Sexual & Reproductive System

Some boys are slower to develop than their peers, and many boys are quiet and shy. There’s a normal range when it comes to physical and social development. But sometimes these qualities show up alongside learning problems or trouble paying attention in school. When this happens, it could be an indication that something else is going on.

If you’re worried about your son’s emotional or physical development, talk to your doctor. Occasionally, symptoms like these can be linked to a condition called Klinefelter syndrome.

About Klinefelter Syndrome

Klinefelter syndrome, also known as XXY syndrome, is a fairly common genetic condition found in males only. It occurs when a boy is born with an extra sex chromosome in most or all of his cells. Many boys with Klinefelter syndrome have no signs or symptoms, and some don’t even know they have it until later in life.

Klinefelter syndrome typically causes a boy’s testicles to grow at a slower rate than those of other boys. It also prevents the testicles from producing normal amounts of sperm and the hormone testosterone. Testosterone affects the way a boy develops both physically and sexually. Low hormone levels and problems with sperm production make it difficult or sometimes impossible for a boy with Klinefelter syndrome to father a child later in life.

The XXY condition that causes Klinefelter syndrome can’t be changed, but medical treatment and working with therapists can help a boy’s development and help lessen the condition’s effects. Even without treatment, most boys with Klinefelter syndrome grow up to live productive, healthy lives.

Cause

Everyone’s genetic material, or DNA, is contained in tiny structures called chromosomes that are found inside their cells. A person’s physical gender (whether they have male or female sex organs) is determined by their sex chromosomes. Females have two X chromosomes, or XX. Most males have one X chromosome and one Y chromosome, or XY. Males with Klinefelter syndrome are born with cells that have an extra X chromosome, or XXY.

Klinefelter syndrome is a genetic condition, meaning people are born with it, but it’s not passed down through families like some genetic diseases. Instead, Klinefelter syndrome occurs randomly due to an error in cell division when a parent’s reproductive cells are being formed. If one of these defective cells contributes to a successful pregnancy, the baby will have the XXY condition in some or all of his cells. Some boys will even have more than two X chromosomes (XXXY or XXXXY, for example), which increases the risk of severe symptoms and other health concerns.

When a boy is born with the XXY condition in only some of his cells, it’s called mosaic Klinefelter syndrome. Often, boys and men with this condition can have milder signs and symptoms than others with the XXY condition.

Signs & Symptoms

Not all boys with Klinefelter syndrome will have noticeable symptoms. Other boys can have symptoms that are physically apparent or problems with speech, learning, and development.

Babies with Klinefelter syndrome typically have weak muscles, reduced strength, and quiet personalities. They also can take longer to do things like sit up, crawl, walk, and speak.

Compared with other kids their age, boys with Klinefelter syndrome might have some or all of the following symptoms:

• a taller, less muscular body
• broader hips and longer legs and arms
• larger breasts (a condition called gynecomastia)
• weaker bones
• a lower energy level
• smaller penis and testicles
• delayed or incomplete puberty (some boys won’t go through puberty at all)
• less facial and body hair following puberty

In addition to physical symptoms, many boys with Klinefelter syndrome will also show symptoms related to their development of social and language skills. They may have difficulty paying attention. A lot of boys learn to talk late or have trouble using words to express their emotions. They also can have trouble with things like learning to spell, read, and write.

Socially, boys with Klinefelter syndrome tend to have quiet, docile personalities. They rarely cause trouble and are often more helpful and thoughtful than other boys. They are often shy and sensitive, and many are less self-confident and less active than other boys their age.

Since boys with Klinefelter syndrome can have problems with schoolwork and sports, they may feel like they don’t fit in with other kids their age. But by the time they are men, most will have normal social relationships with friends, family members, and others.

Related Problems

The main complications of Klinefelter syndrome are related to problems with speech, learning, and physical and social development. Most boys aren’t likely to have major health problems, but the condition can bring some other challenges later in life. Klinefelter syndrome puts males at greater risk of breast cancer, some other cancers, and some other diseases like type 2 diabetes, varicose veins and problems with blood vessels, problems with sexual function, and osteoporosis (weak bones) later in life.

Most boys with Klinefelter syndrome can have sex when they become men, usually with the help of testosterone treatment. However, problems with their testicles prevent them from making enough normal sperm to father children.

The vast majority of men with Klinefelter syndrome are infertile and can’t father a child the normal way. At present, options for becoming natural parents are limited, but fertility researchers are working on new treatments. By the time a child with Klinefelter syndrome is ready to become a dad, there may be new options.

Diagnosis

Since Klinefelter syndrome can be hard to notice, many parents don’t know their son has it until he grows up or shows delays in puberty. Sometimes, parents who are worried about their son’s development consult a doctor, and the diagnosis reveals Klinefelter syndrome. This can help, because the earlier a boy is diagnosed with Klinefelter syndrome, the more effective the treatments usually are.

To diagnose cases of Klinefelter syndrome, doctors usually begin by asking about any learning or behavior issues and examining the boy’s testicles and body proportions.

There are two main types of tests used in the diagnosis of Klinefelter syndrome:

1. Hormone testing, which is usually done by taking a blood sample to check for abnormal hormone levels.
2. A chromosome analysis, or karyotype, which is usually done on a blood sample. This test checks the number of chromosomes to see if the XXY syndrome is present.

Treatment

There’s no way to change the XXY condition if a boy is born with it, but treatments can help relieve some of the symptoms. As with many conditions, beginning treatment early can greatly increase its effectiveness.

Testosterone replacement therapy (TRT) works by increasing a boy’s testosterone levels into the normal range. Additional testosterone can help a boy with Klinefelter syndrome develop bigger muscles and a deeper voice, as well as promote growth of the penis and facial and body hair. It can also help improve bone density and reduce the growth of a boy’s breasts. Testosterone therapy cannot increase the size of a boy’s testicles or prevent or reverse infertility, however.

Educational support services can help boys and teens with Klinefelter syndrome keep pace in school. Many benefit from extra assistance when it comes to schoolwork. If your son has Klinefelter syndrome, let his teachers and school nurse know about his condition and see what kind of support is available. He may be eligible for an individualized education plan (IEP) or 504 education plan, which both can provide accommodations for kids with special needs.

Speech therapy and physical therapy can help boys with Klinefelter syndrome learn to speak, read, and write better, or improve muscle strength and coordination.

Other forms of therapy include behavioral, mental health, and occupational therapy. These can help improve low self-confidence, shyness, and delayed social development.

Supporting Your Son

It can be difficult for boys with this condition, who feel like they’re developing differently from their peers. They’re more likely to have low self-esteem, which can make things harder socially and academically.

If your son is struggling in school or having trouble making friends, talk to your doctor, school principal, or school counselor. Counselors and therapists can give boys practical skills to help them feel more confident in social settings. And many schools provide supplementary educational services or accommodations that can help your son succeed.

