Louisa* sounded very anxious on the phone. She was calling to schedule an emergency appointment for her 10-year old daughter Lavinia* on short notice. They came in at 4 o’clock and while the mother was visibly concerned, Lavinia was only upset at having missed her swimming practice.
That morning, Lavinia had reported a discharge from the vulvovaginal area, which had soiled her underwear. She showed this to her mum before she took her morning shower. Now, Louisa was here for answers. Her biggest concern was that Lavinia may have been sexually assaulted. A thorough history and physical exam revealed a mildly inflamed vaginal opening with yellowish-creamish vaginal discharge, but with otherwise normal external genitals for a 10-year old. She had no lacerations or tears and her hymen was intact.
Lavinia responded well to antibiotic treatment and we discussed safe hygiene practices, avoidance of irritants and the need to keep reporting any abnormalities to enable timely treatment. This was the beginning of a longstanding relationship with Lavinia. We went through human papillomavirus vaccination and age-appropriate sexuality and reproductive health education as she got older. Adolescence and all its challenges showed up in its own time as anticipated.
There were moments of low self-esteem, triggered by the developmental changes, a rough patch of painful, heavy menses, and even a short stint with acne. We surmounted each of these challenges with ease based on the trust established years back.
Now at 20, Lavinia is in college and does not need her mum to bring her to the clinic. She continues to come by because she knows she has a safe space to get answers regarding her health. She has also brought along some of her peers who have never known about the need for a gynaecologist’s visit.
These visits recognise the autonomy and rights of young people to access comprehensive sexual and reproductive health. It is truly satisfying to see great reproductive health outcomes from continued education, treatment of common gynaecological ailments, early diagnosis of complex conditions and promotion of a healthy sexual lifestyle.
Unfortunately, not all young people have the privilege of accessing this basic service. This is as a result of multiple issues, most commonly lack of information. Many women have been raised to know that the only time they need to see a gynaecologist or seek reproductive health care is when they are pregnant. Keeping in mind that female demographics are changing and for many, fertility desires are getting more diverse, this late entry into care means we have missed the boat for many.
Take Terry* for instance, a 37-year old executive who recently broke her leg, making it impossible for her to exercise. This, coupled with the recent sedentary lifestyle occasioned by Covid-19, has resulted in her gaining 18 kilos.
This sudden weight gain has precipitated an otherwise quiet pre-diabetic state, coupled with hormonal imbalance from polycystic ovarian syndrome. Extensive tests show that Terry has a high risk of infertility, a prognosis that is giving her nightmares.
Then there’s Lucy, a 30-year-old school teacher who recently got pregnant and started clinics at six weeks gestation, only to find that she has an abnormal pap smear. Though she may not have cervical cancer yet, we are forced to wait for at least eight months before she can get definitive treatment to prevent progression to cancer.
The case for adolescents and young adults to prioritise self-care on reproductive health could not be stronger. Young people need to pick up where their parents left off, replacing routine visits to the paediatrician with routine ones to the gynaecologist.
It is paramount to know that the efficacy of the cervical cancer vaccine is not dependent on age but rather on sexual exposure. Hence, a 27-year old virgin will have a great immune response to the HPV vaccine compared to a 16-year old sexually active adolescent. She will most certainly miss the opportunity for the vaccine if she does not access this information.
Even more important is that these visits ensure the introduction to contraceptives is done appropriately. Many young people have no idea that it is critical to have a wholesome medical review before initiating contraceptive use. The review ensures that one is appropriately appraised for risk factors for complications or adverse effects so as to select a method that is best suited to them. Unfortunately, we are often left dealing with the undesired effects after the fact.
As we wind down the cancer awareness month, may it be the springboard for promotion of routine reproductive health care for our adolescents and the youth.
