Paediatric & Adolescent Conditions

Paediatric
& Adolescent Conditions

Paediatric and adolescent gynaecological care encompasses a broad range of issues affecting the reproductive health and well-being of young people, including girls, transgender, non-binary, and gender-diverse individuals, from infancy through adolescence

These conditions can significantly impact physical health, emotional well-being, and future reproductive capabilities.

Early diagnosis and appropriate management are crucial in ensuring optimal outcomes.

In Australia, there is a growing focus on improving healthcare services to address these conditions effectively and compassionately.

Common Paediatric & Adolescent Gynaecological Conditions

Menstrual Disorders

Menstrual disorders in adolescents can include conditions such as dysmenorrhoea (painful periods), menorrhagia (heavy menstrual bleeding), and amenorrhoea (absence of periods).

Causes: Causes include hormonal imbalances, polycystic ovary syndrome (PCOS), thyroid disorders, stress, and underlying medical conditions.
Symptoms: Symptoms vary depending on the disorder but can include severe menstrual cramps, heavy bleeding, irregular periods, and missed periods.
Risk Factors: Risk factors include a family history of menstrual disorders, obesity, stress, and certain medical conditions like PCOS or thyroid disorders.
Treatment Options: Treatment can include NSAIDs for pain relief, hormonal therapies (birth control pills, progestin therapy), lifestyle modifications (diet and exercise), and addressing any underlying conditions.

Dysmenorrhoea (Painful Periods)

Causes:
- Primary dysmenorrhoea: Caused by the release of prostaglandins during ovulation, leading to uterine contractions and pain.
- Secondary dysmenorrhoea: Associated with underlying conditions such as endometriosis, adenomyosis, pelvic inflammatory disease, or uterine fibroids.
Symptoms:
- Cramping or sharp pain in the lower abdomen or pelvis, typically beginning just before or during menstruation.
- Pain that may radiate to the lower back or thighs.
- Nausea, vomiting, diarrhoea, or headaches in severe cases.
Risk Factors:
- Early onset of menstruation (before age 12).
- Heavy menstrual flow or irregular periods.
- Family history of dysmenorrhoea.
- Smoking or stress.

Treatment Options: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for pain relief. Hormonal therapies, including combined oral contraceptives or progestagen-only treatments, to regulate periods and reduce pain. Lifestyle modifications, such as regular exercise, stress management, and a balanced diet. Heat therapy, such as heating pads applied to the abdomen or lower back, for symptom relief. For secondary dysmenorrhoea, treatment focuses on managing the underlying condition, such as endometriosis or fibroids.

Precocious Puberty

Precocious puberty is the onset of puberty at an unusually early age, typically before age 8.

Causes: Causes include central precocious puberty (due to early activation of the hypothalamic-pituitary-gonadal axis), peripheral precocious puberty (due to hormone production from other sources like adrenal glands or ovarian cysts), and other underlying conditions like hypothyroidism.
Symptoms: Symptoms include early breast development, pubic and underarm hair growth, rapid height increase, and the onset of menstruation at an unusually young age.
Risk Factors: Risk factors include obesity, exposure to external sources of oestrogen, and certain medical conditions or genetic disorders.
Treatment Options: Treatment may involve the use of GnRH analogues to delay further development until a more appropriate age. Psychological support is also important to help the child and family cope with the early changes.

Delayed Puberty

Delayed puberty is the absence of physical signs of puberty by age 13.

Causes: Causes can be constitutional (a family history of delayed puberty), chronic medical conditions, malnutrition, excessive physical activity, and disorders affecting the hypothalamus or pituitary gland.
Symptoms: Symptoms include lack of breast development, absence of pubic hair, and delayed onset of menstruation.
Risk Factors: Risk factors include a family history of delayed puberty, chronic illnesses, and significant stress or nutritional deficits.
Treatment Options: Treatment depends on the underlying cause but may include hormone therapy to induce puberty, nutritional support, and addressing any underlying medical conditions.

Congenital Anomalies

Congenital anomalies of the reproductive tract are structural abnormalities present at birth that can affect the uterus, fallopian tubes, vagina, or external genitalia.

Causes: These anomalies can result from genetic factors, exposure to teratogens during pregnancy, or unknown environmental influences.
Symptoms: Symptoms may vary depending on the type of anomaly but can include difficulty with urination, abnormal menstrual cycles, pelvic pain, and issues with sexual function or fertility in the future.
Risk Factors: Risk factors include a family history of congenital anomalies and maternal exposure to harmful substances during pregnancy.
Treatment Options: Treatment often involves surgical correction of the anomaly, which can be complex and require a multidisciplinary approach. Regular follow-up is essential to monitor reproductive health and manage any complications.

Vulvovaginitis

Vulvovaginitis is inflammation or infection of the vulva and vagina, commonly seen in prepubescent girls.

Causes: Causes include poor hygiene, irritants (soaps, detergents), infections (bacterial, yeast, or parasitic), and foreign bodies.
Symptoms: Symptoms include itching, redness, swelling, unusual discharge, and discomfort during urination.
Risk Factors: Risk factors include poor hygiene practices, use of irritating products, and wearing tight or non-breathable clothing.
Treatment Options: Treatment involves improving hygiene practices, avoiding irritants, using topical treatments (antifungal or antibacterial creams), and ensuring proper clothing and bathing habits.

Labial Adhesions

Labial adhesions occur when the labia minora stick together, partially or completely covering the vaginal opening.

Causes: Causes are often related to low oestrogen levels in prepubescent girls, irritation, or infection.
Symptoms: Symptoms may include difficulty urinating, urinary tract infections, and discomfort.
Risk Factors: Risk factors include irritation from nappies or clothing and poor hygiene.
Treatment Options: Mild cases may resolve on their own with good hygiene practices. More severe cases may require topical oestrogen cream or, rarely, surgical separation.

In Australia, managing paediatric and adolescent gynaecological conditions requires a collaborative, multidisciplinary approach involving paediatricians, gynaecologists, endocrinologists, and mental health professionals.

This ensures that young individuals receive comprehensive and sensitive care tailored to their physical, emotional, and developmental needs.

The National Women’s Health Strategy 2020–2030 emphasises the importance of education, prevention, and early intervention for adolescent health concerns. Public health initiatives aim to improve menstrual health literacy, reduce stigma, and encourage early consultation with healthcare providers when symptoms of gynaecological conditions arise. School-based health education programs play a critical role in equipping adolescents with the knowledge to identify and address health concerns early.

The Australian and New Zealand Society of Paediatric and Adolescent Gynaecology (ANZSPAG) provides guidelines and resources to support healthcare providers in delivering evidence-based care for paediatric and adolescent gynaecological conditions. These efforts are aligned with the strategy’s goals of improving access to age-appropriate, culturally sensitive, and equitable healthcare services across Australia.

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