The teen years can be difficult — for both teens and parents. Physical changes during puberty can make adolescents feel awkward and unsure of themselves.

This is especially true for girls when it comes to menstruation. For a girl, getting her first period is a physical milestone and a sign of becoming a woman. But it also can be confusing and scary, particularly if she has certain problems, like irregular periods or premenstrual syndrome (PMS).

Common Menstrual Problems

Premenstrual Syndrome (PMS)

It’s common for women to feel a few symptoms, such as mild bloating or breast soreness, before a period. But women with PMS have a wave of emotional and physical symptoms that start in the second half of the menstrual cycle and end after a period begins.

PMS includes many physical and emotional symptoms, such as:

• acne
• bloating
• backaches
• sore breasts
• headaches
• constipation
• diarrhea
• food cravings
• depression or feeling sad
• irritability
• anxiety

PMS is usually at its worst during the 4 days before a period. It tends to disappear 2 to 3 days after the period begins. PMS can happen at any time in women of childbearing age. Not all women get PMS, and some only get the worst symptoms when they are older or closer to menopause.

Although the exact cause of PMS is unknown, it seems to happen because of changing hormone levels in the body and changing chemical levels in the brain. During the second half of the menstrual cycle, the amount of progesterone in the body increases. Then, about 7 days before the period starts, levels of both progesterone and estrogen start to drop.

Some girls’ bodies seem to be more sensitive to these hormone changes than others. Talk to your daughter’s doctor if her symptoms are severe or interfere with her normal activities.

Cramps

Many girls have abdominal cramps during the first few days of their periods. They’re caused by prostaglandin, a chemical in the body that makes the smooth muscle in the uterus contract. These involuntary contractions can range from dull to sharp and intense.

The good news is that cramps usually only last a few days. Using heating pads can help soothe the pain. Over-the-counter ibuprofen, given for 2 to 3 days as soon as a period begins, also can help. Call your daughter’s doctor if she has severe cramps that keep her home from school or from doing stuff with her friends. Also let the doctor know if the cramps do not improve with home treatment.

Irregular Periods

A girl’s body usually does not develop a regular cycle until 2 to 3 years after she begins her periods. During that time, the body is adjusting to the influx of hormones unleashed by puberty. And what’s “regular” varies from girl to girl. The typical cycle of an adult female is 28 days, although some are as short as 24 days and others are as long as 38.

Changing hormone levels might affect the length of a period. A girl’s period may last just a few days during one month and up to a week the next. She may skip months, get two periods very close together, or alternate between heavy and light bleeding from one month to another.

If your daughter’s period still hasn’t settled into a fairly predictable pattern after 3 years, or if it becomes irregular after she’s had several normal periods, make an appointment with her doctor to check for possible problems.

Also, let your daughter’s doctor know if her cycle is less than 24 days or more than 38 days, or if she goes for 3 months without a period.

Delayed Menarche

Girls go through puberty at different rates. Some reach menarche (the medical term for the first period or the beginning of menstruation) as early as 9 or 10 years old. Others don’t have their first periods until they’re well into their teen years. So if your daughter is a “late bloomer,” it doesn’t necessarily mean there’s something wrong.

Genetics plays a big role in determining when girls get their periods. Girls often start menstruating at about the same age at which their mothers or grandmothers did. Also, certain ethnic groups, on average, go through puberty earlier than others. For instance, African-American girls generally start puberty and get their periods before Caucasian girls do.

Let your daughter’s doctor know if she hasn’t gotten her period by age 15, or by 3 years after starting puberty, which begins with breast development.

Problems That May Be Cause for Concern

Although most period problems are harmless, a few conditions can be more serious and require medical attention. These include:

Amenorrhea (the Absence of Periods)

Girls who haven’t started their periods by the time they’re 15 years old or 3 years after they’ve shown the first signs of puberty have primary amenorrhea. This is usually caused by a genetic problem, a hormone imbalance, or a problem with the way the reproductive organs developed.

Hormone imbalances also can lead to secondary amenorrhea, which is when a girl who had normal periods suddenly stops menstruating for more than 6 months or three of her usual cycles.

Since pregnancy is the most common cause of secondary amenorrhea, a girl with skipped periods should have a pregnancy test. In addition to hormone imbalances and pregnancy, other things that can cause both primary and secondary amenorrhea include:

• stress
• significant weight loss or gain
• anorexia (amenorrhea can be a sign that a girl is losing too much weight and may have anorexia)
• stopping birth control pills
• thyroid conditions
• other conditions that can affect hormone levels

Exercising too much (often in sports like distance running, ballet, figure skating, or gymnastics) combined with a poor diet also can lead to amenorrhea. This happens because a girl may lose too much weight or not gain weight during key periods of growth.

But this doesn’t include the usual gym class or school sports team, even those that practice often. To exercise so much that she delays her period, a girl would have to train vigorously for several hours a day, most days of the week, and not get enough calories, vitamins, and minerals.

Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is when periods are very heavy, last much longer than normal, or don’t come regularly. The name might sound serious, but most AUB isn’t a problem and doesn’t need treatment.

Most cases of AUB are due to an imbalance between the levels of estrogen and progesterone in the body, which allows the endometrium (the lining of the uterus) to keep building up. This may lead to the period coming early or late. And when the period does come, the shedding of this thick endometrium can result in very heavy bleeding.

A girl with heavy periods could soak through a sanitary pad or tampon every 1-3 hours. Or, she may have periods that last longer than 7 days. This heavy or prolonged bleeding may keep a girl home from school or social functions because she’s worried she won’t be able to control the bleeding in public.

Because many adolescents have slight hormone imbalances during puberty, lots of teen girls have heavy periods. But in some cases, heavy menstrual bleeding can be caused by problems such as:

• fibroids (benign growths) or polyps in the uterus
• thyroid conditions
• clotting disorders
• swelling, irritation, or infection in the vagina or cervix

If your daughter has heavy periods or periods that last longer than 7 days, talk to her doctor.

Dysmenorrhea (Painful Periods)

There are two types of dysmenorrhea, which is painful menstruation that can interfere with a girl’s ability to attend school, study, or sleep:

1. Primary dysmenorrhea is very common in teens and is not caused by a disease or other condition. Instead, the culprit is prostaglandin, the chemical behind cramps. Some prostaglandin can lead to mild cramps. But large amounts of prostaglandin can lead to nausea, vomiting, headaches, backaches, diarrhea, and severe cramps. Fortunately, these symptoms usually only last for a day or two.
2. Secondary dysmenorrhea is pain caused by some physical condition like polyps or fibroids in the uterus, endometriosis, pelvic inflammatory disease (PID), or adenomyosis (when tissue that usually lines the uterus grows into the muscular wall of the uterus).

