of develpomental anatomy and physiology of female genitalia during childhood and puberty.
Next, erudition in rectal palpation and in vaginoscopy, with necessary equipment. Pediatric gynecologists must have knowledge in border-line specializations, e.g. of pediatrics, endocrinology, genetics, surgery and others.
Last but not least, he must be able to communicate with children and adolescent girls, what it not automatically given to each doctor. It needs suitable psychological approach and training by often contact with this group of patients.
Reasons for gynecological examination in children are not only diagnostic and therapeutical, but also preventive ones. Diagnostic examination is indicated by symptoms, which are or could be the signs or genital pathology: First of them is vulvovaginitis, whose most striking symptom is vaginal discharge.
It is not only discomfort for girl, but it is dangerous by the risk of transmission of infection into the urinary system. Chronic discharge represents an infection focus in genitalia, which can be activated during general weakening, but can manifest during puberty into acute form (for example trichomoniasis or mycosis).
The way of infection of genitalia in children is different from those in adults, also the mode of examining and treatment of discharge. (Examination needs obligatorily vaginoscopy!) The next important symptom is lower abdominal pain. The most common causes in girls are linked with digestive tract (appendicitis mainly), but it may be caused by pelvic inflammatory disease as well.
If it is not diagnosed and treated soon, it can influence negatively the future fertility. This risk stay actual event nowadays, when the primary tubal infertility can be solved by methods of asisted reproduction.
Irregularities of menstrual cycle are common during first one-two years of gynecological age. But, we can often see serious cases of dysfunctional uterine bleeding as well, which forces us to examine our girl-patient gynecologically for determining of proper therapy.
Indiscriminate hormonal therapy (as for e.g. using hormonal contraceptives) we do not consider to be suitable and physiological solvation. Delayed sexual maturation and primary amenorrhoea after 15 years of age are unambiguous indication of gynecological examination of girl.
Retarded or missing sexual development is very frustrating moment for the adolescent girl , of course, but much more serious is the negative influence of missing sexual hormones on development of bones (bone maturation and mineral density mainly). Unfortunately, also existence of genital tumor, even though they are mostly benign, gives substance to gynecological examination in girls and adolescents.
The matter of course would be the gynecological examination in congenital developmental anomalies and malformations of genital tract (or suspection of them) Also genital injuries and cases of sexual missuses and rapes needs unavoidable gynecological examination made by pediatric gynecologists. Preventive gynecological examinations is also well-founded.
In Czech Republic the preventive gynecological examinations are organised so, as each girls would be examined at least once prior age of 15 years. This examination confirms the proper development and function of genitalia, gives girl an opportunity of individual contact with specialist, with whom she can consult all, what is linked with sexual development, with sexuality, contraception and STD-prevention.
Personal experiences of Czech pediatric gynecologists confirms profit of such approach: In districts, where 85 - 95 % of girls in the age between 14 and 15 years absolved the preventive gynecological examinations, in 1,5 till 3,5 % there were found some irregularities or symptoms, which was not so strong to lead girl to gynecologist, but which was the reason for detailed examination and in some also for treatment. This way PG fulfils its main purpose and aim - to protect and save the future women's fertility.