Synechia of the labia in girls: how to recognize and how to treat. What is synechiae in girls: photos of the initial stage of the disease, treatment with conservative therapy and surgery

Fusion of the labia (adhesion, synechiae, clumping) is a very common and harmless condition among girls. Many doctors tell the mothers of such girls that the cause of fusion is poor hygiene and the presence of a sexually transmitted infection. But most girls have good care with respect to genital hygiene. Due to fears that their child has a defect in the development of the genital organs, parents agree to any surgical intervention.
Malformations of the external genitalia are extremely rare. If such a defect is excluded, the fusion of the labia sponges itself is not a dangerous condition for the child and does not threaten him with fertility problems in the future. Sometimes fusion of the labia minora can be accompanied by symptoms from the urinary system (in 20-40% of cases), especially when an infection is associated. Most often, fusion of the labia occurs in girls aged 6 months to 6 years.
Immediately after birth, girls’ labia are not closed, because some of the mother’s estrogen enters the girl’s body through the placenta. Over the course of 3-6 months, estrogen levels decrease. Against the background of low estrogen levels, under the influence of urine accumulated in pads and diapers, the skin of the labia minora becomes irritated, and they can stick together. Irritating factors include the following: urine, feces, infection, bubble baths, worms (pinworms), synthetic and perfume soaps and powders, contact dermatitis, tight underwear, trauma to the external genitalia. In some cases, the cause of sticking together of the labia may be trauma to the external genitalia as a result of sexual abuse (in the countries of the former Soviet Union the level of pedophilia has increased significantly).
What examination should be performed in girls with fusion of the labia minora?

The examination of such girls is very simple:
Examination by a pediatric gynecologist;
General urine analysis;
Analysis of feces for worms.

Other examination methods are very rarely used, depending on the complexity of the case.
If a fusion of the labia minora is detected in a girl, it is necessary to explain to the parents that as the child grows, the level of estrogen in the body will begin to increase, which will lead to spontaneous divergence of the labia minora. An examination by a pediatric gynecologist can rule out malformations of the reproductive system. According to many studies, independent divergence of the labia is observed in almost 95- 98% of girls without any treatment. Artificial separation of the labia minora in girls under 6 years of age should be carried out only in the presence of an inflammatory process in the bladder. Many doctors suggest not treating girls under 10 years of age if there are no complaints or signs of genitourinary infection. The girl must be examined every 6 months.
If parents insist on treatment, they need to be explained that there are conservative (medicinal) and surgical treatments. Often doctors themselves suggest surgical dissection of the labia, frightening parents with extremely negative consequences if treatment is not carried out immediately. However, practice shows that within 12-24 months of observation, most girls do not need treatment.
Surgical dissection of the labia should be performed with complete anesthesia, often with the use of anesthesia, otherwise the pain that the girl will experience will leave a huge negative mark on her life.
Inserting tampons (especially medicated ones) into the vagina after a surgical procedure is strictly not recommended. It is important to know that relapse occurs in 20% of cases.
Most doctors suggest using a conservative treatment method if necessary. For this purpose, estrogen cream is used, and the effectiveness of such treatment is 90%. Hormonal treatment is carried out for two weeks according to a specific scheme. Many girls experience a change in the color of the labia (pigmentation), swelling of the labia and perineum, swelling of the mammary glands, and very rarely, bloody discharge from the vagina.

Sticking of the labia minora to each other or with the labia majora, which occurs in girls at a younger age. Fusion of the labia minora may be asymptomatic or accompanied by impaired urine outflow, pain and discomfort during urination, vulvitis, and vaginal discharge. The diagnosis of fusion of the labia minora is made by examining the external genitalia; To determine the causes of the pathology, microflora culture, PCR and ELISA diagnostics, and stool analysis for dysbacteriosis and worm eggs are performed. Treatment of fusion of the labia minora includes local therapy with estrogen-containing creams and ointments, and, if necessary, surgical separation of the synechiae.

Symptoms of fusion of the labia minora

Fusion of the labia minora is asymptomatic in most cases. Externally, synechiae look like a thin translucent film of whitish-gray color, which connects the labia minora to each other at different lengths.

Fusion of the labia minora in a small area usually does not cause any discomfort in girls. With complete or almost complete fusion of the labia minora, a disturbance in the outflow of urine is observed, and straining during emptying is noted. Bladder, pain and discomfort when urinating; urinary retention behind the labia, decreased number of urinations.

A stream of urine pours upward and can wet the skin of the lower abdomen and underwear, resulting in urine irritation of the genitals and thighs, diaper dermatitis. When the labia minora fusion occurs against the background of an inflammatory process or an allergic reaction, redness and rashes on the external genitalia and vaginal discharge (leucorrhoea) may occur.

Fusion of the labia minora can progress, lead to improper formation of the perineum in a girl, be complicated by the development of recurrent vulvitis and vaginitis, and predispose in the future to impaired reproductive function (threat of miscarriage, spontaneous abortion, pathological childbirth, infertility).

Diagnosis of fusion of the labia minora

Fusion of the labia minora in girls can be diagnosed by visual examination of the external genitalia by a pediatric gynecologist or pediatrician, or by instrumental examination (vulvoscopy).

To determine the causes of fusion of the labia minora, microscopic examination of a smear, bacteriological culture for microflora, PCR and ELISA diagnostics of infections (chlamydia, mycoplasmosis, gonorrhea, trichomoniasis, CMV, HSV) can be prescribed. A child with a burdened allergy history is advised to consult a pediatric allergist-immunologist with the study of diagnostic panels and allergy tests.

To exclude concomitant diseases, a general blood and urine test, a blood test for sugar, a stool test for dysbiosis and worm eggs, and a scraping for enterobiasis are performed.

Treatment of fusion of the labia minora

Depending on the severity of the fusion of the labia minora, treatment can be carried out using conservative (medicinal) or surgical methods.

If the fusion of the labia minora is asymptomatic and there are no signs of inflammation, normal hygiene procedures and observation are indicated. There are cases of independent resolution of fusion of the labia minora by the time of puberty due to an age-related increase in the level of estrogen in the girl’s body.

Conservative treatment of fusion of the labia minora is more preferable; it includes local application of ointments and creams containing estrogen (for example, Ovestin) to girls over 1 year of age in courses of minimal duration. The ointment is applied to the fusion site carefully and without strong pressure, always after a hygienic toilet or bathing. Under the influence of estrogen, tissue loosens in the area of ​​fusion, which promotes the gradual separation of the labia minora and prevents them from sticking together again. The use of estrogen-containing creams does not have a systemic effect on the child’s body; in isolated cases, short-term changes may be observed (pigmentation of the vulva, the appearance of hairs, swelling of the mammary glands), which go away on their own after cessation of treatment. After a course of use, the cream containing estrogen is gradually replaced by a neutral baby cream that does not contain flavors or dyes. In case of previous infection of the genital or urinary organs, complex antibiotic therapy is carried out.

Surgical intervention is indicated only in advanced cases of fusion of the labia minora associated with impaired urination, severe urinary tract infection, or when conservative therapy is ineffective. Separation of synechiae of the labia minora is carried out under local or general anesthesia.

Surgical treatment of fusion of the labia minora is not very desirable, since it is accompanied by pain, discomfort during the healing and treatment of the vulva, the possible development of psychological trauma, and a high risk of relapse. To prevent relapse after surgery, the use of estrogen creams is indicated. A prerequisite for the effectiveness of treatment for fusion of the labia minora is constant hygiene.

