Researcher, obstetrician-gynecologist, founder and head of the International Academy Healthy life(International Academy of Healthy Life), Toronto, Canada.
V last years placing a child in kindergarten and school becomes an extremely serious headache due to the need to collect huge amount"Pieces of paper" about the state of health of the child with the involvement of a large number specialists.
Elena Petrovna Berezovskaya,
obstetrician-gynecologist,
founder and leader
International Academy of Healthy Life
What is required of parents in such cases in most countries of the world? Just a certificate from a family doctor or pediatrician that the child:
- vaccinated according to country / region
- the child has no contraindications for attending school or preschool, or does he need specialized assistance ().
And nothing more. As simple as that. This means that no other expert opinion is required. Why? Because there are practically no contraindications for children to visit kindergartens and schools, except for the presence of a disease in a child at a stage that threatens his life or the health and life of other people. For example, at the time of registration of documents in kindergarten, the child has measles or another acute infectious disease. Not necessarily an infection, but in general - the child suffers from a disease that usually requires treatment in a hospital.
Often require special assistance for the care and maintenance of their health, which means that if the kindergarten or school is not adapted to work with such children, then they have the right to refuse to accept the child. Although abroad, very often such children attend ordinary kindergartens and schools, sometimes accompanied by a parent, nurse, assistant.
When a specialist examination is required
Only if there are indications that are determined by the family doctor or pediatrician. In other words, the doctor can put the mark “Healthy (a)” in the certificate of the certificate when he does not see absolutely any deviations that require the involvement of specialists. And on this "going to the doctors" should be stopped. That is why he is a family doctor or pediatrician in order to make conclusions about the state of health of children who come to see him.
It sounds strange when they bring to the pediatrician completely healthy child to get help, he sees that the child is really "normal" (healthy!), but he is afraid to issue his own conclusion - the conclusion of the pediatrician that from his pediatric point of view, the child is healthy, and he sends the child and mother to specialists, because without them signatures will not sign the certificate either. A rare absurdity, which is not found in Europe, Australia or the Americas.
Unfortunately, referral to specialists just for the sake of collecting signatures is a manifestation of "going too far", that is, spontaneous.
Even in the orders of the Ministry of Health, it is clearly stated that examination of specialists is required only according to indications, which includes making a diagnosis in the presence of complaints or signs of a disease.
This means that if a girl comes to the pediatrician, and she has a strange bulge in the lower abdomen, which, although it does not bother her, is not a sign of the norm, then the doctor should recommend an examination by a gynecologist to exclude a tumor of the pelvic organs. Although, in general, this condition is not a contraindication for admission to kindergarten or school. Therefore, it does not matter what the gynecologist writes, this should not affect the conclusion: "Healthy for a kindergarten / school." A girl with a tumor can also go to kindergarten, because the issue of treatment or observation is the prerogative of the parents.
At what age is a girl examined by a gynecologist
Now let's talk about gynecological examinations of girls, which has become a certain fashionable extortion in clinics and consultations.
The most is carried out by a neonatologist (pediatrician) in the maternity hospital, examining the external genitals almost immediately after the birth of the child. And this examination is enough so that the next visit of a healthy girl to a gynecologist is not before the onset, that is, in 13-15 years.
In the past, in most countries of the world, a gynecologist's examination was not recommended before the onset of sexual activity or 18 years in the absence of complaints. Most doctors still adhere to these recommendations. The American College of Obstetricians and Gynecologists (ACOG), like professional societies of obstetricians and gynecologists in other countries, recommends the first visit to a gynecologist at 13-15 years old. In most cases, such a visit will end with the usual questioning without a gynecological examination.
And who, then, examines girls before this age? More often than not, there is no need to "get into panties" and examine the external genitals of girls without strict indications. If there are complaints, if some kind of disease occurs that affects the work of the pelvic organs, if there is a suspicion of, then the first examination is carried out by the family doctor or pediatrician. They are obliged (and this is usually the case in all countries):
- Know what changes occur in newborns after childbirth (nipple swelling, vaginal and nipple discharge) and explain this to parents if they are concerned.
