Don’t worry guys. The spotlight will shine on you next time. It’s all about the girls for right now. There are many unique aspects of healthcare for young girls and women. Taking girls to the doctor is almost a rites of passage in an odd sort of way. I’m sure every woman reading this can remember her first pap smear and mammogram.
For the most part, recommendations provided by the doctor for infants are generally the same for both girls and boys. However, from birth to the 1st month visit, a few concerns are unique. The initial exam determines if your baby has any abnormalities such as adhesions on the outer visible skin in her pelvic area (labia) or if the vagina appears normal. Adhesions can sometimes resolve without any additional procedures but occasionally they need surgical intervention. Another common finding is discharge. Parents for the most part are shocked to see discharge in their baby’s vagina but this mucus-like material is generally normal. It should not have an odor and it usually passes rather quickly.
As your little princess grows up, the provider will look at her vagina at routine wellness exams as well. During this time the provider is looking for redness, degree of proper hygiene, and signs of trauma. This is the time the doctor engages your child in the discussion regarding safe touch versus unsafe touch. My personal talk to little girls is as follows: “Coming to the doctor is a safe place. The doctor can look at your private parts to make sure you are healthy. But no one else can touch your private parts. If they do, scream then tell your parents immediately!” It’s unfortunate that I must have that conversation but we live in a sick world where predators do not hesitate to harm children.
Around the time of puberty, discussion shifts to menstruation, the monthly cycle that begins on average at 12.1 years for black girls and for white girls at 12.6 years. Menarche, the age of a girl when she starts her period for the first time, has a lot to do with genetics, environmental factors and ethnic variation. Research over the years has shown consistently that girls with a higher BMI start their periods earlier than on average. Furthermore, studies have also shown that early menarche increases the risk of premature death and breast and endometrial cancers.
This specific life event is such a huge emotional roller coaster for most families. “My baby can get pregnant” is usually the most pressing concern for parents. On the other hand, this millennial generation of girls enters this phase of their lives extremely calm and unashamed. I am shocked at how often they casually discuss who is and who isn’t on their periods and many times in front of the boys! In my day, you would have died if someone knew you were on your period!
As you could logically imagine, contraception becomes the next hot topic not only for the prevention of pregnancy, but also for regulation of the periods. Certain forms of birth control can cause the periods to be much lighter or not present at all. I am often asked “when is the right time to start birth control?” My answer is always the same: prior to sex of course!
Teen girls are far more savvy and physically mature than teen girls 30-40 years ago. Their exposure to sex and their sexual curiosities occur at much younger ages as compared to teen girls in the past. Therefore, this conversation around birth control begins sooner than most people would like. Doctors play a crucial role in teaching safe sex practices to your moody, hormonally driven teen and more times than not a confidant with whom your daughter can share highly sensitive information.
The next major milestone for girls is the initial pap smear, a test for cervical cancer. The recommendations for this exam have changed dramatically over the years. When I was a teen, this test was done at age 18. It then changed to three years after the first sexual encounter and now it is at age 21. Paps are no longer yearly, but occur every three years during the twenties if normal.
Immunizations are also a huge component of proper preventative maintenance for girls. From birth to adulthood, vaccination recommendations are the same for boys and girls. The HPV
(human papilloma virus) vaccine is especially important for girls starting at age 9-26. This particular immunization protects against the virus that causes cervical cancer.
Children go through so many stages on their path to becoming an adult, especially girls. As their parent, it is important that you keep them on track with their routine visits with their providers. Preventing disease costs less than treating it!
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