Even with a successful result of treatment for fusion of the labia minora, the girl should be under the supervision of a pediatric gynecologist for a year to control the condition of the external genitalia.

Forecast and prevention of fusion of the labia minora

The prognosis for fusion of the labia minora with timely detection and proper treatment is favorable. It is possible to prevent fusion of the labia minora by observing the rules of personal hygiene. The girl should toilet the external genitalia in the morning, evening and after each bowel movement; It is necessary to wash the child in the direction from front to back; It is advisable to minimize the use of hygiene products (diapers, wet wipes, bubble baths, creams, powders, etc.), use gentle, dye- and fragrance-free detergents, toilet paper, and 100% cotton underwear. When a girl reaches the age of 1 year, a preventive visit to a pediatric gynecologist is necessary.

Somehow it just so happened that when it comes to the hygiene of boys, mothers have many questions. But with the girls, everything seems to be clear and understandable. However, everything is not so simple. We are talking about procedures that are aimed not only at maintaining cleanliness, but also at preserving reproductive health, first and foremost.

Features of intimate care for a newborn girl

After a mother and child return home from the maternity hospital, the issue of hygiene for a newborn girl falls entirely on her shoulders. Caring for a girl is indeed a responsible matter, it must be safe and well organized.

In the early postnatal period, girls' genitals and buttocks are in almost constant contact with urine and feces, making it difficult to keep these parts of the body dry and clean. Delicate skin reacts with redness, irritation, and rashes. And if the baby’s skin is hypersensitive, then this aggravates the problem.

Also, mommy should know that newborn girls do not yet have the protective barrier that an adult woman has, and due to the characteristically specific structure of the female genital organs, it is very easy to get infections and various diseases. In the future, this may negatively affect menstrual cycles, the course of pregnancies, and also reduce the possibility of pregnancy, etc.

However, the only thing worse than frequent washing is washing with soap.

Using Soap

Everyone knows that when we wash our face with soap, we try in every possible way to avoid getting it in the eyes or on the mucous membrane of the eyelids. We clearly understand that getting soap on the skin is normal, but not on mucous membranes. When you wash a girl with soap, the rule remains exactly the same: soap should not get on the mucous membranes. Everything that is deeper than the labia majora is the mucous membranes. Therefore, soap is used only for superficial treatment of the labia majora, and not deeper. If this rule is not followed, problems will arise.

It’s a paradox, but when a mother pays special attention to washing her daughter, when the girl is regularly washed with soap, then many more problems arise, and they arise much more often than when she is not paid such close attention.

Fusion of the labia

Another topic that is discussed so often on mom forums. There is a strong opinion floating around the Internet that this problem appears due to insufficient hygiene, due to the use of wet wipes, frequent or, conversely, infrequent washing, as well as the use of “wrong” care products, etc. So is this true or myths?

In the scientific world, the fusion or sticking together of the labia minora is called “synechia” (synechia is an anat. “commissure”).

What causes this problem?

In newborn girls, the condition of the mucous membranes of the genital organs depends on the amount of sex hormones (estrogens) in the blood, which they still have very little of. A low amount of estrogen in the blood is one of the main causes of sticking of the labia minora.

It is also believed that this problem can be caused by microtraumas of the delicate and thin vulva resulting from its mechanical damage during too vigorous washing. Microtraumas begin to heal, and the labia minora begin to grow together. Delicate washing will reduce the risk of such microtraumas.

Synechia or fusion of the labia minora is not a disease, but a physiological feature of girls six months and older, which occurs against the background of a lack of sex hormones estrogen

At what age does it start?

Remember: Synechia never occurs in girls under 6 months. Because they have their mother’s estrogens, which they received during pregnancy and childbirth. Then the problem arises, and, as a rule, its peak occurs between the ages of 1 and 3 years.

Interesting: according to medical textbooks, this phenomenon is observed in only 1.5-3% of girls. But in fact, in some clinics in our country the number of girls with synechiae reaches 30 and even 50%. That is, if you look very closely, synechiae can be found in almost any girl under 2 years of age.

It should be noted that synechiae is not a disease. This is a physiological feature of children of this age. No wet wipes or “harmful” care products affect its appearance.

When should you treat?

Very rarely, synechiae are of such severity that the labia minora completely grow together, which leads to difficulty in the outflow of urine. When this happens, urine accumulates in the vagina, leading to inflammation. This is what needs to be treated.

Main: if nothing bothers the child, there are no problems with urination, there is no itching, redness or discharge, nothing needs to be done. This is not a problem and no one is to blame. Don't be afraid that something will overgrow there. As soon as the baby begins to produce estrogens, with a probability of 80-90% everything will completely disappear. And in 20% you may need treatment for 2 weeks with a special ointment.

Important: even when synechiae are discovered, no one separates them with any instruments or fingers (especially without pain relief)! They are first treated with ointments containing estrogen, and only if the ointments are ineffective is mechanical separation resorted to.

Washing a girl: algorithm of actions

Intimate hygiene of a newborn girl is very important. You must remember this. Your daughter is also a future mother, and her reproductive health depends on your adequate actions and the right approach to the issue.

Washing girls is an important procedure. The intimate health of babies depends on this elementary action. Washing is done strictly from front to back - from the labia to the butt, so that feces do not get into the vagina

How to wash a girl:

1. Wash your hands before washing.
2. Turn on a stream of running water, not very strong. Check that it is neither cold nor hot.
3. The child's head should lie on the elbow, the body should lie on the forearm, fix one leg with your hand.
4. You should wash in the direction from the labia to the butt - from front to back, and in no case vice versa. You also need to rinse the inguinal folds and between the labia (shallow).
5. We wash without soap, but after defecation, you can use an intimate hygiene product intended for children under one year of age (with a neutral pH) to wash.
6. Next, you need to treat the genitals with sterile oil - olive or peach. Peach juice can be bought ready-made at the pharmacy, and olive oil can be sterilized in a water bath.
7. Leave 10-15 minutes for your baby to take an air bath. Don't wear a diaper, let your skin rest.

Adviсe:

• Use a minimum of cosmetic products in your care, as all this can lead to itching, redness, and allergic reactions.
• Wet wipes are a great modern invention, but they should also be used sparingly.

So, the hygiene of girls is an important and responsible issue. Specific knowledge from specialists will not hurt here, but you should not be guided by myths and advice from ignorant people. “Trial and error” methods will not work either - your baby still has to go through the process of “maturing” as a woman and becoming a mother. It is not difficult to remember and follow the hygiene rules described above. Let your little ones grow up happy and healthy!

A woman's reproductive health largely depends on how the girl was cared for in childhood. Gynecologists believe that little ladies could avoid many diseases in the future if their parents took a responsible approach to sexual hygiene. Caring for the genital organs of girls is more complex than that of boys, and in order to properly carry out hygiene procedures, as well as know when you need to see a doctor, listen to our advice. And one more thing: do not listen to the stories and advice of other mothers and your friends, as their daughters may have completely different problems.

A little anatomy

In girls, the distance from the entrance to the vagina to the anus is small, so intestinal microorganisms, if washing rules are not followed, easily enter the vagina, causing inflammation.

In addition, babies have a wide and short urethra (urethra), the external opening of which is open and also more accessible to infection.

The vaginal microflora in girls is significantly different from that in women and has a different pH value (an indicator of acid-base balance); Before puberty, babies do not have lactic acid bacteria in their vaginas that protect against infection, so the only protection should be proper care of their intimate areas. For the same reasons, medications and treatment methods for women (suppositories and douching) are not suitable for girls.