Having cramps for a day or two each month is common, but if your daughter has symptoms severe enough to keep her from her normal activities or cramps that last for more than 3 days, discuss it with her doctor.

Endometriosis

In this condition, tissue normally found only in the uterus starts to grow outside the uterus — in the ovaries, fallopian tubes, or other parts of the pelvic cavity. It can cause abnormal bleeding, dysmenorrhea, general pelvic pain, and lower back pain.

Treatment

To determine whether a problem requires treatment, the doctor will ask several questions and do a physical exam. The doctor may do a pelvic exam, blood tests, or urine tests. If there might be a structural problem, an ultrasound or CT scan might be done. These tests can help the doctor decide how to handle a condition.

Growths such as polyps or fibroids often can be removed, and endometriosis treated with medicines or surgery. If a hormone imbalance is to blame, the doctor may suggest hormone therapy with birth control pills or other hormone-containing medicines. Conditions like clotting disorders or thyroid problems also may require treatment.

For menstrual pain not due to any medical problem, anti-inflammatory medicines like ibuprofen are the most effective treatment.

When to Call the Doctor

Although most period problems aren’t cause for alarm, certain symptoms do call for a doctor visit. This is particularly true if a girl’s normal cycle changes.

So take your daughter to her doctor if she:

• Hasn’t started her period by the time she’s 15 or her period hasn’t become regular after 3 years of menstruating. The most likely cause is a hormone imbalance (which may need treatment), but this also might point to another medical problem.
• Stops getting her period or it becomes irregular after it has been regular. Also let your daughter’s doctor know if her cycle is less than 24 days or more than 38 days, or if she doesn’t get a period for 3 months at any time after first beginning to menstruate.
• Has heavy or long periods, especially if she gets her period frequently. In some cases, significant blood loss can cause iron-deficiency anemia. Also, heavy bleeding could be a sign of a growth in the uterus, a thyroid condition, an infection, or a blood clotting problem.
• Has very painful periods. Having cramps for a couple of days is normal, but if your daughter isn’t able to participate in her normal activities, or has cramps for more than 3 days, let the doctor know. She might have a medical problem, such as endometriosis, causing the pain.

Helping Your Daughter Feel Better

When your daughter’s having a particularly bad bout of PMS or cramps, you can help make her more comfortable. Suggest that she:

• eat a balanced diet with lots of fresh fruit and vegetables
• reduce her salt intake (salt can cause water retention) and caffeine (which can make her jumpy and anxious)
• include foods with calcium, which may reduce the severity of her PMS symptoms
• try over-the-counter pain relievers like acetaminophen or ibuprofen for cramps, headaches, or back pain
• take a brisk walk or bike ride to relieve stress and aches
• soak in a warm bath or put a hot water bottle on her abdomen, which may help her relax

If you notice that your daughter’s periods are causing her great discomfort or interfering with her life, talk to her doctor to make sure nothing else is causing the problem and to see if anything can help. Sometimes hormone treatment, often in the form of birth control pills, can help ease many symptoms of uncomfortable periods.

Most important, talk to her and explain that most annoying or uncomfortable parts of menstruation are normal and may improve over time. And be understanding when she’s cranky and unhappy. After all, no one’s at her best all the time.

Understanding Miscarriage

Losing a pregnancy can be heartbreaking. And unfortunately, miscarriages are fairly common. On average, about 1 in 5 pregnancies will end in a miscarriage — usually in the first trimester.

In most cases, a miscarriage cannot be prevented because it is the result of a chromosomal abnormality or problem with the development of the fetus. Still, certain factors — such as age, smoking, drinking, and a history of miscarriage — put a woman at a higher risk for losing a pregnancy.

While miscarriages usually cannot be prevented, by taking care of yourself and following your health care provider’s recommendations, you can increase the chances that you and your baby will be healthy throughout the pregnancy.

What Is a Miscarriage?

A miscarriage is the loss of a pregnancy (the loss of an embryo or fetus before it’s developed enough to survive). This often happens even before a woman is aware that she is pregnant.

A miscarriage usually happens in the first 3 months of pregnancy, before 12 weeks’ gestation. A small fraction of pregnancy losses — happening in less than 1% of pregnancies — are called stillbirths, as they happen after 20 weeks of gestation.

Symptoms of a Miscarriage

Many women don’t even know that they’ve had a miscarriage (since they hadn’t known they were pregnant), thinking that it’s just a particularly heavy menstrual flow.

Some women experience cramping, spotting, heavier bleeding, abdominal pain, pelvic pain, weakness, or back pain. Spotting is often not a sign of a miscarriage; many women experience it early on in pregnancy. But just to be safe, if you have spotting or any of these other symptoms anytime during your pregnancy, talk with your doctor.

Types of Miscarriage

If you think you may have had a miscarriage, your doctor may use a number of terms to explain what has happened:

• If a pregnant woman has bleeding, little or no pain, a closed cervix, and is found to still have a fetus with a heartbeat in her uterus, she may have had a threatened miscarriage. Most pregnancies with early bleeding but with a detectable heartbeat turn out fine.
• An inevitable miscarriage is when bleeding and cramping happen during pregnancy, with an open cervix.
• An incomplete miscarriage is when a miscarriage has happened, but the body does not expel all the tissue from the pregnancy.
• A complete miscarriage is when all of the tissue from the pregnancy is expelled by the body.
• If you have miscarried, your doctor may say you have a blighted ovum, which is a miscarriage that has happened so early that no clearly defined fetal tissues have formed.
• A missed miscarriage is when the fetus has died or has not developed, but the body does not discharge the fetus or tissues from the pregnancy. Sometimes women with missed miscarriages notice that they no longer “feel pregnant.”

Stillbirths

A stillbirth, which many experts define as the death of a baby after the 20th week of pregnancy, can happen before delivery or during labor or delivery. It is rare and happens in less than 1% of all births. A stillbirth also is sometimes referred to as intrauterine fetal death or antenatal death.

While there are some known risk factors for stillbirth (such as smoking, obesity, problems with the placenta, a pregnancy lasting longer than 42 weeks, and some infections), there is no way to predict when stillbirth will happen or who will have one, and the cause of many stillbirths remains unknown.

The common sign of a stillbirth is decreased movement in the baby. If you notice your baby moving less than usual, call your doctor immediately.

Your doctor can use an ultrasound to look for the heartbeat or, later in pregnancy, give you an electronic fetal non-stress test. This involves lying on your back with electronic monitors attached to your abdomen. The monitors record the baby’s heart rate, movements, and contractions of the uterus.

Why Do Miscarriages Happen?

The most common cause of pregnancy loss is a problem with the chromosomes that would make it impossible for the fetus to develop normally.