- Know how to diagnose correctly, how to guide and observe girls with such a diagnosis, explain to parents that in 80-90% of cases no treatment is required, because synechiae will go away on their own, which very rarely requires treatment hormonal ointments that it is enough for parents to observe the hygiene of the girls and monitor their behavior.
- To know what nonspecific vulvovaginitis is, to explain to parents that it is enough without any treatment, that it is a frequent occurrence after colds, overheating, with helminthic invasions.
- Know what the signs are and refer the child for testing if necessary.
- Recognize the signs of sexual violence and take appropriate steps to clarify the presence of this type of violence.
Pediatric gynecologist - who is this
Overseas pediatric gynecologists are a rare specialization, and the number of specialists is determined by the needs of the population, as well as the level of prevalence gynecological diseases girls. The most frequent category of patients of such doctors is adolescent girls. Therefore, most pediatric gynecologists around the world, as in the most developed countries, and in the most retarded, deals with issues of adolescent gynecology.
Younger patients come to such specialists in the presence of tumors in the small pelvis, discovered by chance or during examination, the appearance pronounced signs early puberty, the presence of malformations of the urogenital organs, when there are problems with urination, after an injury to the perineal region, and less often for other indications.
Why are there so many pediatric gynecologists in the post-Soviet countries, as in no other country in the world? This is due to the distortion of the policy of improving the health care system. The state allocated money for the development of those branches of medicine that were in an extremely neglected state. Among them are genetics, hematology and pediatric gynecology. This made it possible to create a multitude of rates for these specialists, where the overwhelming majority of doctors settled down through connections, through acquaintances and bribes.
Since these subjects were practically not touched upon in medical schools, with the exception of a few hours of lectures, then, accordingly, there are practically no progressive specialists.
But there are rates filled by doctors, and in order to receive a larger budget from the state, it is necessary to create the appearance of the employment of doctors (they will not sit all day without patients). Therefore, in a directive order, they are now sent to hematologists, geneticists, pediatric gynecologists without any indication.
Hematologists prescribe an expensive examination for all pregnant women and those who have lost a pregnancy. thick blood"And such dangerous drugs like heparin and aspirin. Geneticists are looking for in collaboration with hematologists and obstetricians, so that later this trinity could "heal genes" for a long, long time.
And pediatric gynecologists demand visits from frightened, frightened mothers to examine the girls almost every month. And, of course, they intimidate and provoke unnecessary bacterial crops vaginal discharge, for a long time they treat the discharge that they "do not like", and redness of the perineum, they try to part the labia minora with their fingers (and most importantly, not even in the place where their fusion carries a certain risk).
Thus, in the reports of polyclinics to the state to receive a new portion of the budget, there is a bold tick on the full employment of all specialists. Although a lot of money is siphoned out of the pockets and the patients themselves. And what mother, for the sake of “saving” her child, will regret the money, even the last one?
What parents need to know about a girl's pelvic exam
- Examination of the child (children) cannot take place without the presence of one of the parents, up to 14-15 years old, when a teenager has the right to confidentiality of examination in most cases.
- None of the examinations, including by specialists, in a kindergarten or school, are optional. If the child does not feel well, they are obliged to inform the parents about this, and then decide what to do next. If in children's institution source found dangerous infection, it is also necessary to inform the parents about this and obtain their permission to conduct an examination if necessary.
- Refusal of examination cannot be a reason for exclusion from kindergarten or school. There must be a strong justification for such an action.
- The examination of the child should not be carried out in the presence of other children and people. In reality, educators and teachers have no right to know how a child is suffering, if this does not concern the safety of other children and adults. Any findings during the examination should be discussed by doctors only with parents (guardians), and no one else.
How is a girl's gynecological examination carried out?