And although the baby has important anti-infective barriers (narrow entrance to the vagina, the presence of a hymen), the genitals, due to anatomical and physiological characteristics, until puberty (at this age estrogen begins to be produced, which supports protective microflora and stimulates local immunity in the vagina) have low resistance to various types of infections and, therefore, require especially careful but thorough care.

Intimate problems

In the first days after birth, vernix lubricant may accumulate in the folds between the labia, which will serve as a substrate for the proliferation of pathogenic bacteria, so it must be removed. Using a cotton swab or pad moistened with boiled water, carefully wash all the folds between the labia from front to back. If the lubricant is not completely removed, moisten a cotton swab with sterile vegetable oil (boil olive or sunflower oil for 15-20 minutes in a water bath) and use it to remove lubricant from all folds of the genital slit, also from front to back.

Redness in the area of ​​the external genitalia may indicate an infection that migrated to the baby from the mother while passing through the birth canal. If a genitourinary infection or thrush is not treated by the end of pregnancy, then during childbirth the baby will receive a fungal or bacterial infection instead of beneficial microorganisms. In addition, redness and itching of the external genitalia can be one of the manifestations of allergic diathesis.

Synechia- these are adhesions between the labia, they are detected in the first days of life. This is a congenital malformation that can cause acute urinary retention, which necessarily requires consultation with a pediatric surgeon, since surgical intervention may be necessary. At a later age, the formation of synechiae is most likely the result of a previous (or untreated) genital tract infection, as well as a congenital urinary tract infection. Yes, and the usual failure to comply with hygiene rules, improper washing, sometimes even irritation of the labia minora, caused by a wet diaper that was not replaced on time, can cause synechiae, because with inflammation, scars form and the edges of the labia minora grow together. Therefore, remember that even a small woman requires special care.

Leukocyturia is an increased content of leukocytes (blood cells) in the urine, which indicate an inflammatory process. Leukocytes can enter the urine not only from the urinary tract, but also from the vagina. In this case, a possible cause of leukocyturia may be gynecological infections in the mother, but more often everything is explained by non-compliance with the rules of sexual hygiene.

On the 3-4th day of life, babies experience colorless or grayish-white vaginal discharge, sometimes it can be bloody - these are manifestations of the sexual crisis of newborns. The absence of vaginal discharge may indicate a continuous hymen or fusion of the labia (congenital synechiae). On the contrary, discharge from the genital tract not during the period of sexual crisis (that is, in girls older than one month of age) should alert attentive parents. For example, a baby who has had a respiratory viral infection may experience vaginal discharge, but most likely, after 5-7 days it will stop on its own. Girls who are predisposed to infections of the ENT organs (otitis, sinusitis, pharyngitis) can quite often have discharge from their genital tract, because the mucous membrane is the same everywhere.

You may notice a whitish coating in the fold between the labia minora and labia majora - this is accumulated secretion from the sebaceous glands - a completely normal and harmless phenomenon. Plaque often remains even after washing: you just need to remove it with a cotton swab moistened with sterilized vegetable oil from front to back.

Your daughter needs to consult a pediatric gynecologist if she has:

Synechiae, both congenital and acquired (their treatment can be conservative and surgical).

Leukocyturia and bacteriuria.

Discharge from the genital tract not during a period of sexual crisis.

Redness of the skin or mucous membrane of the external genitalia.

Itching and burning of the genitals (itching can be guessed if the girl has become restless and often puts her hands in her diaper or panties).

Suspicion of abnormal structure of the genital organs.

Rules of sexual hygiene

Examine your daughter's genitals only with clean hands with short-cut nails and do not forget to wash your hands with soap before washing your baby.

It is advisable to wash the girl after each urination and always after each bowel movement under running water both from the tap and from a ladle in the direction from front to back. You need to hold the baby with her tummy up so that the water first washes the perineal area, and then the anus, flowing downwards. Before the age of one year, try to use only boiled water.

After bathing, washing, or changing a diaper, wipe all folds of the genital crevice with a cotton swab moistened with sterilized vegetable oil. Before bathing in the bath, be sure to wash your baby under running water.

In no case should you wash a girl after defecation by placing her in a basin or bathtub, since feces always contain a large number of microorganisms, which, if they enter the vagina, will quickly develop inflammation.

Do not use soap when washing your face: it dries out the skin, destroys the protective layer and can cause disruption of microbiocenosis. Use special pH-neutral baby soap once a week and, if necessary, after bowel movements. In this case, wash only the outer surfaces of the labia majora with soap, avoiding soap getting into the genital slit. Never use sponges and washcloths for washing - they injure delicate baby skin.

You should not use powder to treat the perineal area: the smallest particles of this product (and even more lumps) can scratch the delicate mucous membrane of the genital organs as a result of friction, especially under a diaper. You should absolutely not use powder if your baby is prone to skin irritations (atopic or diaper dermatitis, diaper rash and weeping).

Any moisturizer (milk, cream) is applied in a thin layer to the baby’s previously cleansed skin, i.e. after washing. In the genital area of ​​girls, the cream is applied to the outer surface of the labia majora, around the anus and on the buttocks. Use moisturizers only as needed so as not to disturb the natural oil balance of your baby's skin.

Note to parents

Sleeping with the baby in the parent's bed saves the mother a lot of energy, especially when breastfeeding. In this case, it is unacceptable for parents to sleep without underwear: even if you do not have any diseases, foreign flora is not good for the child. Remember: the baby should lie on her own diaper, and not on a sheet shared with her parents, and, of course, not naked.

The girl should always wear rompers or panties; do not leave naked a baby who is actively crawling or already walking around the apartment, because it will still not be possible to keep the house completely sterile.

Do not allow your child to be naked in the sandbox or on the beach: be sure to wear a disposable diaper, thick panties or tight shorts. Children's underwear should only be made from natural materials, since synthetic fabric does not provide healthy condition and comfort to the skin and mucous membranes of the genital organs.

The baby needs her own soap, washcloth and towel. Always wash children's underwear separately from adults, and underwear - separately from suits and overalls.

So, dear parents, be very careful about your baby’s sexual hygiene from birth. You now know the hygiene rules, follow them - it’s not difficult. And remember: the reproductive well-being of your daughter depends on your care, and you will enjoy your grandchildren in the future! Good luck!

Intimate hygiene for girls (just like intimate hygiene for boys) involves a certain daily ritual of washing, which helps maintain the natural cleanliness and health of perhaps the most vulnerable area on the baby’s body. Moreover: by properly caring for the baby’s genitals, you are essentially engaged in the most effective prevention of many “delicate” diseases that potentially threaten the young lady in the future.

The ritual of daily proper washing of a little girl is not only an obligatory part of caring for the baby, but also a guarantee of her future “intimate” health.

How often should a girl be washed?

In the case of newborns and infants up to one year old, it makes sense to wash the girl every time she “went to the toilet.” However, given the wearing of diapers and their excellent properties of quickly and reliably absorbing moisture, the optimal washing regimen for girls will be as follows:

• after every bowel movement(in other words, the girl went big);
• during an evening swim, just before bed.

And please don’t overdo it! There's no point in carrying your baby under the tap every time you just decide to change her diaper or give her a baby. In the case of intimate hygiene, excessive attention to washing is more likely to harm the girl’s health than to benefit it.

There are a huge number of beneficial bacteria that live on the mucous membranes. They are extremely small, but not insignificant. And many of them “walk” with us through life all the time that is allotted to us.