Other factors that could contribute to a miscarriage include:

• abnormal hormone levels in the mother, such as thyroid hormone
• uncontrolled diabetes
• exposure to environmental and workplace hazards, such as radiation or toxic agents
• certain infections
• uterine abnormalities
• incompetent cervix, or when the cervix begins to open (dilate) and thin (efface) before the pregnancy has reached term
• certain medications, such as the acne drug Accutane

Certain behaviors also increase the risk of a miscarriage. Smoking, for example, puts nicotine and other chemicals into the bloodstream, causes the fetus to get less oxygen, and increases the chance of losing a pregnancy. Alcohol and illegal drug use also can lead to miscarriages.

After a Miscarriage

If you have miscarried, your doctor will do a pelvic exam and an ultrasound to confirm the miscarriage. If the uterus is clear of any fetal tissue, or it is very early in the pregnancy, then there often won’t be any more treatment.

But if the uterus still contains the fetus or other tissues from the pregnancy, this will need to be removed. The doctor may give you medicine to help pass the tissue or may need to dilate the cervix to perform a dilation and curettage (D&C), a scraping of the uterine lining, or a dilation and extraction (D&E), a suction of the uterus to remove fetal or placental tissue. You may have bleeding or cramping after these procedures, which are done with anesthesia.

If it is determined that your baby has died later in pregnancy, the doctor might decide to induce labor and delivery. After the delivery, the doctor will have the baby and the placenta examined to help determine the cause of death if it’s still unknown.

If you’ve had several miscarriages, you may want to be evaluated to see if any anatomic, genetic, or hormonal abnormalities are contributing to the miscarriages.

Can Miscarriages Be Prevented?

Although miscarriages usually can’t be prevented, you can take precautions to increase your chances of having a healthy pregnancy:

• Eat a proper diet with plenty of folic acid and calcium.
• Take prenatal vitamins daily.
• Exercise regularly after you’ve gotten your doctor’s OK.
• Maintain a healthy weight (women who are overweight or too thin may be more likely to have miscarriages).
• Avoid drugs and alcohol.
• Avoid deli meats and unpasteurized soft cheeses such as feta and other foods that could carry listeriosis.
• Limit caffeine intake.
• If you smoke, quit.
• Talk to your doctor about all medications you’re currently taking. Unless your doctor tells you otherwise, many prescription and over-the-counter medicines should be avoided during pregnancy.
• Avoid activities that could cause abdominal trauma.
• Get immunized against communicable diseases and know your family medical and genetic history.
• Go to all of your scheduled prenatal appointments and discuss any concerns with your doctor.
• Call your doctor right away if you have fever, feel ill, notice decreased fetal movements, or are having bleeding, spotting, or cramping.

Trying Again

If you’ve had a miscarriage, it’s important to take time to grieve. The loss of a baby during pregnancy is like the loss of any loved one. Give yourself time to heal emotionally and physically. Some health care providers recommend that women wait one menstrual cycle or more before trying to get pregnant again to give their bodies and psyches time to heal.

Some other things that can help you get through this difficult time:

• Attend a support group. Ask your doctor about local support groups for women who are trying again after a loss.
• Find success stories. Other women who have had a successful pregnancy after having a miscarriage can be a great source of encouragement to you. Your doctor might be able to give you the name of someone to talk with.

During future pregnancies, it can help to:

• Request frequent prenatal visits. Even if you aren’t medically high-risk, when you do get pregnant, ask your doctor if you could schedule prenatal appointments more often for your own peace of mind.
• Be proactive. The more you know about the medical aspects of your pregnancy, the better you’ll be able to discuss treatment options and outcomes with your doctor.
• Monitor the baby’s movements. If you’re far enough along — usually between 18 and 22 weeks — to feel kicks and jabs, keep a log of the baby’s activities each morning and night and report any abnormalities or lack of movement to your doctor. If your baby isn’t moving, eat or drink something sugary and lie down on your side. You should feel at least 10 movements in a 2-hour period. If you don’t, call your doctor immediately.
• Try not to compare. No two pregnancies are exactly alike, so try not to dwell on any similarities between this pregnancy and the one that ended in a loss.
• Stay positive. Remember that before long, the lost pregnancy will be a distant memory and that there is a good end in sight.

Puberty is when kids develop physically and emotionally into young men and women. Usually, this starts to happen in adolescence — no earlier than about 7 to 8 years of age in girls (the average age is about 10) and 9 years of age for boys (the average age is about 11).

But what if a younger child — for example, a 5-year-old girl — begins showing the signs of puberty? How would it affect her?

Precocious puberty — the onset of signs of puberty before age 7 or 8 in girls and age 9 in boys — can be physically and emotionally difficult for kids and is sometimes the sign of a health problem.

Signs of Precocious Puberty

In girls, the telltale signs of precocious puberty include any of the following before 7 or 8 years of age:

• breast development
• pubic or underarm hair development
• rapid height growth — a growth “spurt”
• start of menstruation (her period)
• acne
• “mature” body odor

In boys, the signs of precocious puberty before 9 years of age include:

• enlargement of the testicles or penis
• pubic, underarm, or facial hair development
• rapid height growth — a growth “spurt”
• voice deepening
• acne
• “mature” body odor

Many kids who show some of the early signs of puberty have what’s known as “partial” precocious puberty. Some girls, usually beginning between the ages of 6 months and 3 years, may show breast development that later disappears or may last without other physical changes of puberty.

Similarly, some girls and boys may have early growth of pubic and/or underarm hair that isn’t related to other changes in sexual development.

Kids with “partial” precocious puberty may need to see their doctor to rule out “true” precocious puberty or other health problems. But most need no treatment and usually will show the other expected signs of puberty at the usual age.

How Precocious Puberty Affects Kids

When puberty ends, growth in height stops. Because their skeletons mature and bone growth stops at an earlier age than normal, kids with precocious puberty usually don’t reach their full adult height potential. Their early growth spurt may make them initially tall when compared with their peers, but they may stop growing too soon and end up at a shorter height than they would have otherwise.

Going through puberty early also can be difficult for kids emotionally and socially. For example, girls with precocious puberty may be confused or embarrassed about physical changes such as getting their periods or having enlarged breasts well before any of their peers. But the hardest part may be the teasing that kids with the condition — especially girls — may experience.

Even emotions and behavior may change in kids with precocious puberty. Girls can become moody and irritable. Boys can become more aggressive and also develop a sex drive inappropriate for their age.

Causes of Precocious Puberty

The onset of puberty is normally triggered by the hypothalamus (the area of the brain that helps control pituitary gland function). It signals the pituitary gland (a pea-sized gland near the base of the brain) to release hormones that stimulate the ovaries (in girls) or testicles (in boys) to make sex hormones.

Sometimes, precocious puberty stems from a structural problem in the brain (such as a tumor), brain injury due to head trauma, an infection (such as meningitis), or a problem in the ovaries or thyroid gland that triggers the onset of puberty ahead of schedule — but this usually isn’t the case.

