It seems like just yesterday you were teaching your little girl to ride a bike, and now, right before your very eyes, she is growing into a young woman. As she develops, your daughter is bound to have questions about the physical and emotional changes of puberty, then further development into her teens and young adult brings on other questions. Although most girls are unlikely to encounter any major gynecologic issues before puberty, there are a number of common conditions that can affect the pre-pubertal girl, teenagers and young women. And notably, there are more serious health concerns that can have a long-term impact if left untreated. This information has been summarized to provide support and guidance for you regarding your daughter’s health and development.
WASH WITH CARE
- Wet wipes, bubble baths, shower gels, and perfumed products are a common cause of allergies and are best to be avoided.
- The vulva does not need to be washed too often as that can cause itching, irritation, and infection.
- Vaginas aren’t supposed to smell “fresh” or have a “floral” fragrance. Normal vaginal scents can range from musky to tinny and everywhere in between.
- It’s normal for the vagina to produce up to two teaspoons of thin, clear discharge a day during ovulation.
- The vagina has self-cleaning capabilities, as the vaginal discharge acts to flush cells from the vaginal wall, excess water and bacteria. Teach your daughter to simply swipe mild, scent free soap and water between the labial folds and along the perineum during her shower. There is no indication for the use of feminine products specifically designed to flush the vagina (such as douches). In fact, these products could result in causing an infection.
USE COTTON UNDERWEAR AND BREATHABLE CLOTHING
- Active children can get hot and sticky and non-breathable clothing can irritate sensitive skin.
- Avoid dressing your daughter in tight trousers or leggings and opt for cotton underwear.
- There is no need to be actively looking for issues or physically inspecting your daughter, but do pay attention to symptoms that may indicate a problem.
- Many young girls can have sore, itchy and red vulvas. This might be because of not cleaning properly after using the bathroom or wiping from back to front or allergies to harsh wash products.
USE OVER THE COUNTER MEDICATIONS WITH CAUTION
- Never apply any type of topical medication to the vulva without medical advice, as it may make things worse.
- Hair removal creams are generally safe but I recommend using one formulated for sensitive skin. Teach your daughter to perform a patch check for redness or swelling. Keep a safe zone between harsh creams and the vaginal tissue.
- Keep in mind that hair removal is a personal choice and is not medically necessary.
THE FIRST GYNECOLOGIC VISIT
- The American College of Obstetricians and Gynecologists recommends a first reproductive health visit between the ages of 13 and 15.
- The first visit to the gynecologist is a great time for your daughter to talk to her doctor about important health issues, such as:
- Her growth and development
- Breast health
- Pregnancy and birth control
- Infection risk and prevention
- Talk to your provider about getting the HPV vaccine.
- The HPV vaccine is literally a vaccine against cancer.
- Vaccines have been developed to protect against getting the human papillomavirus (HPV), the number one sexually transmitted infection in the country and the development of subsequent HPV associated disease. The series of three injections to protect against the types of genital HPV that cause most cases of cervical cancer and genital warts.
- Routine HPV vaccination is recommended for both females and males. The HPV vaccine is currently recommended for all boys and girls to complete at age 11 to 12 and can be administered as early as age nine. HPV vaccinations can be administered to the age of 45 if needed.
- Despite what you might have heard, numerous extensive studies have found that the vaccine is safe.
- For many young women, their first gynecologic visit can feel invasive and uncomfortable. While it is important to choose a medical provider you trust, it is equally important to prepare your daughter for the examinations she will undergo. Let her know what she should expect when she is being examined. Every effort should be made to communicate and provide reassurance to your daughter and the exam should be stopped if she is too anxious or uncomfortable.