If we show excessive “washing” activity, we wash away these bacteria from the skin over and over again, thereby depriving ourselves of special unique protection. Simply put: we independently increase the risk of inflammatory and infectious diseases.

The same applies to the “depth” of the process. Remember: for a girl’s intimate hygiene, using soap or special wet wipes is only permissible on the area of ​​the outer labia, that is, on the outside.

The most common cause of vaginitis (inflammation of the vagina) in little girls is soap getting into the genitals. Without washing, soap causes irritation of the vaginal walls, and as a result, an inflammatory process occurs.

What products are included in a girl’s intimate hygiene arsenal?

The question of what should be used to wash a girl is no more important than knowing what not to wash her with. In general, the intimate hygiene of a baby is an area of ​​parental care in which moderation and regularity play key roles. Judge for yourself:

• The water should be running (if you draw water from a basin or any other container, then washing itself immediately loses all reason - you simply create a cycle of bacteria and dirt between your child’s perineum and the pelvis).
• The water temperature should be approximately equal to body temperature - 34-36 ° C.
• Regarding soap and other cosmetics, let us repeat once again: their frequent use causes more problems to a girl’s health than not using them at all. Any cleansing cosmetics (even the mildest, pH-neutral, etc.) are allowed in the genital area maximum once a day. And most likely this time happens during your evening swim. This means that the girl should be washed during the day without using any cosmetic products - soap, foam, gel, etc.
• If there is no running water nearby (you are on the road, visiting relatives in the village, etc.), you can use hygienic wet baby wipes. Moreover, they can only be used “unilaterally” - strictly in the direction from the pubis to the coccyx, and in no case vice versa. Otherwise, you will simply introduce dangerous bacteria onto the delicate mucous membrane of the genitals.
• Make sure that the napkins do not contain alcohol or antiseptics!

Most pediatric gynecologists agree that soap and other cosmetics can be used to wash a girl on average 2-3 times a week, not more often. The rest of the time, the main tool and means of hygiene is only warm running water.

If you decide to use a special cosmetic product or wet wipes for a girl’s intimate hygiene, make sure that your baby meets the age category indicated on the packaging - all products of this kind have significant differences in composition and are strictly divided by age audience - some are intended specifically for little ones girls, others for little boys, others for teenagers, others for adult women, etc.

If you decide to give preference to a simple bar of soap, then you should choose it wisely. It is best to choose regular (not bar, but liquid) soap intended for the hygiene of a child in the first year of life. It is these products that are subject to the highest production requirements - they do not contain dyes, they have an ideal pH, etc. Often this infant liquid soap is much more suitable for the intimate hygiene of a child of any age and even an adult than any other special product originally intended specifically for caring for the genitals.

Why is regular soap bad?

This paragraph is especially for those who believe that ordinary soap is quite suitable for intimate hygiene. And spending on a separate product “for tender places” is just a marketing gimmick and a pointless waste of money.
But no! In this case, buying a special product (namely, liquid soap for a child of the first year of life) is a completely reasonable and correct action.

Let's imagine that every time you wash your face with regular soap, in addition to your cheeks, chin and forehead, you thoroughly soap your wide-open eyes and mouth - from the inside. Do you think your mucous membranes of the eyes and mouth will like such “rough” treatment? The sensations will definitely be negative: expect burning, itching, drying out and a sharp increase in the number of bacteria. So why do you value your own cheeks, but don’t care about your daughter’s health?
After all, in a little girl, more than 85% of the genitals are made up of mucous membranes.

What to wear on sensitive areas?

Requirements for clothing in the genital area of ​​girls are the strictest.

• Clothes and underwear should not be allowed to be tight, or even worse, to squeeze the genital area.
• Materials are only natural, the best of all - one hundred percent natural cotton.
• It is advisable that the panties that the girl wears are white (this is especially true for very tiny girls, who are gradually weaned off wearing diapers and trained to use a potty and wear underwear). White means no dyes. The fact is that the dyes used in the production of fabrics are very mysterious in nature. By themselves, they can be completely harmless, but when mixed with human sweat, they can suddenly turn into serious allergens. There is no reason to take risks - it is wiser at first to simply use linen without dyes.

The role of diapers in girls' hygiene

Most pediatricians these days are sincerely grateful for the appearance of diapers on the Russian market. It would seem like such an insignificant wardrobe detail! But as is the case, in matters of intimate hygiene for girls, diapers play a significant positive role.

The fact is that the diaper prevents liquid feces from entering the vagina of a newborn girl. Namely, this is the main cause of severe infectious diseases in infant girls.

As soon as diapers “came into fashion,” the statistics on infectious diseases of the genital organs in girls under one year of age decreased several times.

In other words, let your baby wear a diaper, in the literal sense of the word, for health! And the grandmother, who always grumbles that her granddaughter “has a butt in this armor,” you don’t have to convince, but you shouldn’t rely on her outdated knowledge in this matter either.

Does proper hygiene help a girl avoid synechiae?

Let us explain: synechia of the labia is a fairly common physiological phenomenon (remember: this is not a disease!), the main feature of which is the sticking of the labia minora in infant girls.

The fact is that the work of the mucous membranes of the genital organs is determined by the amount of sex hormones in the blood. Little girls aged 6 months to about two years have very little female sex hormones (estrogens). This is why the mucous membranes of the genital organs often stick together (and in very rare cases can even grow together).

Synechia is never observed in babies in the first six months of life, because each girl receives a certain supply of estrogen at the time of birth - a kind of parting gift from the mother. After 2-3 years, the amount of estrogen in a girl’s body gradually begins to increase, reaching its first peak at the initial stage of puberty (about 7-9 years).

The most common age for synechia to occur in girls is from 10 months to two years.

According to the observations of Dr. O. E. Komarovsky: official statistics in our country indicate 1.5-3% of girls who have synechiae between the ages of 6 months and 3 years. However, the professional practical experience of pediatricians states that in some regions of Russia such a phenomenon as synechiae is observed in 30-40% of girls of this age.

How do synechiae affect a girl’s daily intimate hygiene?

In the vast majority of cases, synechiae “go away” on their own during adolescence, when the amount of estrogen in the girl’s blood gradually increases. But sometimes, quite rarely, there are such serious cases of sticking together of the labia, in which the excretion of urine is almost completely blocked. In this case, the physiological phenomenon already acquires the status of a disease and is treated.

Under no circumstances, if you discover synechiae in your little daughter, do not even think about trying to separate the labia yourself in any way. Even when separation is discussed in principle in the office of a pediatric gynecologist, this is done first and foremost with the help of special ointments. And not at all mechanically!

Let us repeat: if a girl has synechiae, but apart from sticking together of the labia, there are no other symptoms, then nothing needs to be treated.

If, in addition to sticking together of the labia minora, some discharge, redness, itching, difficulty urinating and other symptoms are also observed, then synechiae is treated with special ointments containing the required amount of estrogens. The use of ointments helps the vast majority of girls. Of course, there are cases when the fusion has occurred so strongly that there is no other way to separate the tissues other than mechanical intervention. But the percentage of such “operations” these days is negligible.

