Despite all enlightenment, even today numerous women shy away from the necessary visit to the gynecologist in their own interest. Even many mothers unfortunately lack insight for the necessary control after a delivery and miss the obligatory follow-up examination out of carelessness or false shame. But if even the daughter at a young age complains of abdominal discomfort or has vaginal discharge, then, unfortunately, the shyness of a visit to the doctor usually prevails, because the mothers from outdated ideas believe they should be ashamed of their child.
No shame at the gynecologist
Despite all the education, even today numerous women shy away from the visit to the gynecologist, which is necessary in their own interest. Perhaps some of them just force themselves to a bashful inquiry in the medical consultation, what “that” has to mean, or whether one should do something “against it”. But we can’t help like that. As before any treatment, the doctor himself must make the diagnosis, disease must be researched for its causes. This is especially true of vaginal discharge (fluorine), which is not a self-contained clinical picture, although it has long been a concern for us gynecologists and occurs in more than 50 percent of our patients. There are numerous causes for the occurrence of fluorine, and it is absolutely necessary to find out the specific one among numerous possible origins. This already shows that no universal remedy for the discharge can and must be prescribed, that each treatment must be adapted to the individual circumstances of each patient. This is true not only for the adult, but also for the child. Therefore, the attitude that one cannot bring a child to the gynecologist is completely untenable. Even though in many cases infantile discharge is an everyday matter that is not particularly tragic, it must still be investigated and treated by a doctor early, seriously and consistently.
Vaginal disorders in children and adolescents
Even in newborn girls, we can often observe a white mucous secretion, similar to a jelly-like mass, on the external genital area in the first few days, which is similar to vaginal discharge in later years. This is a mild, natural inflammation with shedding of the finest surface cells as the maternal hormonal effect subsides, which can also quite sporadically cause sparse bleeding from the vagina or from the uterine lining of the child towards the end of the first week of life. The actual fluorine occurring in infants and later is an increased secretion of fluid from the area in front of the vaginal entrance (vulva), from the vaginal mucosa or from parts of the uterus. It must be borne in mind that the vaginal mucosa is normally never dry and is germy from the hymen (hymen) up to the outer cervix and the vaginal vaults, even in a healthy state. Only from the cervix upwards does an actually germ-free zone begin, as long as no diseases or pregnancies have altered the balance of the vaginal secretion. The presence of vaginal bacteria is by no means pathological. These germs, also called “Döderlein bacteria” after their discoverer as well as their form, belong to the lactic acid bacteria, which produce fermentation lactic acid from the starch portions of decaying cells. However, starch, vaginal bacteria and lactic acid together with fluid secretion form the normal vaginal secretion in which most foreign bacteria perish. Therefore, one rightly speaks of an anatomical and functional protective mechanism of the vagina as a result of constant self-cleaning. Any shift within this bacterial flora leads to pathological manifestations and thus to discharge. Until the first years after the Second World War, before the widespread use of antibiotics, vaginitis caused by gonorrhea in infants and young children was at the forefront of childhood diseases of fluorine. Like gonorrheal ophthalmitis in infants, it can develop during childbirth if a woman suffers from unnoticed, untreated gonorrhea. This inflammation is seldom immediately noticeable in the newborn and usually does not appear until after about two to three weeks, and often not until the second year of life.Sometimes direct transmission of the infection is possible through the use of the same bathing sponges, the same bathing water or shared hand towels, although this route is less common. When fresh, the diagnosis of this disease will often be able to be made by the physician with the naked eye, even before the typical pathogens, gonococci, can be detected in the laboratory. The labia majora are reddened and covered with creamy, yellow-green pus; yellow patches are then found in the little girl’s laundry. If this inflammation remains unnoticed and untreated, it becomes chronic; the discharge subsides and is eventually hardly noticeable. It is also typical that before puberty, the child’s vaginal mucosa is particularly prone to inflammation, while in adult women it is primarily the urethral, uterine and rectal mucosa that is affected and the vagina itself remains insensitive. Another common pathological disorder is the so-called vulvitis simplex, a “simple” vaginitis in which only a slight watery-mucous discharge is observed. Even the inflammation appears little, and in particular the urethral orifice and mucosa are not involved in the redness. This is often a concomitant of congenital increased irritability of the skin and mucous membranes, so that at the same time eczema or itchy lichen appears on the rest of the body, mainly also in the folds of the groin. In this case, a predominantly herbal diet prescribed by the doctor will already bring about the decrease of the disorders. Purulent fluorine can also occur in the wake of acute infectious diseases such as diphtheria, measles, smallpox, typhoid, chickenpox or erysipelas. However, it subsides again when the disease is cured. Where locally irritating causes are added, for example worms, poor hygiene, scratching or onanism with unclean hands, vaginal discharge becomes more frequent and more noticeable. Foreign bodies in the vagina also promote phenomena of this kind. We find this even in two- to three-year-old girls, whose curiosity about their bodies is very great and who make small objects disappear during play, not only in their noses and ears. However, almost two thirds of cases of infantile fluorine are infections of the vaginal secretion by “everyday” germs, which are mostly harmless and can be treated in a short time. Finally, mild pubertal fluor may occur in older girls, which is usually also harmless. In this case, although quite isolated, other diseases can hide behind the discharge, for example, urogenital tuberculosis, so in general, at any sign of fluorine should immediately consult a specialist.
No danger for girls at the gynecologist
We can refute the fears that the gynecological examination is not yet reasonable for a child because it cannot be performed gently enough and involves injury to the hymen. In the case of very young children and infants, an ear funnel is sufficient to perform a certain assessment of the vaginal mucosa including the collection of secretions. Children can also be examined gently from the anus, which allows us to determine whether the organs in the pelvis are in order. Furthermore, very small special mirrors are available to the gynecologist for examining children, which are harmless and leave the hymen unharmed if the girl is relaxed and calm. In passing, however, the question may be asked as to what is more harmful to the child: a protracted condition with the danger of an inflammation rising to the fallopian tubes and thus later childlessness, or a possibly no longer preserved hymen, which today no one can make a prerequisite for marriage. In most cases, a very simple curative treatment frees the girl from her unpleasant suffering, for which the gynecologist can also enlist maternal help. Whether it is, for example, external ointment application, medicinal baths, taking certain medicines or instilling certain solutions into the vagina, must be prescribed by the specialist according to the particular condition. In general, the same principles apply to infantile fluorine as to adult women: early treatment, exact compliance with the doctor’s instructions, and punctual re-presentation at the consultation. In this way, the girls can be relieved of the by no means embarrassing condition.