How is a gynecological examination carried out if you still had to forcibly visit a pediatric gynecologist (although there can be nothing forced)? The doctor should first ask a few questions to one of the parents (usually the mother). If there are no complaints, then the trip to the doctor may end there. Undressing the child and examining his genitals in such cases is completely unnecessary. If the doctor finds signs of possible sexual abuse (bruises, scratches on the skin, withdrawal and fear in a child, etc.), he may suggest an examination of the external genitals.
Since in girls it is impossible to carry out a manual (finger) examination through the vagina, it is carried out through the anus. However, this examination can be very uncomfortable and even painful. In rare cases, anesthesia is required.
Thus, a healthy girl does not need gynecological examinations until the onset of menstruation and even later in the absence of complaints.
For women who grew up in conditions of endless preventive examinations (which turned out to be completely irrational) and the eternal search for diseases, in the constant fear of “missing something, such recommendations may seem strange, unacceptable, and harmful. But if the Ukrainian society is equal to the West, taking into its life the progress of Western technologies and electronics, fashion, novelties of everyday life, then it is time to accept the progress of Western medicine too. Health to you and your girls!
Parents of girls should always remember that care for the reproductive health of their daughters does not begin after they face the first problems, but immediately after their birth. After all, anatomically, a newborn girl is no different from adult woman, all organs are still formed in utero, in the first three months after conception. Of course, until the age of 8 he is at rest, but this does not mean that before this age there is no need to visit a specialized doctor.
Many parents do not even know what problems their babies have. Sometimes only a children's gynecologist can determine sluggish inflammatory diseases vagina, vulva, see adhesions on the labia minora, notice congenital defects development of reproductive organs or too early
So, in some cases, it is necessary to visit a doctor in the first months of life. Many people know that often the mother's hormones are transferred to a newborn girl, which can begin to work. Parents will definitely notice this, because the baby's breasts will swell, vaginal discharge in the form of mucus may appear, and sometimes bloody. By the end of the fourth week of life, all changes should stop. If this did not happen, and by 2-3 months the crumbs have all the same manifestations of work female hormones, then you need to contact a specialist. Only a children's gynecologist will conduct an adequate examination, assess the condition of the baby and prescribe treatment.
Increasingly, girls have such a problem as synechiae. If the neonatologist in the maternity hospital did not conduct an examination too carefully or did not pay attention to this fact, then the young mother may not even guess that something is wrong with her newborn daughter. Even if there were no problems at birth, then the examination of the external genital organs should be regular. At every appointment during the first year of life, a pediatrician must do this. It is he who, in case of problems, should notice the changes and send them to a specialist on time. The children's gynecologist will definitely determine if there are synechiae and will select the optimal treatment regimen. In one case, it can help, and in others, surgical intervention is necessary.
The reasons can be as certain infectious diseases, and the excessive efforts of the mother. Too frequent washing with detergents, which dry the skin, are often the cause of the appearance of synechia.
That is why you should not think that in vain the children's gynecologist is included in the list of doctors who must be visited before going to kindergarten. It will also be necessary to bring the girl to him before starting school and during puberty. And from the age of 14, visits should become regular, at least once a year a growing woman should be examined by a doctor.
You should not get too old if you are not inspired by the district children's trust - this is a city where there are many qualified doctors... First, talk to the mothers of girls you know, they may be able to advise a specialist. After all, such a doctor should not only be a good gynecologist, but also a psychologist who can dispel the fears of the mother and the baby herself. It is unlikely that you will like a pediatric gynecologist, the reviews about which are not the most pleasant and say that children after such a visit are afraid to go to the doctors.
Doctors such as pediatric gynecologists observe, monitor, and prevent childhood illnesses. It is quite important to find a doctor who, from childhood, can protect and prepare the girl for adult life women. Even from birth, some children have health problems, and girls may have congenital gynecological diseases... Pediatric gynecologists examine the girl's genitals, observe congenital diseases, treat and advise on puberty and puberty. Pass the examination of the pediatric gynecologist and pass all the necessary gynecological tests it is possible in the children's clinic, gynecological consultation at the place of residence or for a fee in the clinic of aesthetic medicine.