Hygiene of a newborn girl

The rules of intimate hygiene for a newborn girl are not very different from how an infant or older girl should be washed: the ritual is based on the same running water and a minimum of cosmetics. But there are some nuances. For example:

• 1 In the first days after the birth of a newborn girl, the external genitalia are covered with a layer of whitish lubricant - this is a special protective “barrier” that does not allow infections to penetrate into the “holy of holies” at first. You will be doing your baby an unfortunate disservice if you wash her properly, thereby depriving her of her protective barrier. Don't touch anything and don't put your hands anywhere! Gradually, during normal washing and bathing, the white grease will wash off by itself.
• 2 A newborn girl should change her diaper every couple of hours (provided it is not empty). If the baby has done something “big”, definitely carry her under warm running water. And hold it so that the water moves along the perineum of a newborn girl strictly in the direction from the pubis to the butt.
• 3 During the first month, there is no need to use any cosmetics or herbal infusions when washing a newborn girl.
• 4 After washing, if possible, do not dress the girl immediately - let her be naked for 10-15 minutes. Firstly, it is good for the baby's skin. Secondly, this simple event does a good job of strengthening the baby. Thirdly, this will allow you to use less cosmetics for diaper rash, which are good for the butt, but not very useful for the perineum: any oil, cream or powder that gets on the intimate area “works” against it in the first weeks of a girl’s life. To quickly establish the proper functioning of the mucous membrane in this area, all you need is running water and air. Any other textures - powder, fatty cream or oil - will only hinder the work of the mucous membrane.

11 main rules of intimate hygiene for girls: a reminder “for the refrigerator”

Let us summarize the basic rules of girl hygiene that any parent, even one who is poorly versed in the intricacies of female anatomy, must strictly observe:

• 1 Every day, to cleanse the genital area, it is best to use plain running water and nothing more. In cases where water is not available, it makes sense to use baby wipes without alcohol or antiseptics. The cosmetic product can be used no more than once a day, but 2-3 times a week is best.
• 2 As a cosmetic product, it is best to use ordinary liquid soap for the care of children in the first year of life. And without regard to how old your daughter really is.
• 3 You can use soap (like a wet wipe) only externally - on the outer labia.
• 4 If a girl has synechiae, but there are no negative symptoms, then they do not require any treatment. She should be washed in the same way as any other girl.
• 5 You can only wash the girl with your hands (clean, of course) - no washcloths or sponges, cotton pads or cotton swabs are allowed. The movements when washing are always the same - from the pubis to the butt, and in no case vice versa.
• 6 After washing with running water, do not rub the girl’s genital area with a towel, but only lightly blot it.
• 7 If you and your baby visit the pool, then before going home you just need to rinse off in the shower; there is no need to use cosmetics or washcloths. But when visiting the pool, like any other “public” establishments, it is important that you have your own personal towel.
• 8 If you already dress your baby in panties from time to time, then these panties should be: not tight-fitting, made of cotton, white. They should be washed with baby soap and a final double rinse.
• 9 Even if you do not find any visible problems in the girl’s genital area, she still needs to be shown to a pediatric gynecologist occasionally: at the age of 1 year, before kindergarten and before school.
• 10 The best time to teach a girl the ritual of intimate hygiene so that she can wash herself daily is at 5-6 years old.

Don't sit on a tree stump!

Intimate hygiene for girls involves not only the daily ritual of washing. But also certain rules of behavior. The main thing is to keep your distance from any cool surfaces.

Millions of girls in any generation hear stern warnings from their childhood and others: “Don’t sit on a cool stone! Get up from the ground - it's cold! Wear leggings - you'll catch a cold! Get out of the water and you’ll catch a cold!” And a lot of similar notations in dozens of variations...

What it is? Where are the compelling reasons that give rise to so many prohibitions for little and big girls? Why can’t we sit on the tiled floor in just shorts, even if it’s a forty-degree summer outside?

The meaning of all these prohibitions (and they are absolutely fair and true!) is this: when a little girl (she has barely learned to sit down on her own), a teenager or even an adult young lady sits down on a cold stone, or stands for a long time in cold water, etc. etc., local hypothermia occurs in the genital area.

You yourself (if you belong to the female half of humanity) may not even notice this insidious chill in the area below the waist, nevertheless it is there and, alas, it will do its “dirty” deed even without your knowledge. Hypothermia, in turn, causes contraction of the vessels of the uterus and ovaries. The sad result of this chain is that blood circulation in the genital organs is sharply disrupted, which significantly increases the chances of protracted and painful inflammatory processes occurring in the “tender” area.

Teach your baby from the first year of life not to sit on stones, tiles, marble window sills and steps, and other similar surfaces. After all, this is neither more nor less - partly a guarantee that in the future you will thoroughly enjoy the company of your grandchildren...

One of the most exciting times of pregnancy is determining the sex of the baby. But it often happens that the child’s genitals do not look at all like what mom and dad expected.
After birth, the baby's genitals may be covered in bruises or remain sore for several days after the baby is born due to injuries during childbirth. Swelling may also appear due to an excess of maternal hormones that enter the baby’s body during intrauterine development. As a rule, after a few days the baby’s genitals acquire their normal appearance.
Parents of newborns pay a lot of attention to the genitals of their babies. And not only them, but also what stands out from them. Indeed, this part of the child’s body is far from the least important when it comes to his health. The size, shape, and smell of the genitals can signal a number of diseases, from the most minor to the very serious and life-threatening. Parents can easily determine whether the baby’s urinary system is functioning normally. To do this, it is enough to monitor how he urinates, as well as the speed and power of the urine flow.

Boy or girl?:

Sometimes it happens that after the birth of a baby it is not possible to fully determine his gender. This suggests that the child was born with pathologies of sexual development. Previously, this phenomenon was called external genitalia of the intermediate type. This is quite a rare occurrence. At the same time, the child’s genitals do not look the way we are used to seeing them. A girl may have an enlarged clitoris, making it look like a penis. The labia may grow together and resemble a scrotum.

In fact, the sex of the baby is determined at the moment of conception. But various hormonal, genetic, chemical and many other factors during pregnancy can affect the development of tissues from which the male and female genital organs of the fetus are formed. The exact reason for this is not always possible to determine. At risk are those babies whose families have had similar cases, as well as whose mothers took steroid hormones, progesterone, and estrogen during pregnancy.
The main cause of pathology of sexual development in girls is congenital adrenal hyperplasia. This is a very rare and dangerous genetic disorder in which the adrenal glands produce too much androgens (male sex hormones) and too little cortisol. Boys with the same congenital disease may have an enlarged penis, but in most cases they will not have any external manifestations of the pathology.

In most US states, newborn babies are required to be tested for congenital adrenal hyperplasia. In the absence of proper hormone replacement therapy, this condition can lead to acute adrenal insufficiency. Signs indicating the possible presence of pathology in newborns are the following:

Weight loss;
Lack of appetite;
Vomit;
Dehydration.

Treatment for congenital adrenal hyperplasia includes hormone therapy or reconstructive surgery (usually removal of the adrenal gland). Despite the presence of this disease, most children live normal lives, have a normal sex life and have children of their own.
If you have any doubts about the sex of your baby, you should consult a pediatric endocrinologist as soon as possible.

Vaginal disorders:

Children's periods

Newborn babies have vaginal discharge, which is called physiological leucorrhoea. The reason for their appearance is maternal hormones, which actively circulate in the girl’s blood in the first weeks after birth. They can be transparent, or have a pink, red or white color. If such leucorrhoea contains blood, it is called pseudomenstruation. They are very similar to menstrual flow in women and are associated with a sharp increase in estrogen levels in the blood.
Such discharge is absolutely safe for a newborn girl. They stop within a few days. But there are times when they last for several weeks. If pseudomenstruation lasts too long, this may indicate the presence of a vaginal infection in the newborn.

