Pediatric and Adolescent Gynecology

At Seattle Children’s, your family has a team helping you from diagnosis through treatment and follow-up. We work together with providers who are experts in many different fields. From our appointment schedulers to our pediatric nurses, our team is specially trained to work with children, adolescents and their families.

Research shows that a person’s physical, emotional and social development during adolescence can affect their overall health throughout their life. Our Pediatric and Adolescent Gynecology specialists are board-certified in obstetrics and gynecology and have a certificate of specialized practice in pediatric and adolescent gynecology. This training gives us a deeper understanding of the development that happens during infancy, childhood, adolescence and into early adulthood. It also helps us create a care plan that uniquely addresses your child’s development now and in the future.

Our team is involved in research that is transforming the diagnosis, treatment and care of conditions affecting adolescents and young adults. We are studying new ways to improve gynecological and reproductive health for adolescents. Some of the topics we have studied or are currently studying are:

• Experiences of adolescents who use long-acting contraception (LARC), like intrauterine devices (IUDs)
• Providing the best treatments for conditions, including congenital differences (anomalies) of the reproductive system and differences of the labia
• Caring for the gynecological concerns for patients with other medical conditions, like Ehlers-Danlos, or those who have undergone organ transplantation or hematopoietic stem cell transplantation
• Educating providers in other specialties about how to treat children and adolescents with gynecological health needs

Fluid (discharge) from the vagina helps to clean the vagina and protect it from infection. Unusual discharge may be a sign of a problem. Before puberty, it may be a sign of an infection, skin irritation, allergy, inflammation of the vulva (outer part of the female genitals) or having something in the vagina (like pieces of toilet paper). After puberty, unusual discharge is often caused by a yeast infection, bacterial infection or sexually transmitted infection.

Androgen insensitivity syndrome happens when the body is unable to respond to androgens, like testosterone. Most people who have androgen insensitivity syndrome have female genitals and are diagnosed with the condition after they have breast development with puberty but never have a menstrual period. Some people are diagnosed as infants when they are evaluated for inguinal hernias.

Some babies have differences (anomalies) in their reproductive organs that happen as the organs form. These differences are present at birth (congenital). They may be found at birth or later in life, such as at puberty. The organs inside the body (uterus, cervix, vagina and hymen) and outside the body (labia and clitoris) may be affected. Learn more about developmental differences of the female reproductive organs. (PDF)

Signs of puberty, such as developing breasts and starting menstrual periods, usually begin in the early teens. The age range varies. Development may begin later for many reasons. Sometimes medical problems can cause delayed puberty. In these cases, careful treatment with hormone medicines may help.

Our doctors care for babies, children and adolescents with all types of DSDs through the Pediatric and Adolescent Gynecology Clinic and the Differences in Sex Development program. DSDs include intersex conditions and conditions that affect how genitals develop. Conditions we treat include changes in genes or chromosomes, problems with hormones or issues with the testicles or ovaries.

Signs of puberty, such as developing breasts and starting menstrual periods, usually begin in the early teens. The age range varies. Development may begin earlier for many reasons. Sometimes medical problems can cause early puberty.

Endometriosis is when tissue that is similar to the lining of the uterus grows outside of the uterus. The most common places where endometriosis occurs are the ovaries; the fallopian tubes; the bowel; and the areas in front, back and to the sides of the uterus. Some people with endometriosis have few or no symptoms, while others have pain or difficulty getting pregnant. The best treatment depends on your individual situation.

The skin around the outside of the vagina (labia) may grow together in places (labial adhesions). Some children and adolescents have labia that are larger than average. This may cause discomfort. Medicines like estrogen or steroid creams may be needed for conditions that affect the labia. Rarely, surgery is considered for labial conditions. Read more on labial adhesions (PDF) and labia minora hypertrophy (PDF).

In MRKH syndrome, a baby is born with a small or not fully developed vagina. There may also be a small or absent uterus. People with MRKH experience normal puberty but never have a period. We offer evaluation and management of MRKH. Read more on MRKH syndrome (PDF).

Youth may have a range of problems with menstrual periods. Their periods may be hard to predict, painful, too frequent or too heavy, or they may not get periods. Youth with other medical conditions may require special consideration for the management of their menstrual symptoms because of medication interactions or worsening of their other condition during menstruation. Learn more about the symptoms, causes and treatments of painful periods (PDF) (Spanish).