For the majority of girls, there’s no medical problem at fault — they simply start puberty too early for no known reason.

In boys, the condition is less common and more likely to be related to another medical problem. And for about 5% of boys, precocious puberty is inherited. (Less than 1% of girls with precocious puberty have inherited the condition.) Early puberty can be passed to a son by his father or to the son from his maternal grandfather through his mother (who will not be affected by the disorder).

Diagnosing Precocious Puberty

Talk to your doctor if your child shows any signs of early sexual maturation (before age 7 or 8 in girls or age 9 in boys), including breast development, rapid height growth, menstruation, acne, enlarged testicles or penis, or pubic or underarm hair.

The physical changes boys and girls go through during puberty are usually evident to a doctor during an exam. To confirm a diagnosis of precocious puberty, the doctor may order blood and urine tests to look for high levels of sex hormones. And X-rays of your child’s wrist and hand can show whether the bones are maturing too rapidly.

Imaging and scanning tests such as CT scans, MRIs (magnetic resonance imaging), and ultrasound studies can help rule out specific causes of precocious puberty, such as a tumor in the brain, ovary, or testicle.

Treatment for Precocious Puberty

If your doctor thinks that your child has precocious puberty, he or she may refer you to a pediatric endocrinologist (a doctor who specializes in growth and hormonal disorders in children) for further evaluation and treatment.

Once precocious puberty is diagnosed, the goal of treating it is to stop or even reverse sexual development and stop the rapid growth and bone maturation that can eventually result in adult short stature.

Depending upon the cause, there are two possible approaches to treatment:

1. treating the underlying cause or disease, such as a tumor
2. lowering the high levels of sex hormones with medicine to stop sexual development from progressing

Sometimes, treatment of a related health problem can stop the precocious puberty. But in most cases, no other disease is triggering the condition, so treatment usually involves hormone therapy to stop sexual development.

The currently approved hormone treatment is with drugs called LHRH analogs — synthetic hormones that block the body’s production of the sex hormones that cause the early puberty. Dramatic results are usually seen within a year of starting treatment with an LHRH analog, which is generally safe and usually causes no side effects in kids.

In girls, breast size may decrease — or at least there will be no further development. In boys, the penis and testicles may shrink back to the size expected for their age. Growth in height will also slow down to a rate expected for kids before puberty. A child’s behavior usually becomes more age-appropriate, too.

Caring for Your Child

Give your child a simple, truthful explanation about what’s happening. Explain that these changes are normal for older kids and teens, but that his or her body has started developing a little too early. Keep your child informed about treatment and what can be expected along the way.

Also be sure to watch for signs that teasing or other difficulties associated with precocious puberty may be affecting your child’s emotional development. Common warning signs to discuss with your doctor include:

• poor grades
• problems at school
• loss of interest in daily activities
• depression

How you cope with the issue can also determine how well your child will cope. The goal is to prevent kids from dwelling on sexual development or developing a poor self-image or low self-esteem. To create a supportive environment, try not to focus your comments on appearance. Instead, offer praise for achievements in school or sports and support your child’s participation in other activities.

The important thing to remember is that kids with precocious puberty can be treated. Doctors can help them preserve their adult height potential as well as limit the emotional and social difficulties they may face from maturing early.

For most boys, talking seriously about their private parts can be a little embarrassing. And for teen boys, the topic is strictly off-limits — especially in front of their moms. But if you have a son, it’s important that he knows to tell you or a health care provider if he ever has genital pain, especially in his scrotum or testes.

Genital pain is usually nothing more than a mild, brief discomfort. But when it’s more painful, it can be caused by a very serious condition called testicular torsion. Testicular torsion is a medical emergency that usually requires immediate surgery to save the testicle.

About Testicular Torsion

Testicular torsion (also called testis torsion) happens when the spermatic cord that provides blood flow to the testicle rotates and becomes twisted, usually due to an injury or medical condition. This cuts off the testicle’s blood supply and causes sudden, severe pain and swelling.

Testicular torsion requires immediate surgery to fix. If it goes on too long, it can result in severe damage to the testicle and even its removal.

Torsion can happen to males of any age, including newborns and babies, but is most common in 10- to 25-year-olds and teens who’ve recently gone through puberty.

Causes

The scrotum is the sack of skin beneath the penis. Inside the scrotum are two testes, or testicles. Each testicle is connected to the rest of the body by a blood vessel called the spermatic cord.

Testicular torsion is when a spermatic cord becomes twisted, cutting off the flow of blood to the attached testicle.

Most cases of testicular torsion are in males who have a genetic condition called the bell clapper deformity. Normally, the testicles are attached to the scrotum, but in this condition the testicles aren’t attached, and therefore are more likely to turn and twist within the scrotum.

Testicular torsion also can happen after strenuous exercise, while someone is sleeping, or after an injury to the scrotum. Often, though, the exact cause isn’t known.

Symptoms

If your son has sudden groin pain, get him to a hospital emergency room as soon as you can. Testicular torsion is a surgical emergency — when it happens, immediate surgery is needed to save the testicle.

Because surgery may be necessary, it’s important to not give a boy with testicular pain anything to eat or drink before seeking medical care.

If your son has testicular torsion, he’ll feel a sudden, possibly severe pain in his scrotum and one of his testicles. The pain can get worse or ease a bit, but probably won’t go away completely.

Other symptoms:

• swelling, especially on one side of the scrotum
• nausea and vomiting
• abdominal pain
• one testicle appears to be higher than the other

Sometimes, the spermatic cord can become twisted and then untwist itself without treatment. This is called torsion and detorsion, and it can make testicular torsion more likely to happen again in the future.

If your son’s spermatic cord untwists and the pain goes away, it might be easy to dismiss the episode, but you should still call a doctor. Surgery can be done to secure the testicles and make testicular torsion unlikely to happen again.

Diagnosis

When you get to the hospital, a doctor will examine your son’s scrotum, testicles, abdomen, and groin and might test his reflexes by rubbing or pinching the inside of his thigh. This normally causes the testicle to contract, which probably won’t happen if he has a testicular torsion.

The doctor also might do tests to see if the spermatic cord is twisted, including:

• Ultrasound: High-frequency waves are used to make an image of the testicle and check blood flow.
• Urine tests or blood tests: These can help determine whether symptoms are being caused by an infection instead of a torsion.

Sometimes, a doctor will have to perform surgery to make a diagnosis of testicular torsion. Other times, when the physical exam clearly points to a torsion, the doctor will perform emergency surgery without any other testing in order to save the testicle.

