Adolescent Gynecology - A Comprehensive Guide

Introduction

The adolescent stage is an essential phase of human life. It is crucial regarding both psychological and physical changes that occur during this period. It is the junction period between childhood and adulthood. The effect of several hormones causes the changes that occur during this period. Gynecological changes in this period are numerous and most prominent. Also, several gynecological problems can manifest early symptoms during this period.

What Is Adolescence?

The transitional stage between childhood and adulthood is known as adolescence or puberty. A person between the age range of 10 to 19 years is known as an adolescent. The appearance of the primary (development of reproductive organs, starting of the menstrual cycle) and secondary (appearance of sexual characteristics like the development of breast, deposition of fat in the various parts of the body, and change in the voice) sexual characteristics is the most prominent clinical feature of the adolescence period. The crucial hormones in this period are estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).

Which Are the Stages of Adolescence?

Based on the appearance of the sexual features, the stages of adolescence are:

• Thelarche - The development of breasts characterizes the first symptom of puberty. The action of estrogen and progesterone hormones influence this.

• Pubarche - This phase is observed six months after the appearance of the first phase. In this phase, the development of pubic hair takes place. After two years of the appearance of pubic hair, axillary hair will begin to grow.

• Menarche - The onset of the menstrual cycle is seen during this period. This phase is influenced by the action of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This phase appears around 15 years which is three years after the larche.

What Is the Role of Hormones?

The role of hormones in adolescent gynecology are:

1. Estrogen - The ovary mainly secretes estrogen hormone. Apart from that adrenal gland (a gland situated above the kidney) and fat cells in the body produce this hormone. The functions of this hormone are:

• This hormone regulates the maturation and growth of the uterus and ovary.

• Development of the vagina and skin around it (known as labia majora and labia minora) is maintained by this hormone.

• Estrogen is responsible for ovulation (release of the egg).

• This hormone aids the development of breasts and the ductal system of the milk gland.

• The action of this hormone maintains the thickness of the epithelium of the uterus.

• Growth of hair in different parts of the body, like the pubic and axillary regions, is aided by the action of estrogen.

2. Progesterone - It is secreted from the corpus luteum (a group of cells formed inside the ovaries during the menstrual cycle), adrenal gland (a gland on the kidney), and placenta.

• This hormone regulates capillary growth during the menstrual cycle and blood flow.

• This hormone maintains immunity in the genital tract.

• This hormone regulates the implantation of the ovum.

3. Follicle-Stimulating Hormone (FSH) - It is secreted from the pituitary gland (a small gland located underneath the brain) in response to the gonadotropin-releasing hormone (GnRH) from the hypothalamus. The actions of this hormone are:

• The action of this hormone maintains the synthesis of estrogen and its level.

• The action of this hormone regulates the maturation of the ovarian follicle.

4. Luteinizing Hormone (LH) - Gonadotropin-releasing hormone (GnRH) stimulates the release of this hormone from the anterior pituitary.

• This hormone regulates the release of estrogen and progesterone.

• The action of this hormone regulates ovulation (release of the egg).

• This hormone maintains the development of corpus lutetium.

What Are the Gynecological Problems?

Hormonal factors mainly cause the disorders associated with the adolescent reproductive system. Other factors are also associated with this.

1. Vulvovaginitis - This is a common inflammatory condition of the vagina and vulva. This is caused by changes in the vaginal environment and acidity, resulting in bacterial and fungal infections. The responsible bacterias are - Gardnerella vaginalis, Prevotella, and Mobiluncus. It is characterized by the thin, grayish-white discharge from the vagina, elevated pH of the vagina, and presence of odor. Patients often complain of swelling of the vagina, redness, and itching sensations. Such complications can be treated by topical antibiotics such as Metronidazole gel 0.75 % nightly for five days or Clindamycin intravaginal cream 2 % nightly for seven days. Systemic administration (oral route ) of drugs like Metronidazole, Tinidazole can also be advised in severe cases.

2. Polycystic Ovarian Syndrome - This common condition affects around 4 to 6% of women worldwide. This is characterized by the formation of cyst-like structures in the ovary due to dysfunctional ovulation. This is characterized by oligoovulation (irregular and infrequent menstrual cycle), hirsutism (appearance of hair in unusual parts of the body), and alopecia ( thinning and loss of hair). This is caused by increased levels of testosterone in the blood. Also, the level of FSH in the blood is decreased, and the level of LH is elevated.

3. Amenorrhea - The absence of the menstrual cycle is known as amenorrhea. Primary amenorrhea is the total absence of the menstrual cycle. Tumor, infraction of the pituitary gland, or nutritional deficiency is responsible for this condition. In secondary amenorrhea, menstrual bleeding is absent for at least six months, but there was a previous history of normal bleeding. This is associated with dysfunction of the hypothalamus and pituitary gland caused by tumors or damage caused by thrombosis or hemorrhage.

4. Sexually Transmitted Diseases - Adolescents are unaware of safe sexual practices and protection during intercourse. Syphilis, gonorrhea, herpes, and human immunodeficiency virus infection are common sexually transmitted infections in adolescence.

5. Precocious Puberty - Early puberty is known as precocious puberty. This is associated with the mutation of the MKRN3 (a protein helping during the beginning of puberty) gene or tumors present in the hypothalamus.

Conclusions

Adolescence is the transition period of human life. Primary and secondary sexual characteristics are developed during this phase. Hormones play a crucial role in this process. Also, gynecological health depends upon safe sexual practice and maintenance of health and hygiene. Defects in the various hormone secretions cause various gynecological problems.