The pediatric gynecologist examines:
- Fallopian tubes and uterus.
- Vagina.
- Vagina.
- Thyroid.
Children's gynecologist. Treatment of such diseases:
- Tumor of the uterus, vagina and other genitals.
- Cystitis: prevention and treatment.
- Inflammation of the uterus and appendages.
- Treatment and prevention of thrush: advice on personal hygiene, preventive measures.
- Delayed menstruation, irregularities in the cycle. Increased bleeding.
- Vulvovaginitis.
- Endometriosis is the formation of nodes outside and inside the uterus.
In addition to treatment and monitoring, a gynecologist can give good advice about personal hygiene, is able to talk about the upcoming changes in the girl's life. The gynecologist will correctly present and explain to the girl about menstruation: what it is, how important it is to take care of yourself during this period, what means to use, pads or tampons. The doctor also explains how important it is to take a bath and shower, change and maintain cleanliness of underwear, care for the genitals and give other advice. What soap or gel to use, what ointments to use for prevention. In addition to the data, the pediatric gynecologist gives advice on caring for more than just intimate organs. The doctor will talk about breast care, armpits, will give advice to a teenage girl about depilation: how to carry it out correctly, when to start doing it this procedure what tools are best to use and so on.
You should consult a gynecologist when:
- Hormonal disruptions, both in newborns and girls in adolescence... Babies have such disruptions when maternal hormones enter their body, including from breast milk... A crisis can manifest itself in the form of discharge from the genitals, painful sensations in the area of the mammary glands.
- Violations and failures menstrual cycle, puberty. Symptoms appear as changes in mood, delay, or frequent menstruation... Likewise: increased sweating, dramatic weight loss and vice versa. The doctor will tell you how to eat, take care of your figure and personal hygiene.
- Inflammation of the genitals. Older girls may experience itching in the area. intimate organs, slight pain, redness. Infants may also develop inflammation: inappropriate diapers, cream, soap or milk, not sufficiently clean mother's hands, etc.
The gynecologist can advise:
- Pass a blood test: detailed or partial.
- Pass a urine test: expanded or aimed at identifying a specific disease.
- Pass the calla lily test: smears for the presence of microbes, worms, infection.
- Ultrasound.
- A smear from the walls of the cervix, vagina - vaginoscopy.
- Cytological and histological examinations.
Take care of health and reproductive system of a girl, a future woman, is necessary from the very early age... The development of the body from prenatal period to puberty is a responsible and long-term process that should not be left to chance.
Deal with problems, provide professional advice, train proper hygiene genitals will be helped by a competent and experienced specialist - pediatric gynecologist.
Fear of a female doctor often arises in childhood, and here the main task of the mother is to proper preparation girls to see the doctor... Only a mother can clearly explain to her growing daughter how important it is to pass regular examinations for the prevention of gynecological diseases, and to be healthy at any time in your life.
At what age and how often is it necessary to take a girl to a gynecologist?
Show the girl to the gynecologist it is possible at any age, if necessary, because even the smallest patients already have the same structure of the genitals as adult women, and who, unfortunately, can also be susceptible to the development of undesirable processes. There are cases when during ultrasound examination during pregnancy, ovarian cysts were found in embryos. Such children must be observed by a gynecologist from birth.
In the absence of complaints, visit a gynecologist twice a year, as for adult women, girls do not have to, but there are certain age periods when it is necessary to do this at least once:
- the period from birth to 3 children,
- the onset of puberty (9-11 years old),
- the period of the establishment of menstruation (12-13 years),
- the beginning of sexual activity.
In what situations is it necessary to consult a pediatric gynecologist?
