Aspects of student health. Adolescent gynaecology.

Most adolescent gynecological problems are related to sexual activity or the development or failure of hypothalamic-pituitary-ovarian-uterine activity. The 1st years of menstruation are usually anovulatory resulting in variable periods of amenorrhea which corrects itself in time. In profuse menstrual loss, endocrine, metabolic, and hemorrhagic disorders must be exlcuded before treatment with progesterone for endometrial hyperplasia. Primary amenorrhea requires detailed examination before diagnosis. Secondary amenorrhea is commonly caused by a disturbance of the hypothalamic-pituitary-ovarian axis due to an emotional disturbance. If pregnancy is eliminated, examination and reassurance are sufficient treatment. Most dysmenorrhea may be treated with mild analgesics and reassurance; in severe cases ovulation may be inhibited by estrogen treatment. Dilation of the cervix should never be attempted. In complaints of vaginal discharge, examination should be made for trichomonas, monilia, gonorrhea, or a forgotten tampon. Requests for contraception should be taken seriously regardless of age. The combined contraceptive pill or Gravigard or copper 7 IUD is the method of choice. Lower abdominal pain caused by pelvic inflammatory disease should be treated early to prevent tubal occlusion after salpingitis. Evidence of higher cervical cancer incidence among women who were sexually active in adolescence suggests routine cervical cytology should be performed. Treatment of adolescents should dispel ignorance and embarrassment with patience and skill.