Saving a testicle becomes more difficult the longer the spermatic cord stays twisted. The degree of twisting (whether it’s one entire revolution or several) determines how quickly the testicle will become damaged. As a general rule:

• within about 4-6 hours of the start of the torsion, the testicle can be saved 90% of the time
• after 12 hours, this drops to 50%
• after 24 hours, the testicle can be saved only 10% of the time

Treatment

Testicular torsion almost always needs surgery to fix. In rare cases, the doctor may be able to untwist the spermatic cord by physically manipulating the scrotum, but surgery usually is still needed to attach one or both testicles to the scrotum to prevent torsion from happening again.

Most torsion surgeries are done on an outpatient basis (with no overnight hospital stay). If your son has a torsion, he’ll be given a painkiller and a general anesthetic that will make him unconscious for the procedure.

Surgery consists of making a small cut in the scrotum, untwisting the spermatic cord, and stitching the testicles to the inside of the scrotum to prevent future torsions. Afterward, your son will be taken to a recovery room to rest for an hour or two before he’s released.

Following the surgery, your son will need to avoid strenuous activities for a few weeks, and if he’s sexually active, he’ll need to avoid all sexual activity. Talk to the doctor about when it will be safe for your son to return to his normal activities.

Testicle Removal

If a torsion goes on too long, doctors won’t be able to save the affected testicle and it will have to be removed surgically, a procedure known as an orchiectomy. Most boys who have a testicle removed but still have a viable testicle can father children later in life. However, many also opt for a prosthetic, or artificial, testicle a few months after surgery. This can help make some boys feel more comfortable about their appearance.

With newborn boys, saving the testicle depends on when the torsion happens. If it’s before a boy is born, it may be impossible to save the testicle. In this case, the doctor may recommend a surgery at a later date to remove the affected testicle. If torsion symptoms appear after a boy is born, the doctor may recommend emergency surgery to correct the testicle.

Don’t Ignore Symptoms

Boys need to know that genital pain is serious and shouldn’t be ignored. Ignoring pain for too long or simply hoping it goes away can result in severe damage to the testicle and even its removal.

Even if your son has pain in his scrotum that goes away, he still needs to tell you or a doctor and get checked out. A torsion that goes away makes him more likely to have another one in the future. Doctors can greatly reduce the risk of another torsion by performing a simple surgical procedure that secures the testicles to the scrotum.

If your son had a torsion that resulted in the loss of a testicle, it’s important to let him know that he can still lead a normal life, just like anyone else. The loss of one testicle won’t prevent a man from having normal sexual relations or fathering children.

Turner syndrome, a medical disorder that affects about 1 in every 2,500 girls, is a genetic condition in which a female does not have the usual pair of two X chromosomes. Girls who have this condition usually are shorter than average and infertile due to early loss of ovarian function.

About Turner Syndrome

Turner syndrome (TS) was first described in 1938 by Dr. Henry Turner, an endocrinologist, who noted a set of common physical features in some of his female patients. It is the result of a chromosomal abnormality in which a female infant is born with only one X chromosome (instead of two) or is missing part of one X chromosome.

In most cases, untreated females with this disorder are short in stature (average final adult height is 4 feet 7 inches) and may have a variety of related physical features and medical problems.

Because females with TS don’t have proper ovarian development, they usually don’t develop all of the secondary sexual characteristics (the physical changes or features that usually develop at puberty) during adolescence and are infertile (the inability to become pregnant) as adults. However, advances in medical technology, including hormonal therapy and in vitro fertilization, can help women with this condition.

Other health problems that may happen with TS include kidney and heart abnormalities, high blood pressure, obesity, diabetes mellitus, vision problems, thyroid problems, and abnormal bone development.

Girls with TS usually have normal intelligence, but some may experience learning difficulties, particularly in mathematics. Many also have a problem with tasks requiring spatial skills, such as map reading or visual organization. Hearing problems are also more common in girls with Turner syndrome.

Although they aren’t at increased risk for psychological problems, some girls do have problems with body image or self-esteem and some also might be hyperactive.

Despite these physical differences and other problems, with appropriate medical care, early intervention, and ongoing support, a girl with Turner syndrome can lead a normal, healthy, and productive life.

Diagnosing Turner Syndrome

During a physical examination, a doctor may look for certain physical features of Turner syndrome, which can include:

• short stature (below-average height)
• “webbing” of the skin of the neck (extra folds of skin extending from the tops of the shoulders to the sides of the neck)
• a low hairline at the back of the head
• low-set ears
• abnormal eye features, including drooping of the eyelids
• abnormal bone development, especially the bones of the hands and elbows
• a lack of breast development at the expected age (usually by age 13)
• an absence of menstruation (amenorrhea)
• a larger than usual number of moles on the skin

Girls with TS can vary widely in their characteristics or symptoms. Some have many features or symptoms; others have only a few.

A special blood test that looks at chromosomes — a karyotype — is used to diagnose Turner syndrome. Several physical characteristics may be noted at birth, which can alert a doctor to the possibility of TS and prompt him or her to order a karyotype. Results that indicate Turner syndrome show 45 chromosomes instead of the normal 46. In some girls with TS, two X chromosomes are present, but one is misshapen or missing a piece.

Treating Turner Syndrome

Because TS is a chromosomal disorder, there’s no cure for the condition. However, a number of treatments can help:

• Growth hormone, either alone or with other hormone treatment, may improve growth and will usually increase final adult height — often into the normal range if treatment is started early enough. The U.S. Food and Drug Administration (FDA) has approved growth hormone for the treatment of Turner syndrome, and most insurance plans now cover this special treatment.
• Estrogen replacement therapy is often started when the girl reaches 12 or 13 years of age to stimulate the development of secondary sexual characteristics (breast development and menstrual periods). This therapy will not reverse infertility, however.
• Cardiac surgery may be necessary to correct specific heart defects.
• Recently developed reproductive technologies can help women with Turner syndrome become pregnant. Fertilized donor eggs can be used to create embryos, which can be inserted into the uterus of a woman with TS. With the help of hormone treatment, the woman can carry a developing fetus to term.

Learning Differences

Most girls with Turner syndrome have normal intelligence. However, some have learning problems, and early consultation with a developmental pediatrician may help them.

Girls with TS can be screened to determine whether cognitive problems may affect their education. Also, a special set of tests (called psychoeducational evaluation) can identify specific problems. A girl’s doctor can help determine whether this testing is appropriate for her.

The Turner Syndrome Society of the United States stresses the importance of assessing a girl’s intellectual, learning, motor skills, and social maturity before enrolling her in kindergarten. If learning problems are identified, early preventive and intervention strategies, if needed, can help.

If Your Daughter Has TS

Although your daughter may have specific medical problems and different physical characteristics due to Turner syndrome, you can do many things to help her develop daily living skills and cope with new or challenging situations. Note: height-related issues may be less important to girls who have improved growth with growth hormone treatment.

