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What body changes accompany menstruation?

Once your daughter's menstrual cycle begins, she's going to notice some other bodily changes as well. Because of a rise in estrogen levels, which stimulates the vaginal tissue and the glands in the vagina[1], she is going to experience more secretions and lubrication. In fact, a small amount of non-odorous vaginal discharge[2] is normal.

During this time frame, a girl's vagina also becomes colonized by "good" bacteria. These are known as lactobacillus bacteria[3], and they are essential in balancing the environment in the vagina and warding off infections. A general term that encompasses methods, medications, and devices to prevent pregnancy.

A mucus-like substance coming from the vagina. A small amount of non-odorous discharge can be normal. A large amount of discharge accompanied by itching, odor, or unusual color can indicate an infection.

Why are bladder infections more common in younger girls?

Prior to puberty, girls are more susceptible to bladder infections[4]. This is because the urethra[5] (which is the opening to the bladder) is in such close proximity to the rectum. Bacteria from the rectum are what cause the vast majority of bladder infections in girls. (That's why young girls should be taught to wipe from front to back after they have a bowel movement.) It is the introduction of estrogen that begins the process of strengthening the wall between the vagina and bladder, replacing the "bad" bacteria with the "good" bacteria, and building up the tissue of the urethra, which then becomes a stronger barrier and helps prevent the remaining "bad" bacteria from entering the bladder. (Yes, sometimes our bodies seem to serve as the backdrop for a superheroes cartoon.)

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists both recommend routine preventive health visits for adolescent girls.

Why are preventive health visits important?

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists both recommend routine preventive health visits for adolescent girls. I strongly encourage you to follow their guidance. These visits not only provide an opportunity for a doctor to evaluate your daughter's health, but they also provide both you and your daughter with an opportunity to answer any questions you may have.

These check-ups can be part of a routine appointment with a family doctor. Similarly, a pediatrician can evaluate your daughter's health, and they typically are an excellent source of information. As an alternative, you should feel free to schedule an appointment for your daughter with a gynecologist[6]. I can assure you that in most cases there will be no need for the gynecologist to conduct a pelvic exam[7].

What menstrual issues should prompt me to take my daughter to a doctor?

In addition to routine preventive health visits, there are certain signs related to menstruation that should prompt you to contact a doctor about your daughter's health. Specifically, you should schedule an appointment if your daughter's menstrual period:

• has not started within 3 years of her breast development;

• has not started by age 13 and there are no other signs of the onset of puberty;

• has not started by age 14 and she is experiencing excessive hair growth on her body;

• has not started by age 14 and you suspect that she is engaging in excessive exercise or may have an eating disorder:

• has not started by age 15;

• became regular, but then became noticeably irregular;

• occurs more frequently than every 21 days or less frequently than every 45 days;

• occurs more than 90 days apart, even for just 1 cycle;

• lasts more than 7 days;

• requires frequent pad or tampon changes (such as soaking more than one pad or tampon every 1 to 2 hours).

In many cases, even with these signs and symptoms, a doctor will conclude that an adolescent girl is just fine. But in other cases, medical treatment will be required. That's why medical evaluations are so helpful. They're indispensable to us as we fulfill our sacred responsibility as mothers.

  • [1] The muscular, tubelike organ that extends from the uterus and cervix to the outside of the body. The opening is located in between the urethra and the anus. It is lined with glands that produce mucous secretions.
  • [2] A mucus-like substance coming from the vagina. A small amount of non-odorous discharge can be normal. A large amount of discharge accompanied by itching, odor, or unusual color can indicate an infection.
  • [3] The "good" bacteria found in the vagina that are responsible for maintaining a normal vaginal environment. These bacteria help fight off bad bacteria that cause vaginal and urinary tract infections.
  • [4] A common infection in women that occurs when bacteria gain entry into the bladder.
  • [5] The short tube that opens just in front of the vagina. It carries urine from the bladder to the outside.
  • [6] A medical doctor who specializes in the care of women and the treatment of diseases that affect their sexual organs.
  • [7] An examination of the female reproductive organs. This exam can include an external inspection of the genital region, a speculum exam of the vagina and cervix, and/or a manual exam of the internal genital organs, i.e., the uterus and cervix.
 
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