A Visit to the Children
by Elena Chernomazova
In the middle 1980's pediatric policlinic facilities
started hiring specialists in children's and adolescent gynecology. At
the same time, medical schools started training programs in pediatric gynecology
where students learned, along with the specifics related to the physiology
of young patients, about the psychological aspects of teenagers' apprehension
of problems associated with their sexual development, reproductive health
and sexual interactions. Placement of gynecologists' offices in pediatric
policlinic facilities facilitates the access of young girls with reproductive
health problems to specialists. Prior to this change, girls had to face
the unpleasant prospect of being referred either to specialized gynecological
clinics or skin/venereal disease dispensaries, which sometimes had a negative
psychological impact on them.
"We see girls under 17 years of age, beginning with newborns," says Olga
Makkaveyskaya, a children's gynecologist in Moscow pediatric policlinic
12. "At their first visits young patients are usually accompanied by their
mothers, but girls of eleven and twelve begin to come by themselves. As
they reach fifteen, girls are enrolled in an adult gynecology network but
may still visit their old doctor who would render all necessary services
Do some girls look scared when they visit
you for the first time?
What health problems make girls come here most
often? And how do they depend on their age?
Yes, they do. This type of examination, especially for the first time,
is always scaring. A child would be afraid of metallic instruments and
of not knowing what is going to happen to her. What should you expect of
them when even mothers sometimes do not know anything about how we examine
children. "Are you going to see her at that chair of yours? She's virgin,
you know," they would say sometimes. Be it known, that we examine girls
through rectum which is absolutely harmless.
In general, dependent on a girl's mental an and nervous status and family's
emotional health, some of them overcome their fear and take examination
easily. In some other cases, however, the fear is so strong that we have
to postpone it till better times. As for me, I always do everything I can
to make girls feel comfortable. But you must understand that gynecological
chair is not a pleasant place to get onto.
Girl of 7-8 years rare visit us; this age is not associated with any serious
problems. Some complaints about breast hardening is all they may turn up
with, and they arise as the natural course of early sexual development.
Teenagers are our most frequent patients because of menstrual dysfunction
which is usually associated with a variety of somatic diseases and infections.
Often such dysfunction is caused by seemingly insignificant comorbidities,
such as a cold or flu. Sometimes, however, menstrual cycle is ruined with
an inappropriate lifestyle or bad habits. In particular, it may stop at
all as the result of obesity complicated with unreasonably restrictive
Pediatric gynecologists conduct annual examination
of entire female teenage population for sexually transmitted diseases (STD)
and other reproductive health problems in order to guarantee their early
detection and appropriate treatment.
Sexual revolution fruits are no secret: they are
as bad in Russia as they are in the West. Russian National Public Opinion
Study Center 1995 survey revealed that about half of male and over one-third
of female respondents of sixteen years of age in Moscow and St. Petersburg
had already tasted it. Too early beginning of active sexual life, along
with lack of proper education in basics of safe sex, result in catastrophic
rates of STD occurrence and unwanted pregnancies among teenagers. All these
factors produce strong negative impact on reproductive health of the young
generation. The RF Ministry of Health reports that only 6.3% of girls are
absolutely healthy at the point of their graduation from high schools.
The Ministry of Health regulations require that
one gynecologist should serve 1,000 population enrolled in pediatric policlinics.
The policlinic where Olga Makkaveyskaya works is responsible for provision
of health services to students of 11 public schools. During annual medical
examination period, one class a day schedule is effectuated, and girls
come in scores. Pediatric policlinics are short of staff children gynecologists
and have to ask for assistance of adult gynecologists from municipal health
When syphilis or gonorrhea is suspected,
cases are usually referred to skin/venereal disease dispensaries. What
other STDs may be detected in patients so young?
Could you share your opinion of what makes
girls start their sexual activities so early?
In past six months we examined 6,518 teenagers in our service area; 1,450
of them had various STDs: non-specific vaginal diseases (coccal flora),
genital herpes, trichomoniasis, chlamidiosis. The most frequent diagnosis
is bacterial vaginosis.