• Follow her lead regarding how much information she wants to share with others. Make sure she knows the facts and then allow her to explain TS to her friends and relatives, if she wants.
• Treat her according to her age (not her size) when considering the amount of responsibility given to her and the types of social activities she enjoys.
• Arrange your home so that it’s comfortable for her (provide sturdy footstools in the bathroom and kitchen and easy access to clothing, closets, personal care items, and other necessities). Kitchen chairs or stools that have rungs are especially helpful, as it can be tiring for her if her feet don’t reach the floor.
• Carefully assess her classroom environment. Ask for help from teachers to provide appropriate accommodations in the classroom so that she can reach water fountains, classroom materials, and supplies. The same suggestions apply to the school’s library and gymnasium.
• Help her cope with new situations and encourage her to ask her friends for help, too.
• Compliment her often on her strengths and coping skills. Be patient, positive, and open to discussions about her limitations and fears.
• Allow her to try on different clothing styles until she finds what flatters her or suits her personality. This can help build a more positive body image and self-esteem.
• Encourage participation in activities in which height isn’t an issue, such as skating, diving, horseback riding, babysitting, or volunteer work. Volunteering, in particular, can be a big confidence booster.
• If she is depressed or having problems with her self-esteem, consider counseling and treatment by a mental health professional. Don’t ignore your gut instinct if you think she’s sad or withdrawn.
• Take care of yourself. You won’t be able to provide good care for your daughter if you neglect your own needs. Your community may offer TS support groups or you may want to join the Turner Syndrome Society of the United States. Or consider starting your own support group for parents.

Remember that although Turner syndrome can affect your daughter in many ways, it’s only a small part of her total physical, emotional, and intellectual being.

Don’t hesitate to enlist the help of her doctor, developmental pediatrician, or other medical specialists and mental health professionals. And don’t let your daughter’s diagnosis or medical problems define who she is.

Yeast infections (also known as candidiasis) are common infections caused by candida albicans, a type of fungus.

Yeast infections usually happen in warm, moist parts of the body, such as the mouth, and moist areas of skin. When an infection is in the vagina, it is known as vulvovaginal candidiasis. Vaginal yeast infections are common among growing girls, and about 75% of all females will have one at some point in their lives.

Vaginal yeast infections can cause pain, itching, redness, a thick white vaginal discharge, pain during urination (peeing), and sometimes whitish patches on the skin of the vaginal area. Yeast infections often can be prevented by keeping the vaginal area clean and dry.

If your daughter has a vaginal yeast infection, her doctor can prescribe proper treatment that can clear up the symptoms in a couple of days and cure the infection within a week.

Causes

Candida is normally found in small amounts on the skin and inside the mouth, digestive tract, and vagina without causing a problem. The amount of candida in a person’s body is kept under control by a healthy immune system and some “good” bacteria.

Symptoms appear when the candida in the body overgrows and leads to an infection. For example, if someone’s immune system is weakened (due to an illness or medicines like chemotherapy or steroids), candida in the vagina can multiply and cause symptoms of a yeast infection.

Sometimes candida overgrowth happens after a girl has taken antibiotics for a bacterial infection (such as strep throat) because antibiotics can kill off the “good” bacteria that keep the candida from growing. Yeast also can overgrow if a girl’s blood sugar is high. Girls who have diabetes that isn’t controlled are more likely to get yeast infections.

Yeast can thrive in moist, dark environments, so clothing (especially underwear) that is too tight or made of materials like nylon that trap heat and moisture might lead to yeast infections.

As girls mature and go through puberty, hormonal changes can make them more at risk for yeast infections — sometimes, girls get yeast infections right before their menstrual periods. Pregnant women are also more prone to yeast infections. Young girls who haven’t gone through puberty yet are less likely to get yeast infections, but they can happen. So if your young daughter complains of itching or discomfort in her vaginal area, it’s important to talk with her doctor.

Yeast infections can happen to any girl, and they’re not considered sexually transmitted infections — although they may be able to be spread from one sexual partner to the other.

Prevention

For most girls, there’s no way to prevent yeast infections. Girls may feel more comfortable and have less irritation if they wear breathable cotton underwear and loose clothes and avoid vaginal sprays and douches. But there is no scientific proof that doing these things prevents yeast infections. If your daughter has diabetes, keeping her blood sugar levels well controlled will help her avoid getting yeast infections.

If you think your daughter has an infection, call your doctor for advice. Don’t give her leftover antibiotics or someone else’s antibiotics or medicine because these may be the wrong choice for your daughter’s condition. And taking antibiotics when they are not needed can make yeast infections more likely.

Treatment

If your daughter is having any symptoms of a yeast infection, like itchiness or abnormal vaginal discharge, she should see her doctor or gynecologist. Other infections can cause similar symptoms but require different treatments. The doctor might take a urine sample (to rule out a urinary tract infection (UTI)) and swab some discharge from your daughter’s vagina to examine under a microscope.

If she does have a yeast infection, her doctor can prescribe a medicine to take by mouth or a vaginal cream, tablet, or suppository that will quickly clear up the symptoms in a few days and the infection within a week. Anyone using a vaginal treatment should abstain from sex until the infection has been completely treated — these medicines can weaken condoms and diaphragms.

If your daughter is not feeling better within a few days of finishing treatment, call the doctor.

As girls grow into teens, it’s important that they receive appropriate medical care. The American College of Obstetrics and Gynecology (ACOG) recommends that young women have their first visit with an obstetrician-gynecologist (OB/GYN) between the ages of 13 and 15.

For most teens, the first visit will include an external examination of the genitals but not an internal examination of the reproductive organs, which is recommended beginning at age 21 for healthy women. However, if your daughter has abnormal vaginal bleeding, painful periods, unusual vaginal secretions, or other problems that may be associated with her reproductive health, she may need a pelvic exam sooner.

The idea of seeing a gynecologist or having a pelvic exam can make a girl feel nervous, embarrassed, or scared. By explaining why the visit is necessary, giving your daughter a sense of what to expect, and addressing any questions or fears she might have, you can help her feel more comfortable about taking this step.

Explaining the Importance of the Visit

Chances are, your daughter has associated visits to the doctor with health problems. She may not understand why she would go to the doctor when she feels perfectly fine.

Explain that the visit serves at least three main purposes:

1. Information. She can get accurate information and confidential answers to any questions she may have concerning sex, sexuality, her changing body, and menstruation.
2. Prevention. She can learn about pregnancy prevention, sexually transmitted diseases, and healthy lifestyles.
3. Treatment. For girls who experience missed periods, pain, or other reproductive problems, the doctor can look into why the problems are occurring and offer treatment.

Also, you may want to reassure your daughter that even though there are a lot of different parts of the gynecological visit, the actual physical exam — and the part she might feel most uncomfortable about — doesn’t take long.