Vaginal swelling

Most girls are born with swollen labia. While in the womb, both girls and boys are exposed to maternal hormones, which lead to swelling of the breasts and genitals, which is very often observed by parents of newborn girls. As a rule, everything goes away in 2-4 weeks.
But if the child’s swelling does not go away, then this may be a sign of congenital vaginal obstruction. This is a very rare disease caused by a fused hymen. Some girls are born without an opening in the thin fold of mucous membrane that covers the entrance to the vagina. This causes fluid to accumulate in the middle of the vagina, causing swelling. Sometimes there is an enlargement of the uterus.
As a rule, doctors diagnose fusion of the hymen immediately after the birth of a girl, but sometimes it can only be detected during puberty, when the girl begins her period. To normalize the condition of the newborn, a simple outpatient operation to open the hymen is used.

Unpleasant vaginal odor

The presence of an unpleasant odor almost always indicates that there is an infection, which is called vaginitis or vulvovaginitis. In addition to an unpleasant odor, the following symptoms may indicate the presence of the disease:

Irritated and reddened skin around the external genitalia;
- Discharge;
- Itching (more often diagnosed in older girls). Make sure your baby doesn't touch her genitals.

Vaginitis often occurs in babies who have not yet used the potty, since microorganisms contained in feces and urine are retained in diapers and provoke the development of the disease. Girls who were born as a result of premature birth or with low birth weight are prone to vaginitis.
Vaginitis may indicate the presence of other infections. The thing is that older girls love to explore their genitals and can spread infections from the mouth and nose with their hands.

Treatment for vaginitis is as follows:

Thorough washing of the genitals;
- Ensure that the baby does not touch her genitals and does not introduce infection there;
- Use of very mild products for genital hygiene in girls;
- Use of antibacterial drugs (local or for internal use) as prescribed by a doctor.

Pay attention to the nature of the smell. If it has a pronounced smell of yeast, then it is likely that your baby has vaginal candidiasis or the well-known thrush. It is important that girls under two years of age are especially susceptible to this disease. A characteristic sign of thrush is a white, rather thick discharge from the vagina, which may be accompanied by itching. It is also important to be careful if you treated your baby for any other infections with antibacterial drugs. They can provoke the appearance of thrush. The disease goes away very quickly and is treated with antifungal drugs for external use, which can only be prescribed by a doctor.

Important! If your daughter gets thrush very often, it may be a sign of type 1 diabetes or problems with the baby's immune system.

A foreign body in the vagina can also cause vaginal odor. It is important to note that in this case the smell will be accompanied by the appearance of brown discharge. This indicates infection. After removing the foreign body from the vagina in a hospital setting, the smell will disappear almost immediately. But if an infection occurs, then it must be cured.

Excess skin

A fairly common feature of newborn girls is a vaginal fold or vaginal polyp. One in ten girls are born with a piece of excess skin sticking out from their vagina. The cause of this defect is the mother’s hormones, which flow to the unborn baby. This phenomenon is not only considered normal, but also absolutely safe. As a rule, these pieces of skin gradually decrease in size and disappear into the vagina after 2-4 weeks, when there are no maternal hormones left in the baby’s blood. If the polyps do not bleed or become injured while washing the girl, then there is absolutely no need for treatment.

Be attentive to the health of your children and diagnose disorders in a timely manner!

Synechia, or sticking together of the labia minora, occurs in early infancy or somewhat later, before the age of six. Often the disease is asymptomatic and is discovered by parents while caring for the child or by a doctor during a medical examination. Determining what synechiae look like is not difficult in most cases. This can be done by carefully examining the genitals.

The disease is prone to constant recurrence. In approximately a third of patients, new adhesions appear.

How to conduct an inspection

Before the examination, you should thoroughly wash your hands with soap and cut your nails so as not to injure the delicate skin. Spreading the child's legs, carefully examine the genitals. In this case, pay attention to the presence of a genital slit through which the vagina is visible.

If instead of a slit only a whitish stripe is visible, and an attempt to part the labia minora does not bring success, there is a high probability of synechiae. In rare cases, fusion of the labia majora occurs.

Signs of pathology

Synechiae of the labia minora may not cause discomfort to the girl. In some cases, problems with urination are observed; when wanting to urinate, the child begins to grunt, strain hard and cry. After urination, immediate relief occurs.

The following symptoms can also be identified:

• redness of the skin in the genital area, the appearance of a rash;
• irritation of mucous membranes;
• crying indicating pain when touched while washing or bathing;
• the direction of the urine stream is upward, which is typical for boys.

In girls 1 year of age and older, urine leakage occurs, even if the child is already using the potty.

How dangerous is the disease?

The fusion of the labia cannot be regarded as a natural process that should not be paid attention to, but its occurrence rarely brings serious consequences for the female body.

However, the condition can contribute to the development of various infectious processes. With the progression of the disease in the future, associated with the growth of the genital organs and improper formation of the perineum, the girl may have problems with conception and delivery.

The initial stage of the formation of synechiae makes itself felt by swelling of the vulva, its redness, irritation, and pain when urinating. If you suspect a pathology, you need to take your child to a doctor.

Synechia is an insidious disease prone to relapse. Girls under one year old cannot rely on their independent resolution. The problem can be eliminated by puberty. With this pathology, the child should be under the supervision of a pediatric gynecologist, who will determine the necessary treatment and give recommendations on the care of the genitals.

Causes of fusion

The reasons for the formation of synechiae may be different. If they are noticeable even in a newborn, then they were most likely caused by a complicated pregnancy and intrauterine infection of the fetus.

In preschool age, adhesions in girls may appear for the following reasons:

• previous infectious diseases of the genitourinary area (cystitis,), when bacteria penetrate into the site of inflammation, which provokes fusion of the labia minora;
• transmission of viruses through household means (through towels and other care items);
• improper genital hygiene, use of aggressive cosmetics that eliminate the necessary bacterial environment;
• tendency to allergies as a result of skin contact with residues of washing powder on linen, sanitary wet wipes, diapers, leading to swelling of the vulva and the further appearance of synechiae;
• hormonal imbalances caused by;
• wearing underwear made of low-quality synthetic materials;
• helminthic infestations, intestinal discbacteriosis, taking certain medications.

Treatment

Synechiae can be incomplete or complete. If the fusion occurs in a small area of ​​the labia minora, the problem can be solved by following the rules of hygiene and care. A great danger is the complete fusion of the labia minora, which can only be cured with timely consultation with a doctor.

Before determining treatment, the patient is prescribed general blood and urine tests, a smear is taken for bacterial culture from the vagina or tests for hidden infections.

If synechiae is caused by allergies, consultation with an allergist is required.

Local therapy

Ointments and creams containing are used in treatment.

• Ovestin

A hormonal agent used for various diseases associated with estrogen deficiency. The main active ingredient is estriol.

Treatment with Ovestin is carried out for 20 days, then take a short break of 10 days. After a break, the course is repeated. Ovestin is recommended for use no more than once a day. It is better to treat synechiae before the child goes to bed. If the baby sleeps in a diaper, it should not be put on until the cream is completely absorbed.

In some cases, negative reactions are possible: vaginal itching, mucus secretion, skin rashes. The cream should be prescribed with caution to patients with bronchial asthma, epilepsy, and liver diseases.

The ointment is applied in a thin layer. The treatment is carried out with careful rubbing movements. You cannot put pressure on the genitals or try to separate the synechiae yourself. It is strictly forbidden to use various improvised means for this purpose, which can serve as a source of infection.

• Contractubex

The cream is often prescribed for synechiae in girls. The optimal combination of active ingredients (onion extract, sodium heparin, allantoin) has a bactericidal effect, anti-inflammatory effect, and heals wound surfaces.