Bacterial vaginosis is a condition that may be caused by a variety of microorganisms
which are a sort of hybrid between viruses and bacteria. Usually, these
microbes act as parasites on the cell membrane, but may also penetrate
it and make the cell serve their purposes like a virus would do. The immune
system of a woman would not recognize these hostile agents and react to
them. Clinical manifestations of such conditions are usually scarce - minor
secretions, unpleasant smell. On the other hand, chlamidiosis, for example,
would often mask itself with characteristic symptoms of other diseases:
cholecystitis, rheumocarditis, cystitis and so forth.
Many persons are ignorant about the fact that they are carriers of such
misfortune with the potential to share their ill luck with others. By the
way, these infections are not only transmittable through sexual contacts,
but may be also acquired by a newborn from its infected mother. The most
unpleasant health hazard associated with various vaginoses is that they
corrupt young girls' health in a latent manner and may result in infertility.
What would be your advice to parents who look
forward to an opportunity to talk with their daughters about their behavior,
but have no idea of how to approach them with the subject of sexual affairs?
We should admit that our annual examinations detect more and more sexually
active teenagers. As for reasons, 60% of girls explain their sexual debuts
with "being in love" or "falling in love" with their partners, while 17%
simply feel curious of what adults experience.
In my practice, I met cases where virtuous, homely girls would start on
disorderly sexual intercourse just to prove they were no "odd ducks" and
have "some expertise" to boast with. Furthermore, some girls confessed
that early beginning for them was a remedy for fear of finding themselves
lonely, with no partner or husband to support them. Could you suspect such
motives in a fourteen-year old girl?! By the way, their physiology is rather
underdeveloped, and they hardly experience any pleasure or satisfaction
Moreover, most girls gain their first sexual experience in an environment
far from romantic. Seventeen per cent of girls enter their first sexual
contact being heavily drunk, usually at some party. On the next day, some
of the would not even remember what had happen to them and have to learn
it from their friends who happened to be more sober that night. Sometimes,
circumstances are more dramatic; sometimes violent rape is the very first
sexual experience of a girl. For example, one of my patients was unfortunate
to ask for a lift, and the driver took the whole advantage of it. She ended
up raped in deep forest.
Having tasted it once, many girls are eager to repeat and do it "successfully":
86% of them do it on the same day; 36% - within a week; and 26% - within
a month. 64% of girls do it with the same sexual partner, while 15% are
more diverse in their preferences.
Is a girl's early sexual experience in any
way associated with her family social status?
Many parents, in fact, do ask this question. My advice is rather simple:
never overemphasize the issue. Approach it in a matter-of-fact mode. For
example, when watching some film on TV together, just ask your daughter
some hand-off questions: do you think, she's right? did you like it? what
would you do in her place? Her answers may tell you much. Another opportunity
is the tactics of open doors when you discuss private life issues of your
friends and their children and relatives with your husband or a close friend
of yours; I bet, your daughter cannot fight the temptation to silently
listen to what you are talking about; and it will be up to you to make
her learn as many useful lessons as you are able to invent. Girls are curious;
and as soon as you speak of themes that are usually a conventional taboo,
you would be surprised of how absorbed in listening to and learning of
what you have to deliver they become.
As for me, being a health professional, I do my best to talk to them frankly.
By the way, outsider's advice often works better, because it is not so
frequent and aggressive and obligatory as the advice by family members.
You may follow stranger's recommendations, or you may do the contrary -
nobody cares. You are the only one to decide with no pressure upon you.
I remember cases when mothers would burst in happy tears of gratitude:
"How did you manage it? She just wouldn't listen to us anymore! Family
was no longer an authority to her!"
Yes, teenagers tend to be neglectful about elders' advice. They think they
have wits enough to decide for themselves. In fact, however, their self-assurance
is fake; behind the resentful mask, utter chaos rules in teenagers' minds:
neither some steady position in life nor an internal core are present in
them. In this situation, parents face an uneasy task of upbringing their
children's will to behave like they would like to, and not as the street
may dictate. You will never achieve it with threats and prohibitions; the
only way is to make friends with your own child and try to make her trust
you and believe in her aptitude to behave appropriately. Girls who trust
their parents are at far lower risk of premature sexual adventures than
their counterparts who do not.
