Pediatric Gynecology

What is pediatric gynecology?

Pediatric and adolescent gynecology (PAG) is a subspecialty of gynecology. Pediatricians trained in adolescent medicine also have special training in PAG. Specialists in PAG provide reproductive healthcare to infants, children and adolescents. This includes care dealing with vaginal pain or rashes, disorders of development and the female reproductive system. The female reproductive system includes the internal and external organs that are responsible for fertility, menstruation and sexual activity.

Babies, children and adolescents have different medical needs than adults do. PAG specialists receive specialized training to provide empathetic, comprehensive healthcare to this age group.

After medical school, physicians in this area first complete a residency program in obstetrics and gynecology or pediatrics. Then, if they trained in obstetrics and gynecology, they complete a PAG fellowship training program. If they trained in pediatrics, they complete a fellowship in adolescent medicine to become PAG experts in everything medical, leaving the surgical to the PAG gynecologists. A PAG or adolescent medicine fellowship trains physicians to:

• Perform pediatric gynecological exams with compassion.
• Diagnose and treat common and rare pediatric and adolescent gynecologic conditions.
• Manage complex reproductive abnormalities and other issues.
• Learn specialized surgical techniques for children (PAG gynecologists).

When should my child have their first gynecology exam?

The American College of Obstetrics and Gynecology recommends that your child’s first pediatric gynecology exam take place between the ages of 13 and 15.

However, babies, children and adolescents may see a PAG specialist (adolescent medicine or pediatric gynecologist) at any time. Young children are especially prone to certain injuries and infections. This is because their tissues lack estrogen. Providers use special equipment and instruments in examining and treating young children. In addition, exams take place in a reassuring, nonthreatening environment.

What happens during my child’s first gynecology exam?

At your child’s first gynecology exam, they’ll have the chance to meet and get comfortable with their adolescent medicine provider or gynecologist. A person’s first visit should be a positive experience. This meeting will allow your child to have an open and honest conversation with their provider and form a relationship.

The first appointment is mostly about education. Your child’s adolescent medicine specialist or gynecologist will:

• Talk about typical pubertal development: Reassuring your child that the changes they’re going through during puberty are “normal” and expected.
• Discuss your child’s menstrual cycle: Identifying what a typical menstrual cycle looks like but assuring your child that theirs may look different.
• Counsel your child on healthy vs. risky behaviors: Discussing age-appropriate topics including hygiene and sex.
• Dispel myths and alleviate fears: Answering any questions your child may have about development, sex and other concerns.

The provider may perform a visual exam of your child’s breasts and external genitals. They usually won’t perform an internal exam at the first visit, unless there’s a specific reason for it.

What kind of care will my child receive at a routine gynecology exam?

After your child’s initial gynecology appointment, they may begin seeing their provider regularly. At a routine appointment, your child may:

• Learn how to do a breast self-exam: Your child’s provider will explain the importance of breast self-exams and teach your child how to do one. These exams should start at age 20.
• Get a pelvic exam: Your child’s provider may examine their pelvic organs, including their uterus, ovaries and vagina. This exam may not be necessary unless your child is having pain or a problem of puberty.
• Have a routine Pap smear: Your child’s provider may perform a Pap smear, or Pap test. A Pap test screens for abnormal cells in a young adult’s cervix that could be cancerous or become cancerous. First Pap smears are usually done at age 21 years or older.
• Be counseled on birth control: Your child’s provider may talk about birth control (contraception) and explain your child’s options. Birth control is used for many medical reasons, such as for period cramps, menstrual suppression and other health needs.
• Discuss any issues: Your child will have the opportunity to discuss any issues they’re having or abnormalities they’re experiencing with their body.
• Ask questions: Your child can ask questions about their body, health and sexuality.

What kinds of pediatric gynecology issues are treated by adolescent medicine and PAG specialists?

Gynecologic problems can arise at any age. Often, conditions are related to menstruation, including:

• Abnormal uterine bleeding.
• Absent menstrual periods (amenorrhea).
• Delayed puberty.
• Heavy menstrual bleeding (menorrhagia).
• Infrequent periods (oligomenorrhea).
• Irregular periods.
• Painful menstrual periods (dysmenorrhea).
• Precocious (early) puberty.

Children and adolescents may receive treatment for various other conditions, including:

• Breast abnormalities.
• Labial adhesions.
• Ovarian cysts.
• Pelvic pain.
• Polycystic ovarian syndrome (PCOS).
• Sexually transmitted infections.
• Vulvar ulcers or lesions.
• Vulvovaginitis.

Children and adolescents with the following health conditions would benefit from seeing a pediatric and adolescent gynecologist rather than an adolescent medicine specialist:

• Congenital malformations affecting their genitals.
• Endometriosis.
• Foreign objects stuck in their vagina.

How are pediatric gynecology issues managed and treated?

Management and treatment will depend on your child’s condition. Your child’s provider may recommend a “wait-and-see” approach for certain issues. They may need to perform procedures to evaluate an issue further. Other conditions need specific treatment. Treatments and procedures may include:

• Colposcopy: If your child has abnormal test results (such as from a Pap smear), their provider may recommend a colposcopy. A colposcopy is a procedure that checks your child’s cervix and the wall of their vagina for abnormal tissue.
• Minimally invasive laparoscopic surgery: Your child’s provider can use laparoscopic surgery to check abdominal masses, pelvic pain and endometriosis.
• Vaginoscopy: A vaginoscopy is a procedure that can remove foreign objects from your child’s vagina.
• Hormonal therapy: Your child’s provider may prescribe hormone medications to treat certain health conditions. The medicines may be pills, injections, skin patches or intrauterine devices.
• Other medications: Your child’s provider may prescribe other medications such as antibiotics, antivirals and nonsteroidal anti-inflammatory drugs (NSAIDs).

A note from Cleveland Clinic

Adolescent medicine and pediatric gynecology manages the health of the female reproductive system of babies, children and adolescents. It’s a good idea to have your child meet with an adolescent medicine specialist or pediatric gynecologist between the ages of 13 and 15. At this time, they can become familiar with their provider and feel comfortable seeking vital healthcare in the future.

If your child has any gynecologic issues, keep in mind they won’t go away on their own and your child won’t outgrow them. An adolescent medicine specialist can help manage medical conditions of your child’s reproductive tract, and a pediatric gynecologist can diagnose and treat any surgical issues of the reproductive tract affecting your child.