The product is applied to the fused area twice a day in a thin layer. A greater effect can be achieved by combining this drug with Traumeel S or Bepanten. The course of treatment is 20 days, then after a pause it is repeated. Since synechiae is a recurrent phenomenon, Contractubex can also be used for prophylactic purposes.

The drug has virtually no contraindications. The only obstacle to its use is increased intolerance or sensitivity to individual components.

• Bepanten

Bepanten ointment or cream is effective if the disease is complicated by inflammation. Bepanten eliminates ulcers, cracks, and erosions of delicate skin. Its use prevents the development of infection.

Bepanten is a safe drug; it is suitable for both newborn girls and older children. The treatment is carried out after washing and thoroughly drying the genitals.

Baths with the addition of chamomile, calendula, and oak bark will help prevent relapse. When treating synechiae in girls at home, oils of plant origin (sea buckthorn, peach, almond, grape seed) are used.

Surgery

How to treat complete fusion if conservative treatment does not produce the expected results? In this case, a dissection is performed. The operation is performed under local anesthesia. The procedure is not dangerous and does not cause any discomfort or bleeding in the girl.

The operation takes only a few minutes. After the procedure, the wound is treated with an antiseptic solution and after 15-20 minutes the girl and her mother can go home.

After surgical separation of synechiae, regular treatment of the genital organs is necessary for some time. For this purpose, both creams and ointments and vegetable oils are used. Regular baby cream will also work. Soothing baths based on decoctions of chamomile, calendula, sage, and string are prescribed.

You will have to treat small lips with cream for at least a month. In the future, this procedure is carried out once a week for the purpose of prevention.

Massage

This procedure belongs to the auxiliary methods of treating synechiae. Massage is done after applying the ointment. After waiting a minute or two until the cream-gel begins to be absorbed, begin massaging the glued labia. The movements should be smooth, careful, but slightly pressing.

If fusion is not complete, you can try to gently separate the lips, but you should not overdo it. It is undesirable to make sudden movements, especially when trying to separate glued lips, as movements can cause injury or psychological discomfort in the child.

The following home remedy has worked well. Wipe the affected area with a cotton pad soaked in potato juice, trying to slightly stretch the labia in different directions. The procedure must be regular. Thus, in case of incomplete fusion, surgical separation can be avoided with the help of a kind of massage.

Prevention of synechiae in girls

Unfortunately, the phenomenon of synechiae is prone to repeated “returns” even after surgical separation. The problem is solved only with the onset of puberty. Preventive measures, compliance with hygiene rules and daily routine will help significantly reduce the risk of relapse. So, prevention includes following the following rules:

1. You need to wash your child with regular tap water without using soap or other cosmetics that dry out the vaginal mucosa and wash away beneficial microflora.
2. Don't get carried away with bubble baths, if you can't give them up completely, add it just before finishing your bath.
3. The choice of underwear should be made in favor of models made from natural cotton. Only in such panties will the skin breathe freely. You also need to make sure that the underwear does not squeeze or rub the skin, as this can provoke an inflammatory process.
4. Timely detect and treat infectious and viral diseases. In most cases, synechiae occur as a consequence of incorrectly and incompletely treated diseases.
5. Regular visits to a pediatric gynecologist. This recommendation often causes confusion among mothers who believe that a little girl has no business being in a woman’s doctor’s office. However, doctors advise visiting a gynecologist already in preschool age.
6. Changing diapers in a timely manner; in some cases, you will have to stop using them; it is better to wash preschool children’s clothes separately from the clothes of adult family members.
7. Choose commercial detergents and cosmetics, toilet paper and other care products without artificial dyes and fragrances.
8. Preventive use of ointments with estrogen in those girls who have previously been diagnosed with genital fusion. The dosage and duration of treatment is determined by the doctor!
9. Pregnant women in the third trimester should actively combat symptoms (protein in the urine, edema, high blood pressure), as these symptoms lead to complications during childbirth and the appearance of pathologies in the newborn.

Age periods. The International Symposium on Age Periodization (Moscow, 1965) recommended distinguishing the following periods of girl development: newborn (1-10 days), infancy (10 days - 1 year), early childhood (1-3 years), first childhood (4 -7 years), second childhood (8-11 years), adolescence (12-15 years), youth (16-20 years). In this scheme, adolescence is shifted to an earlier date. The scheme is not yet widespread.

Doctors involved in gynecology of children and adolescents often resort to the following classification of stages of sexual development of a girl: the period of intrauterine development, the neonatal period, the “neutral” period (up to 7 years), the prepubertal period (from 7 years to the year of menarche), puberty (from the onset of menarche before 16 years of age) and adolescence (from 16 to 18 years of age) periods.

The identification of the period of intrauterine development in the life of a child began to be carried out in domestic pediatrics from the beginning of the current century, with the work of the school of N.P. Gundobin.

Characteristics of the genital organs of a newborn girl. A girl is born with clearly differentiated female external genitalia. The clitoris is relatively large. The labia are often swollen, hyperemic, and easily stick together. The labia minora are only partially covered by the labia majora. The skin is thin, lightly pigmented and often covered with vernix. The vestibular glands do not function.

At this time, the hymen is located deeper in the genital cleft than in subsequent years.

Noteworthy is the variability in size, shape and type of both the membrane itself and the opening (or openings) of the hymen.

The vagina is located parallel to the vertical axis. Its length ranges from 25 to 35 mm. The arches, especially the posterior one, are already pronounced to some extent. A noticeable folding of the vaginal walls is detected, the muscle layer of which is quite well represented. A smear taken from the vagina of a newborn girl is characterized by high eosinophilic and karyopyknotic indices. The reaction of the vaginal contents is acidic; Dederlein's sticks are discovered. By the end of the described period, the thickness of the epithelial layer decreases: from 30-40 to 2-3 layers. After the first week of life, parabasal and basal cells begin to predominate in smears; microflora is represented by cocci. No more than 30% of intermediate cells remain.

The uterus of a newborn is located in the abdominal cavity; the area of ​​the external pharynx is located not lower than the line corresponding to the diagonal conjugate. The length of the uterus is on average 30 mm; the same figure is typical for the length of the uterus in a 10-year-old girl. The body of the uterus has a lenticular shape, the fundus is slightly concave (“saddle-shaped”). The ratio of the length of the cervix to the body of the uterus is 3:1. The body and cervix almost do not form an angle with each other. The uterus is in the anteversio position.

The myometrium is well developed. Not only the endocervix, but also the endometrium forms a large number of folds. The internal os of the cervix is ​​not formed. The external pharynx changes from a punctate pharynx (in a fetus) to a slit-like pharynx (in a newborn). In the area of ​​the external pharynx there is often pseudo-erosion. The cervical canal is filled with thick mucus, which can flow into the vagina.

Secretory changes are most often observed in the endometrium. Sometimes a desquamation phase is observed, accompanied by menstrual-like discharge from the genital opening.

By the time a girl is born, her fallopian tubes are very long (reaching an average of 35 mm), tortuous due to relatively short wide ligaments. The muscle layers of the pipe wall are well developed. The fallopian tubes are passable along their entire length. Even with normal intrauterine development, their asymmetry is observed: the right tube is usually 5 mm longer than the left.

The ovaries of a newborn girl are located in the abdominal cavity. They have a cylindrical or prismatic elongated shape. The length of the ovaries of a newborn varies from 15 to 25 mm. The surface is convex in places due to maturing follicles. During a normal pregnancy, there are no follicular cysts in the fetal ovaries. The histological structure of the ovaries of a newborn in general resembles the picture of the ovary of an adult woman, although there are some differences.