- It used to be common practice for most young women to have a pelvic exam by the end of high school. Now pelvic exams are reserved for when she is sexually active or has any of the following symptoms:
- Heavy vaginal discharge that itches, burns or has an odor
- No signs of puberty (breast growth, underarm hair or pubic hair) by age 13
- No menstrual cycles by age 15
- Regular menstrual cycles and then an absence of menses for more than three months
- Irregular menstrual cycles and then the absence of menses for more than six months
- Menstrual cramps that cause her to miss school or significantly disrupt her normal activities
- Heavy vaginal bleeding
- Vaginal bleeding lasting longer than 7 days
- Any signs of pregnancy (a missed menstrual cycle, tender breasts, upset stomach)
- Pap tests are now delayed until age 21, regardless of sexual activity
- Many women get their periods every 28 days and can set their watches by its arrival. On the other hand, there are many women whose cycles do not fit into such a regular schedule. Every woman’s menstrual cycle is different.
- It may take six years or more for your daughter’s cycle to become regular. Help your daughter keep track of her periods, which is an excellent method for her to become familiar with her cycle. By tracking her cycle, she might notice a pattern every month.
- Extremely heavy menstrual cycles or terrible cramping pain should warrant an evaluation, especially if the severity is resulting in missed school days or work. Ask your daughter about these symptoms and seek evaluation as there are readily available, simple treatment options available.
TALK ABOUT SAFE SEX
- Tone down the hype. As your daughter grows and estrogen starts flooding her body, she will begin to have sexual urges.
- Help your daughter protect herself from sexually transmitted infections by instructing her on how to use a condom.
- Teach your daughter about intercourse in the context of a caring and mutually respectful relationship, with the right person and under the right circumstances.
- Discuss with your daughter methods by which she can set boundaries, consent and inappropriate touching by others.
REASSURE YOUR DAUGHTER
- Reassure your daughter about the appearance of her labia, as labial growth continues until the age of 18.
- It necessary to stress the importance of reassuring your daughter that she is healthy and normal.
- Early conversations will help your daughter’s menstrual cycles feel natural and she will be more confident about her body.
KEEP THE LINES OF COMMUNICATION OPEN
- Use medically accurate terms for body parts. There are so many parts and structures that make up the female sexual and reproductive anatomy.
- What is seen on the outside is NOT the vagina. Typically, the term “vagina” is used to describe everything between a women’s legs. Technically, the term only describes the narrow canal that runs inside the body from the vulva (the visible area that includes the inner and outer labia, clitoris and perineum) to the cervix (the entrance to the uterus). The vagina serves as the birth canal during labor and carries the menstrual blood flow. The vaginal opening is the only part of the vagina that can be seen externally.
- Not every woman is born with a hymen, which is a thin membrane that partially covers the entrance to the vagina. Even if a hymen is present, playing sports, using tampons or random medical procedure can disrupt the hymen.
- Labia come in all shapes and sizes. There are two sets of labia, the labia majora (the outer set) and minora (the inner set). The labia majora (the lip-like tissue around the opening of the vagina) can be as little as one-quarter inch or up to two inches wide.
- The surrounding area can be different colors and does not necessarily correlate to the tone of the rest of the body. Many light-skinned women have brown or purple-like labia, while darker skinned women can have a lighter labia.
- The vagina is not a black hole. It is impossible for anything (including a tampon) to get lost in the vagina, as the cervix acts as the top portion of the vagina.
- The clitoris can range from the size of a tiny pea to a lima bean. The portion of the clitoris that is accessible externally is only the very tip of the structure. The clitoris extends deep into the tissue between the bladder and the vagina and has extensions off the tip like a wishbone.
- Deciding in advance methods to explain vaginas to your daughter makes the conversation far more relaxed and natural. It also encourages conversations which can be built on as your child matures.
- Answer questions openly and honestly. Let your daughter know that you are available any time to talk, but also schedule the time to talk (do not always wait for your daughter to initiate the discussion). If she has questions or concerns that you cannot answer, talking with a trusted medical provider may help provide reassurance.
- Start the conversations early. By the time a girl is eight years old, she should know what bodily changes are associated with puberty.
- Talk about menstruation before she gets her first menstrual cycle. Girls who are unaware of their impending menstrual cycle can be frightened by the sight and location of blood.
- As your daughter grows into her teens and twenties, teach your daughter about pelvic floor exercises (also known as, Kegel exercises), which will help with bladder control and even pain.