The baby needs to be shown to the gynecologist if she has any discharge, she is worried about itching, redness 
skin of the external genital organs, burning and pain in the lower abdomen.
The reason to visit a doctor is also various injuries, inguinal hernia, painful urination.
The appearance of acne, stretch marks on the skin, body hair in atypical places, excessive weight or underweight in a teenage girl may indicate hormonal disorders, and also require specialist advice.
A teenage girl may have irregular, painful, prolonged periods. profuse bleeding, blood clots. Such symptoms should definitely alert an attentive mother.
Children's diseases most often diagnosed by gynecologists:
- malformations of the genital organs,
- inflammation (vulvitis, vulvovaginitis, cystitis),
- fusion of the labia minora (synechia),
- candidiasis (thrush),
- menstrual irregularities,
- delay or premature puberty,
- polycystic ovary disease.
Children's gynecologist: psychological nuances
Any medical examination a child, one way or another, is a psychological trauma. Therefore, every mother is very worried before her daughter's first visit to the gynecologist. This is not surprising, because often in a woman's mind, a visit to a gynecologist is associated with something unpleasant.
Moms of grown-up girls are especially embarrassed if a man turns out to be a gynecologist. And completely in vain. It is the male gynecologist who will most sensitively and responsibly approach the solution of the girl's problems, well understanding the feeling of bashfulness, fear of pain and uncertainty the young patient experiences.
There is nothing unusual in the fact that a man chooses such a profession, because since ancient times it was men who were engaged in healing and healing. The mother herself must first of all focus on the professional skills of the doctor, and not on his gender, and explain this to her daughter. A girl should understand from childhood that the doctor is only interested in the aspect of her intimate health and his main task is to quickly, professionally and efficiently provide the necessary assistance.
Preparing for admission
A special examination kit must be purchased before visiting a doctor. If the girl is worried about discharge, then on the eve of her appointment it is better not to wash her away so that the doctor can take smears. It is also advisable to empty the intestines. If the girl is already menstruating, it is advisable to grab the monthly calendar. It is necessary to explain to the daughter that there is no need to be afraid of losing her virginity or the procedure for taking smears, since the doctor uses only special instruments for children, which ensure painless and safe manipulations.
Examination by a gynecologist
Examination of girls under 18 years old takes place in the presence or with the consent of their parents, both in clinics and in schools. Conventionally, an appointment with a pediatric gynecologist can be divided into several stages:
1. collection of anamnesis,
2. visual inspection,
3. in case of complaints - anal examination (in anus the doctor gently inserts a finger, and with the other hand probes the stomach),
4. sampling of smears (exclusively from the outer labia),
5. breast examination,
6. conversation-consultation and prescription of treatment (if necessary).
In the event that a young girl is already sexually active, the examination is carried out, like for adult women, through the vagina, with the only difference that the examination device (mirror) is taken of the smallest size.
Mothers should show by their own example that regular hiking to female doctor - this is an important health need. Educational work of parents in the family, trusting relationships, teaching the right attitude to sex life will become the guarantee of the girl's health and her future happy motherhood.
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Examination of girls by a gynecologist is carried out at 3, 7, 12, 14-17 years old (after 14 years old - annually) - before entering kindergarten, school, and then after graduation primary school and during adolescence. In addition, when symptoms of distress from the organs appear reproductive system an extraordinary consultation of a pediatric gynecologist is appointed, during which the doctor not only determines the state of the child's health, but also prescribes the necessary treatment.
Organization and legal basis
Examination by a pediatric gynecologist can be done in a polyclinic at the place of residence for free or on a commercial basis in a private medical institution licensed and professional. It is carried out on the basis of the order of the Minister of Health No. 1346n of 12/27/12 "On the procedure for the passage of medical examinations by minors." If the institution does not have a specialist "pediatric gynecologist", replace him with a doctor of another specialty medical organization can not.
