Paediatric gynaecology can be quite complex, since the usual rules don’t apply. This article provides the basic outline of growth and sexual development of our human children.
There are six stages of a female’s life:
- Neonatal – newborn, first 28 days
- Childhood – up to age 8
- Prepubertal and pubertal – ages 8-12
- Adolescents – ages 12-20
- Sexual maturity – ages 18-50
- Climacterium and senium (menopause and all the changes of mind and body that go with it) – after age 50
Vaginal discharge in newborns
Most newborn girls have some white, mucousy vaginal discharge for about three months after birth, which is due to oestrogen from the mother circulating in the baby. This is normal, and will disappear. After three months old until puberty, vaginal discharge should be minimal.
Vaginal bleeding in newborns
When a girl is born, she may bleed vaginally for about a week, up to two weeks, caused by withdrawal of the mother’s oestrogen. This is normal and does not require treatment.
It is the same type of bleeding that occurs when a woman stops taking birth control pills for her ‘period’, which in fact is not a period, but called withdrawal bleeding.
The newborn’s vaginal and vulvar size and shape
Labia minora can be thick, and protrude past the labia majora – this is due to the mother’s oestrogen, and is something that will go away, and then reappear when oestrogen is more of a feature at puberty.
The labia majora will be pink and covered in discharge. Vaginal length is usually about 4cm long, and it can be difficult to examine or find the entrance.
Up to one year old
Her follicles are being stimulated
Follicle stimulating hormone (FSH) is high in infancy, with highest levels (prior to puberty) found between six and 12 months of age. Her follicles are responding.
That is, the small sacs inside her ovaries that will pop eggs out when the time is right to ovulate. These can cause ovarian cysts, which are the most common cause of pelvic masses in girls.
Between one year old and puberty
Hormones during childhood
This period is essentially hormone-free for the duration, past age one or two. Her follicles will reduce over childhood, but later her ovaries will start to produce bigger follicles, and the ovaries will descend into the pelvis. Sometimes large follicles can be seen, but they usually don’t need any intervention.
The vagina and vulva shape and size in a toddler and young girl
The mucosa of the vaginal introitus (entrance) is pink and wet. The clitoris is small – between 3-5cm in length and 2-3cm wide. Rugae is sparse. The cervix should be able to be seen clearly.
A hymen is a membrane that exists just inside the introitus that girls are born with. It changes with hormones and activities. Read about the hymen.
Examinations of children
Examining a child’s vagina can sometimes be complicated by their lack of cooperation, and should only be done by an experienced paediatric doctor.
Part of the examination is to ensure the child is calm and cooperative, and that the practitioner is trusted. A parent or trusted caregiver should always be present during these examinations while the vulva, vagina, cervix and rectum may be examined.
Any swabs should be taken while the child coughs, avoiding the hymen, since piercing the hymen will cause pain. A small, thin speculum can be used. The child can cough or take a deep breath, and spread her own labia if appropriate. Don’t perform internal vaginal examinations or take vaginal swabs past the hymen unless necessary.
Position 1 – ‘frog leg’, girl lies on her back on top of a parent with knees and feet gently apart.
Position 2 – the girl lies on her side with knees to her chest.
Position 3 – if the girl is old enough, lying alone on her back, knees and feet apart.