Better care for adolescents.

Focus in this discussion is on some approaches physicians and clinics in the US are using to meet the health needs of adolescent females. Attention is directed to problems prior to and at menarche menstrual problems sexuality contraception teenage pregancy and the legal aspects of adolescent health care. Among adolescents gynecologic disorders are frequently diagnosed late because physicians omit the reproductive tract in routine health assessments. Sometimes they have had little training in examining the young girls genitalia or are reluctant to perform such an examination because of parental concerns about inflicting emotional trauma. Elizabeth R. McAnarney M.D. of the University of Rochester Medical Center reports that many 10 to 12 year olds are brought for their 1st gynecologic visit because of a vaginal discharge that simply signifies increased estrogen secretion. Inadequate hygiene may be responsible for nonspecific infections. Dr. S. Jean Emans states that if vaginitis can be traced to a specific pathogen a careful history and search for signs of sexual abuse should be done. In instances of vaginal bleeding it is necessary to rule out such serious conditions as hypothyroidism ovarian tumors pituitary adenomas botryoid tumors or possibly adrenal tumors. The growing breast may become an area of concern particularly if development is assymmetrical. Occasionally breast pathology is found. The most common pathologic diagnosis found in biopsy specimens is fibroadenoma. Menarche usually occurs late in puberty on the average 2 years after breast budding. The gynecologist who sees adolescents should be able to identify normal pubertal variations and to discuss them from the perspective of growth and development. Most dysfunctional uterine bleeding (DUB) is anovulatory associated with variable bleeding patterns and usually due to estrogen withdrawal or estrogen breakthrough. Malignant disease is unlikely. Contributing causes can be psychiatric problems anorexia or a crash diet deficient in protein and vitamins B. The 1 diagnosis that should be considered when seeing an adolescent with amenorrhea is pregnancy. It is important to take advantage of every opportunity to provide teenagers with accurate information about human sexuality contraception and reproduction. Many experts advise that the best way to talk with adolescents about their sexuality is alone. Dr. J. Mostyn Davis suggests asking about dating before discussing coitus. Emans recommends asking about boyfriends and the decisions a girl has made about sex when taking a sexual and a menstrual history. When discussing contraception the physician should find out what the boyfriend thinks of birth control methods and if he has ever used a condom. Emans suggests talking about herpes and other sexually transmitted diseases. Using peers to counsel about contraceptives is 1 approach that may persuade more teenagers to use contraception.