Parents are informed about the medical examination at least 5 days in advance and take written consent to carry it out. Wherein legal representative the child (father, mother or guardian) may be present during the procedure itself in the doctor's office.
Parents or guardians may refuse to conduct a gynecological examination of the child on the basis of federal law about health care. At the same time, the child cannot be denied admission to kindergarten or school.
In Russia, to undergo a medical examination by a gynecologist, a medical policy is required.
If a girl has reached the age of 16, she herself gives written consent to a gynecologist's consultation, while parents are not required to notify about this procedure, and even more so about its results. A 15-year-old girl will most likely not be accepted by a pediatric gynecologist without parents, and an "adult" will not examine at all, because he has no right to diagnose and treat diseases in children.
All data is entered into outpatient card or special forms before entering kindergarten, school, or dispensary observation documents. They constitute a medical secret, and no one can get acquainted with these data without the consent of the child's parents or guardians.
There is an exception to this rule. According to the order of the Ministry of Health dated May 17, 2012 No. 565n, if the doctor, upon examination, reveals signs of unlawful, violent actions against the girl, he will be obliged to report this to the internal affairs bodies.
If a girl underwent an examination by a gynecologist for some reason, and there is information about this in her medical card, these results are "valid" if they are no more than 3 months old.
Indications for visiting a doctor
Planned preventive examinations held for early detection serious health problems, which can then lead to severe violations reproductive function and even . Therefore, you do not need to give up them. Such examinations are completely painless, the gynecological chair has been used since adolescence.
In addition, you need to visit a pediatric gynecologist if a girl has complaints:
- itching and burning in the perineum;
- discharge from the genital tract, stains on linen;
- pain in the lower abdomen with fever;
- absence of menstruation at 15-16 years old;
- the girl has too heavy, painful periods, lasting 7 days or more;
- the appearance in 11-12 years of signs of hair growth male type, acne, insufficient development of the mammary glands;
- accelerated sexual development, the appearance of the first menstruation before 11 years.
The main diseases detected by a pediatric gynecologist
Examination of girls by a gynecologist in kindergarten and subsequent dispensary observation carried out to identify such groups of diseases:
- inflammatory diseases of the pelvic organs;
- non-inflammatory diseases of the genital organs;
- breast disease;
- congenital malformations of the genital organs.
In more late dates in addition, premature sexual development or its delay is diagnosed, as well as a violation of the rhythm and nature of menstruation.
Most often, prepubertal girls have vaginal discharge and irritation of the surrounding tissues. Such symptoms account for up to 70% of all calls to pediatric gynecologist about the disease. Another common problem is parental concerns about normal structure genitals.
Non-infectious vulvovaginitis
It is usually caused by contact dermatitis, which is skin irritation caused by detergents. Redness of the skin is observed, in rare cases, blisters and itchy skin are formed.
Poor perineal hygiene is a common cause. This reveals redness and swelling of the labia majora. Occasionally, residues of white discharge or even fecal matter are visible on the vulva. In more severe cases scratching appears, which can become a gateway for a secondary bacterial infection.
Rare but serious reason non-infectious vulvovaginitis in children - lichen sclerosus (lichen). It is accompanied by itching, irritation, soreness, bleeding, urinary dysfunction, and pain during bowel movements. Characteristic feature- White spots on the skin that looks like parchment paper.
If it enters the vagina foreign body e.g. a piece of toilet paper may develop bloody, purulent discharge With unpleasant odor, irritation of the vulva.
Infectious vulvovaginitis
Any cases of genital tract infections should alert the doctor to child abuse. In this case, it is necessary to diagnose gonorrhea, chlamydia, trichomoniasis, human papillomavirus, HIV infection and virus infection herpes simplex... In children under 3 years of age, the source of chlamydia and papilloma virus can be transmission from the mother during childbirth, even if the woman did not know about the presence of such a disease.
