Puberty Related Disorders:

1. Pediatric vulvitis and vaginitis

Vulvovaginitis is a common condition in the pediatric patient. The child will typically present with chronic discharge, odor, and redness.  Patients presenting with chronic discharge should undergo a careful history including questions regarding history of upper respiratory tract infections, whether the child uses the bathroom on her own, history of skin rashes or sensitive skin, allergies and asthma, and suspicion of sexual assault. Enquiries should be made regarding the volume of discharge, color, and presence of blood, and all measures taken to relieve discharge. While the differential diagnosis includes infection, pin worms, and foreign bodies, the most common cause is a nonspecific vulvovaginitis.

2. Dysmenorrhea

Dysmenorrhea is a common problem for adolescents. Approximately 85% of adolescents report experiencing dysmenorrhea and 15% describe it as severe. Dysmenorrhea is divided into primary and secondary. Primary being without an anatomical cause and secondary due to an organic pathology. Many adolescents do not seek treatment for dysmenorrhea including those with severe dysmenorrhea. As this problem can result in school absenteeism, it is essential that it be managed effectively. Commonly, over the counter non-steroidal anti-inflammatory medications are used for the treatment of dysmenorrhea. However, a randomized, double-blind, placebo-controlled trial demonstrated that adolescents aged 19 years or younger with moderate or severe dysmenorrhea treated with a 20 μg oral contraceptive pill scored lower on a standard menstrual pain scale compared to those randomized to placebo.

3. Uterine bleeding

Uterine bleeding in the adolescent is rarely due to an anatomical cause and is therefore usually classified as anovulatory uterine bleeding. Ovulatory bleeding occurs with stimulation of the ovary, follicle recruitment and development, follicle rupture, and corpus luteum development and involution. This process results in hormonal changes leading to a proliferative then secretory endometrium which then desquamates and repairs. In early adolescents, due to underdevelopment of hormonal signaling along the hypothalamic–pituitary–ovarian axis anovulatory cycles are common and a normal finding. Anovulatory cycles are a common occurrence in the first 1 or 2 years following menarche.