Selecting a Health Practitioner

The doctor or nurse practitioner that your daughter sees should be someone who takes the time to make her feel as comfortable as possible. Though you have probably been the dominant force in making your daughter’s health decisions up until now, it’s wise to involve her in this one.

Here are some ways to consider your daughter’s preferences:

• Ask your daughter what type of health professional she would prefer. A male or female? Someone who is younger or older? In some cases, she might be able to stick with the pediatrician or family physician she has seen before. If either of you would like to move on, though, you have a variety of health professionals to choose from: adolescent medicine specialists, gynecologists, or nurse practitioners trained in gynecology.
• Before sending your daughter to the health professional that you use, check to see if she is comfortable with that. Some girls might be hesitant to confide in someone who has a connection to their mother.
• Ask her if she would like you to be in the exam room with her. Whatever your daughter decides, allow her some time alone with the doctor or nurse practitioner. You want your daughter to be completely honest with the doctor, not withhold information that she is too embarrassed to share in your presence. In addition, alone time will allow her to recognize the doctor as an objective and knowledgeable person to talk to about any concerns she may have in the future.

Your needs are important, too — you should trust this person with giving your daughter appropriate information about important decisions in her life.

Matching a Health Practitioner to Your Family’s Needs

Once you have your daughter’s input, use these suggestions to find a doctor who best fits your family’s needs:

• Get a referral. Ask your pediatrician or family doctor for recommendations. If you have close friends who have recently taken a daughter to the gynecologist for the first time, ask them if they liked their health professional. If there is a particular hospital or practice you prefer, see a physician or nurse practitioner associated with that facility.
• Ask questions. Ask about the health professional’s confidentiality policy. This may affect how open your daughter is during the visit. Most offices will not share the details of the visit with the parent unless the patient says it’s OK or if the physician feels that the child may be engaged in an activity that could be harmful. Also, different states have different rules with regard to confidentiality.

Other questions you may want to ask:

• Are you board certified?
• What is your approach toward discussing sexual activity?
• Do you have experience with first-time patients and teens?
• Will you be the health professional to see my daughter every time she goes or will she see different providers?
• Who else will be in the examining room?

Share the answers to these questions with your daughter. And don’t hesitate to interview several health practitioners before deciding on the best fit.

The Medical History Talk

Your daughter should be prepared to answer questions the doctor asks relating to her medical and reproductive history, including:

• When was your last period?
• Are you, or have you ever been, sexually active (meaning vaginal, oral, or anal sex)? If so, are you using birth control and STD protection?
• Are you having any problems with your period, such as pain or heavy bleeding?
• Do you have any worrisome discharge, sores, itchiness or discomfort in the vaginal area?
• Do you think you could be pregnant?

Through this discussion, the doctor will decide which tests to run and what issues to discuss. Stress to your daughter the importance of answering these questions truthfully, even though she might feel uncomfortable about it. For example, the health professional can help determine, based on your daughter’s sexual history, whether she is at risk for sexually transmitted diseases (STDs). If she is, the doctor will know to test for them.

Encourage your daughter to ask any and all questions she has — no matter how stupid or embarrassing she fears they may be. Let her know that nothing she says will be something that the doctor or nurse hasn’t heard before or will share with anyone else. Remind her that this information is confidential.

The Physical

Your daughter has probably experienced a physical before, so most of this will be familiar territory for her.

One of the health care workers, probably an assistant or nurse rather than the doctor, will measure your daughter’s vital signs, including weight and blood pressure. The doctor may examine her neck, breasts, heart, lungs, and abdomen. Your daughter may also provide a urine sample.

This examination gives the doctor background on your daughter’s general health and a baseline to use for comparisons in future exams.

The Breast Exam

Though breast cancer is very rare in teens, the breast exam is still an important part of a GYN visit. During this part of the exam, the doctor or practitioner will do a breast exam to make sure that your daughter is developing normally and to detect lumps, cysts, or breast problems.

The External Examination

Before the exam, try to give your daughter a sense of what will happen in the exam room. It’s important for your daughter not only to know what to expect, but why the doctor is doing it and how any discomfort she is feeling can be minimized. If applicable — and both of you are comfortable with the idea — consider letting your daughter see these steps firsthand by sitting in on one of your exams.

If she hasn’t already, your daughter will undress and put on an examination gown. Her pelvis and thighs will be draped with a sheet. She may be asked to lie on the table with her knees bent and spread apart. The doctor may have her place her feet in stirrups. In this position, the doctor will check the vulva (the external genitalia).

The purpose of this part of the exam is to make sure there are no sores, swelling, or any other problems with the external genitalia.

The Internal Examination

If an internal pelvic exam is needed, the doctor will place one hand on the outside of your daughter’s abdomen and one or two fingers inside the vagina.

The clinician’s hands are used to feel the size and position of the ovaries and uterus. An instrument that opens the vaginal walls (speculum) allows the doctor to visually examine the walls and cervix and to perform screening tests, such as a Pap smear and tests for some STDs.

Let your daughter know that she may feel some pressure, but this shouldn’t hurt. She may be able to decrease any discomfort by taking slow, deep breaths and relaxing her stomach and vaginal muscles. In addition, the clinician will likely make efforts to make her feel more comfortable by starting up a conversation or having interesting posters in the room to look at.

The Pap Smear

During the internal exam, the doctor or nurse may take a Pap smear. Gynecologists recommend a Pap smear beginning at age 21, and then typically every 3 to 5 years.

In a Pap smear, cells are gently scraped from the cervix using a small brush and a small spatula. The specimen is sent to a lab to check for abnormal cell changes and cervical cancer.

The practitioner may recommend the human papillomavirus (HPV) vaccine. This vaccine protects against the main types of HPV that cause genital warts and certain types of cancer, especially cervical cancer. Even if your daughter receives the HPV vaccine, she should still get regular Pap smears beginning at age 21 to screen for forms of cervical cancer not covered by the vaccine.

Sexually Transmitted Diseases Testing (Optional)

Testing for STDs is not automatically included in a gynecological exam. However, girls who have been sexually active should be tested for STDs. Some STDs can be tested for with blood or urine tests. Sometimes, the clinician obtains a sample with a cotton swab (just like during the Pap smear) during a pelvic exam.

The samples are sent to a lab, where they are tested for STDs like gonorrhea and chlamydia. When talking to your daughter about whether she should get tested, it’s important that she know that vaginal intercourse isn’t the only way to contract these infections — they can be passed through oral and anal sex as well.

The office staff can let you know different options for your daughter to get the results confidentially. For instance, instead of calling the patient or sending a letter with the results, some offices require the patient to call in.

Once you and your daughter have gone to the first visit, encourage her to talk about the experience (as much as she is comfortable). If she indicates that the doctor or nurse practitioner made her feel uncomfortable, discuss finding a new one. Once she starts, your daughter should continue to go for gynecologic visits every year to keep her informed and healthy.