Infectious vulvovaginitis is accompanied by redness and soreness of the skin. Vaginal discharge is yellow-green in color and may be purulent. The disease can occur against the background of a cold, and in this case it is caused not by sexual pathogens, but by streptococci, meningococci, hemophilus influenzae, staphylococci and pneumococci.
Scratching and secondary infection can be caused by pinworms.
Anatomical changes
Often, parents turn to a gynecologist with complaints about the abnormal structure of the external genital organs in little girls. In this case, the doctor conducts an attentive external examination, during which it can reveal such frequent pathologies:
- hymen infection;
- prolapse of the urethra;
- swelling of the vagina.
In such cases, you may need surgical correction detected defects.
Preparation for inspection
A child in 3 years usually does not need to explain anything for a long time. It should only be said that they will go to the doctor with their mother, as usual. In the absence of complaints, the examination is limited to the external, that is, the doctor visually assesses the structure of the external genital organs and the absence of signs of inflammation.
How to prepare a girl 6-7 years old and older for examination by a gynecologist?
It is important to remain calm and confident - before the age of 7 years, the child often does not feel any embarrassment and will not notice the "uncomfortable" topic.
The first visit to a gynecologist by a teenage girl is often remembered for a lifetime. Therefore, the mother needs to explain what will need to be done before (urinate in advance, clean the perineum with a damp cloth) and what will happen during the examination.
Examination by a gynecologist usually does not cause psychological trauma. Parents should not focus on going to the doctor as something unusual or even more shameful. More often the girl worries more in advance than after the visit.
How is the inspection going?
Stages of carrying out:
- A conversation during which, in a calm, benevolent tone, the doctor asks questions to the little patient and her mother about the developmental features of the child, any complaints or abnormalities in the development of the genitals. At the same time, psychological contact with the patient is being established.
- Examination of girls before puberty is usually done while lying on a couch. The child needs to remove all clothing below the waist, and also raise the edge of the blouse or T-shirt above the belly. Then the girl lies down on an unfolded diaper.
- The doctor feels the stomach, then asks to bend the knees - this is done either by the girl herself, or by her mother, who is nearby. The doctor examines the external genitalia.
This is where the inspection ends. Only in rare cases, for example, if there is a suspicion of anomalies of sexual development, the doctor conducts a rectal examination of the uterus and appendages, inserting a gloved finger into the rectum, and prescribes other research methods, in particular, ultrasound.
Girls find out if menstruation has begun, what is the duration of the cycle, is there painful sensations... If (the first menstruation) has already passed, you should take a menstrual calendar for an appointment, which should be kept by every girl and woman, noting the days of menstrual bleeding in it.
Adolescents who have already had their first period are examined on a gynecological chair. The doctor always asks if the girl is sexually active. If the answer is negative, he conducts a rectal examination, probing the uterus and appendages through the anterior abdominal wall, on the one hand, and the rectal wall, on the other. This manipulation is painless, although unpleasant.
In case of severe inflammation, the gynecologist can take vaginal swabs even from a virgin. The hymen always has holes through which blood is released during menstruation. Through one of them, the doctor, under visual control, carefully inserts a thin probe and makes a smear. At the same time, the hymen is not damaged.
If necessary, a special baby vaginal speculum can even be inserted through such an opening to assess the condition of the vagina and cervix. Of course, this is not used during prophylactic medical examinations. But if the doctor suspects serious illness reproductive system, for example, for a tumor, such an examination will be carried out. The integrity of the hymen is not compromised.
If a girl leads sex life, she is examined the usual way- vaginal, as well as using mirrors.
In addition, the condition of the mammary glands and secondary sexual characteristics, in particular, pubic hair, are necessarily checked. Non-compliance with their norm indicates a delay in puberty, which is often caused by serious endocrinological diseases. Only their timely diagnosis will help the girl to conceive and bear a child in the future. Therefore, one should not refuse gynecological examinations in adolescents, because at this time the girls are already embarrassed to talk about these topics with their mother.
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