Not abnormal, just different

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By Dr Liza Ling Ping,

Consultant Obstetrician & Gynaecologist and Fertility Specialist

Puberty is when many young girls notice changes in their body. This normally occurs between the ages of 10 to 14 years old. Although puberty is the natural life transition from childhood to adulthood, many young girls are uncomfortable discussing it openly.

If adult women are apprehensive consulting a gynaecologist for their ‘female’ problems, just imagine how young girls would feel when they face problems with puberty changes or gynaecological issues. Gynaecological problems in adolescents and children are different from that of adults, therefore the approach needs to be knowledgeable, skillful and tactful to ensure patients and parents feel safe and comfortable.

In younger girls between 12 months and 4 years old, labial adhesion and vulvovaginitis are the most common cause for parents to bring their child to see  a doctor. Labial adhesion and vulvovaginitis are common conditions and easily treated.

For adolescents, many girls seek help with heavy or painful periods. Some may experience irregular periods, especially in the first 1-2 years after menarche (first menstrual bleed). Girls should also seek help if they experience primary or secondary ammenorrhoea (absence of a period or if the period suddenly stops).

Sometimes parents are concerned when their child have delayed menses or delayed development of secondary sexual characteristics (eg. breasts and pubic hair development).  If by 14 years old, your daughter has not shown any secondary sexual development or has not had her period by 16, it could be a sign of developmental issue. Menstrual irregularities should be diagnosed and addressed early to prevent complications such as infertility, anaemia (lack of blood) and heamorrhage (excessive bleeding).

More complex conditions such as precocious puberty, abnormality of the genital tract- eg MRKH (absent uterus), OHVIRA syndrome, or disorders of sexual differentiation-eg androgen insensitivity syndrome (AIS), Sywer syndrome requires great knowledge and understanding in order to help both patients and families understand the conditions. Patient and parents also need to be reassured that their lives can be enjoyed and not let these conditions discourage them.

Sometimes, parents will request to stop the menses of their daughter completely, in cases of developmental delay or cerebral palsy. This can be done using reversible treatments such as Mirena IUCD or other medications, until they are able to cope with menses, thus giving both parents and the adolescent some peace of mind.

It is important to be open with your children so that they are comfortable talking about what is happening to their bodies and about any symptoms they may experience. Most of the conditions are treatable.

However, these symptoms are best addressed at an early stage, so as not to miss the opportunity for counselling and early intervention to help adolescents understand that they are not abnormal, just a little different.

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