One of the features of the ovaries of newborns is the abundance of primordial follicles, the number of which, as some researchers have determined, is in the range of 500,000-700,000 each. The second feature is the strongly pronounced process of atresia at all stages of follicular development. There is no ovulation. The third feature is the imperfection of the ovarian structure: thin tunica albuginea, anisocytosis of granulosa cells, moderate luteinization of theca cells, absence of the zona pellucida, and an abundance of degenerated oocytes. The fourth feature is the good development of interstitial (theca) cells and their high endocrine activity.

The size and weight of the right ovary of the newborn prevail over those of the left.

To summarize, it can be emphasized that the genital organs of a newborn girl are highly differentiated. The functional tension they experience is largely transient, associated with a sharp change in homeostasis (in particular, hormonal status) during the neonatal period.

Characteristics of the genital organs in the “neutral” period. At this age, the external genitalia, like other genital organs, develop slowly. In a girl under 6-7 years old, the labia majora do not completely cover the labia minora. Small vestibular glands appear on the lateral surface of the labia at 3 years of age, and on the medial surface at 4 years of age. The maturation of these glands dates back to 6 years of age. The large vestibular glands remain poorly differentiated throughout the entire period.

At the age of 3 years, the process of lowering the internal genitalia and some neighboring organs into the small pelvis becomes noticeable. At this time, the bladder approaches the anterior wall of the vagina. The length of the vagina begins to set at an acute angle to the vertical axis. The length of the vagina almost does not increase and reaches 40 mm by the end of the described period. The epithelial layer is thinned to 4-5 layers. In addition, in girls of this age period, the vaginal mucosa is characterized by abundant folding, its cells contain a small amount of glycogen. The reaction of vaginal contents is alkaline or neutral. In vaginal smears, only cells of the deep layers of the epithelium and single leukocytes are detected. The vaginal flora is not stable; microorganisms such as diplococci, staphylococci, streptococci, and E. coli can be detected. The listed features of the vagina, along with other factors, play a certain role in the occurrence of vulvovaginitis. Among girls suffering from vulvovaginitis, 85% are children under 8 years of age.

In the first years of life, the uterus decreases in size. The ratio of the cervix to the body of the uterus undergoes the following dynamics: at 1 year it is 2:1, at 4 years - 1.7:1, at 7-8 years - 1.4:1. The uterus is in a state of anteversion and anteflexion. By the age of three, the fundus of the uterus drops to the level of the plane of the entrance to the pelvis. In the second year, the circular layer of the myometrium thickens, in which the circular branches of the uterine artery are located. It is important for pediatric surgeons and gynecologists to remember one more feature of the uterus, which is inherent in it until the girl is 10 years old: the uterine artery is not tortuous and is not located at the very lateral surface of the uterus, but 10-12 mm lateral to it. It should be taken into account that the ureter is in contact with the middle part of the cervix, and then, before entering the bladder, with the anterior wall of the vagina.

During this period of a girl's life, the fallopian tubes change little. They are still very thin, long and crimped. There is no peristalsis.

The ovaries begin to descend into the pelvic cavity earlier than other internal organs, however, even at the age of 5 they are located high. The size and shape of the ovaries almost do not change; Some increase in their growth occurs at 6-8 years. Despite the fact that this period is called “neutral” or “asexual”, in the ovaries of girls of this age there is always a small number of maturing and mature, as well as atretic, follicles. The inner lining of the follicles reacts positively to steroid histochemical tests. During this period, the number of primordial follicles is reduced by half compared to the neonatal period. The maturation of follicles is not cyclical.
It is known that in the “neutral” period there is a low level of sex hormones. This circumstance explains the absence of sharp leaps in the development of the genital organs. The process of lowering the internal genital organs into the small pelvis, the cavity of which increases, is characteristic. The topography of adjacent organs also changes.

Thus, until 7 months of age, the top of the bladder is located in the middle of the distance between the womb and the navel. During the first two years of life, the internal opening of the urethra moves downward by 53 mm. The urethra in a girl is wider and relatively longer (on average 29 mm) than in an adult woman (30-38 mm). It has an oblique direction, with its convexity facing anteriorly.

In an infant girl, the external opening of the urethra is located 11 mm more caudal than in a newborn. The bladder sphincter finally develops at primary school age (the beginning of the prepubertal period).

Characteristics of the genital organs in the prepubertal period. Features of the external genitalia during this period include their increase due to the growth of adipose tissue. By the end of the prepubertal period, the opening of the hymen noticeably increases, and the hymen itself is located more superficially than at an early age. The external opening of the urethra becomes clearly visible. The beginning of the functioning of the large vestibular (Bartholin's) glands dates back to this period.

By age 13, the average vaginal length reaches 63 mm. The folding of the walls becomes more pronounced. The posterior arch is quite deep. The thickness of the epithelial layer increases noticeably; If in the smears of a 9-year-old girl intermediate and superficial cells in total do not exceed 10% and parabasal cells still dominate (they are large and not always distinguishable from intermediate cells), then after 2 years intermediate and superficial cells prevail, the karyopyknotic index reaches 30%, eosinophilic - 1-20%. In the prepubertal period, the Dederlein bacillus is again sown, the reaction of the vaginal contents shifts to the acidic side.

Only by the age of 10 does the uterus reach the size characteristic of it during the newborn period; its weight during this period is 4.2 g. The folding of the endometrium gradually disappears; if the folding is not eliminated by the time of menarche, then this circumstance may become one of the causes of algodismenorrhea. By the end of the prepubertal period, the endometrial glands hypertrophy and branch; the stroma is clearly divided into functional and basal layers. The ratio of the length of the cervix and the body of the uterus changes: the length of the cervix is ​​1/3 of the size of the organ, and the body of the uterus is 2/3.

During the prepubertal period, the ovaries noticeably increase (their weight reaches 4-5 g, length - 3-3.5 cm). The process of follicle maturation becomes more intense, but remains chaotic. Ovulation occurs occasionally. The number of primordial follicles decreases to 100,000-300,000.

Thus, the prepubertal period is characterized by the beginning of intensive growth and maturation of all parts of the reproductive tract, which by the end of this period are ready to function.

Characteristics of the genital organs during puberty. During puberty, the genitals gradually become similar to those of an adult woman. So, by the end of the period, the length of the vagina reaches 80-100 mm. The vaults are well formed. Colpocytological pictures reflect the adjusting cyclical changes in the vaginal epithelium characteristic of this period. Depending on the day of the cycle, smears can record a change in four degrees of proliferation (the karyopyknotic index, even in the middle of the cycle, rarely reaches 60%), and then signs of progesterone stimulation.

The uterus quickly increases in size: if at 11-12 years old its average weight is 6.6 g, then at 16 years it is 23 g (in a nulliparous woman - 46 g). The uterine artery is finally located along the lateral surface of the uterus; Some tortuosity of this vessel appears. Asymmetry of the ovaries and fallopian tubes does not decrease with age. Pipe peristalsis appears. Transformations in the ovary and endometrium are becoming increasingly cyclical.

During adolescence, not only the anatomical formation is completed, but also the functional maturation of both the genital organs and the central regulatory departments. At the end of this period, we can talk about the completion of the integration of the reproductive system and its assimilation of the correct rhythm. Puberty usually occurs after 18 years of age. In the future, the female body is able to fully carry out reproductive function.