Ovarian cysts (fluid-filled sacs) tend to happen when the ovary is making an egg (follicle). Surgery may be needed if your child has cysts that are large, cause pain, limit blood flow to the ovaries or might be tumors. Often, we can remove cysts with surgery using small incisions (minimally invasive techniques) and preserve the ovary and fallopian tubes. Our goal is to preserve your child’s option to have children in the future. Read more on ovarian cysts (PDF) (Spanish).

Primary ovarian insufficiency is a condition where the ovaries stop releasing eggs and hormones earlier than expected (or never start). Learn more about primary ovarian insufficiency (PDF).

Your child may have swelling, pain, itching or sores (ulcers) in the skin on the outside of their genitals (vulva). An infection, irritation or inflammatory disorder may trigger these symptoms. Treatment to control these problems and to soothe the skin may help.

Turner syndrome is a genetic condition. It happens when a person assigned female at birth is born with only 1 X chromosome instead of 2 or is missing part of an X chromosome. About 1 in every 2,000 people assigned female at birth has Turner syndrome. Seattle Children’s Turner Syndrome Clinic cares for people with Turner syndrome from birth through age 21. Our team in the Pediatric and Adolescent Gynecology Clinic offers evaluation and treatment of gynecological issues in people with Turner syndrome.

Vaginitis is an infection or inflammation of the vagina. If it also involves the outside of the genitals (vulva), it’s called vulvovaginitis. It can happen because of a yeast infection, sexually transmitted infection or other infection. It can also happen because the skin is irritated by laundry soap or bath products, for example. Some children may get vaginitis if they are too small to fit well on the toilet seat. This may cause urine to enter their vagina when they urinate. Read more on vulvovaginitis (PDF) (Spanish).

Vulvovaginal Graft versus Host Disease (vvGVHD) or chronic GVHD of the vulva or vagina is a condition that occurs following bone marrow or stem cell transplant. It happens when the donor’s cells attack the skin or surfaces of the vulva and vagina.   

When young people are thinking of using birth control (contraceptives) for family planning, healthcare providers can help them find a safe and effective method that fits their needs. Birth control pills (oral contraceptives) may also help treat certain conditions, including some problems with menstrual periods. We also offer long-term contraceptives that are reliable and safe for teens, such as Mirena and the etonorgestrel implant.

Medicines may help with many gynecological problems, like vaginal infections or skin irritations. Hormones may improve some conditions like polycystic ovary syndrome (PCOS) or endometriosis. We offer a full range of medical treatments for reproductive health concerns.

Taking steps to control your child’s menstrual period may help with many kinds of issues. We offer treatment for heavy or painful periods, seizures linked to periods, endometriosis and other conditions. We can also help if your child has disabilities that make it hard to manage periods. The best options depend on the needs of each child or adolescent. In our clinic, options include hormones taken by mouth (orally) or through a skin patch (transdermally), Depo-Provera shots, intrauterine devices and other treatments.

This is surgery done through small cuts (incisions). The advantage of this technique is that surgeons don’t need to cut through as much tissue as when they make a longer incision. Your child is likely to have less pain and to recover faster. This means a quicker return to school, sports or other activities. This technique only leaves a small scar on the outside of the bellybutton, which may be unnoticeable. It also causes less scar tissue inside, making it less likely to affect fertility. Gynecological surgery is used most often to treat ovarian cysts and pelvic pain. Learn more about laparoscopy for gynecological procedures (PDF).

Objects can sometimes get stuck in the vagina. The most common objects are pieces of toilet paper. Small toys or other objects can also get stuck. Sometimes a trapped object is the reason for unusual discharge. Our doctors may be able to remove an object during a clinic visit. In some cases, we may need to remove the object with sedation.

Puberty blockers are medicines that block puberty-related hormones that make your body go through puberty. We can give these in clinic or place them in the procedure area with sedation for people who need to suppress their puberty. Read more about puberty blockers (PDF) (Spanish).

We see many children and adolescents with differences in the way their reproductive organs formed. We work closely with providers from other clinics and services, including our Differences in Sex Development program, to diagnose and treat these conditions. Our team offers a range of surgical and nonsurgical treatment options.