What contraceptives would you recommend to
your teenage patients?
I wouldn't say so. It may happen in any family, irrespective of how wealthy
girl's parents are. Other factors affect a girl's behavior in much more
imperative manner. For instance, it is the loss of live contact with her
mother which forces a girl to behave inadequately. Such families are the
last to know about their daughters' sexual adventures. Some time ago, two
14-year old ladies turned up here for voluntary examination. They confessed
that "two years ago they were stupid and happened to have an affair". Well,
mothers are entitled to free access to their immature daughters' medical
records. One of them was rather shocked with what she learned: "Wow, doctor!
Is it true? She was only twelve then! Yes, I saw condoms in her purse,
but she told me that it was her girl-friend who shoved them in there to
make fun of her." I would say that such ignorance of what is up with your
own children is based on rather uncomplicated underlying reason: mothers
are simply too preoccupied with their own business to pay enough attention
By the way, I can tell virgins from teenage girls with some "experience"
right from the start: they look differently, behave differently, move differently.
Do you inform teenagers about available methods
to avoid unwanted pregnancies and STD infections?
First of all, as soon as they have started their sexual activities, I would
recommend that every girl protect herself with a combination of tools.
For example, young patients may find it expedient to use condoms together
with spermacides (available as creams, pills and suppositories). Such a
combination is helpful to effectively avoid both undesirable pregnancies
and STD infections. In this case, protection reliability rate nears 99%.
Unfortunately, no gadget may guarantee 100% safety. Some patients of 16-17
years of age are prescribed with a monophase hormonal contraceptives that
contain low doses of female hormones. The only prerequisite is that a girl
would live with a regular partner. Low-hormone contraceptives guarantee
girls against impregnation - and, at the same time, they are absolutely
harmless from the standpoint of how the may affect their physiological
development. Moreover, they contain hormones that may prove helpful in
cases of painful menstruation and the monthly cycle disorders. Hormones
make monthly secretions scarce and rare, which is suitable for most girls.
Moreover, pills are helpful to delay a menstruation whenever a girl may
need to travel abroad and so forth. Therefore, girls feel much easier with
such a helper available. However, once they have stopped taking it, their
fertility is restored completely!
With all the above in mind, what would be your
recommendations for sexual educators in public schools?
Teenagers rarely give a thought to how they could protect themselves from
what you are talking about. They are so immature that usually just would
not bother either to protect themselves or access the information available
from a variety of sources. Therefore, I have to act as a lecturer at every
medical examination. I don't mind. As for lectures, I read a lot of them
at schools, where twenty to thirty listeners are present every time I deliver
my message. And in my office every patient is handed with free booklets
on why the abortion is harmful, and what contraceptives are available,
and so forth.
Teenagers are informed to the extent we allow them to be informed. And
this depends not only on our efforts to inform them, but also on our inborn
culture, education, and, most of all, on our willingness to help our children
through the natural process of sexual maturing. Unfortunately, many mothers
complain that they feel helpless to do anything with popular magazines'
(such as Cool Girl) influence on their daughters. Well, informational press
is too heavy today, and children suffer it too.
Standards change time to time. And so did the
standards of how girls and boys behave. Elders are in shock: what a sexual
discrepancy! Hold on, daddies and mammies. "Pilot" copulations are not
to be feared. They simply help strengthen future marriages. Changing of
partners is nothing to be worried about from the standpoint of the young
generation. And so is the constant decrease of minimal age requirements
to partners in sex.
In the process of education, the moral aspect of sexual intercourse should
be emphasized. First of all, teenagers must learn about the price they
will have to pay for any bodily pleasure. Be it known, that they pay with
their health. And we, children gynecologists, do our best to repair damages
thus inflicted .