Good afternoon,
I have a question about my teenage daughter’s health. Just a few days ago she developed a few whitish pimples in private area. She is 15 years old and not sexually active. She said the bumps were not painful but they did itch, I told her it could have come from wearing the wrong underwear and wearing tight fitting clothes also the soap she using. I gave her some hydrocortisone cream to use and she said the bumps are disappearing. Should I still schedule an appointment is this something I should be concerned about?
“Concerned Mom”
Dear “Concerned Mom”,
Certain types of underwear and tight fitting clothes can be irritating to the private area. Scented gels, soaps and crèmes used in the genital area can also cause an irritation. I found that many teenage girls develop a rash consisting of tiny bumps, some pimple like, from shaving in the private area and around the bikini line.
Germs on top of the skin can invade the area through tiny cuts made on the skin during shaving. Dry shaving in particular puts a person at risk for developing rashes, irritation and tiny abrasions because of the pressure that is needed in order to shave hair off of non-lubricated skin.(1) Measures that teenagers can take to prevent skin irritation, cuts and infections in the private area include cleaning the area before shaving, using a clean razor, not sharing razors, washing with a clean cloth and not shaving dry skin.
Teenagers who develop frequent rashes from shaving can alleviate the symptoms and prevent future occurrences by wiping the area with the antiseptic Betadine each time before shaving. (1) Cleaning beforehand reduces the amount of microorganisms that can enter the skin during shaving.
Cortisone crème applied to the genital area needs to be used with extreme caution. The skin in the genital area is very thin which allows the medication to be very easily absorbed. (2) Since steroids crèmes applied to the genital area are so readily absorbed, a moderate potency steroid crème can become equivalent to a super potent steroid crème which has the potential of producing more significant side effects.
Mild steroid crèmes may occasionally be recommended in this area, but they are not recommended for more than 1-2 weeks duration and should only be given under close medical supervision.(2) Some of the potential side effects of steroid crème use include stretch marks, hypopigmentation, secondary infections, hypothalamic pituitary adrenal axis suppression, acne and telangiectasia (dilated small vessels that look red or bluish).
At this point, there is no need to worry that the hydrocortisone crème that your daughter used caused any harm. It is just important to know that medications are absorbed differently from the genital area and should be used sparingly. It is a good idea to consult with your physician before applying any medication to the genital area. Since your daughter's rash is disappearing, at this point no further treatment should be necessary.
Preventive measures such as wearing no underwear to sleep at night, avoiding tight fitting clothes, increased use of skirts, avoiding bubble baths, wearing cotton underpants, decreasing the use of panty hose and avoiding scented soaps and crèmes in the private area can help prevent future irritation. (3) Since your daughter is not sexually active there is no need for further testing or screening for Sexually Transmitted Infections.
Unfortunately, many children fear discussing sexual activity with their parents.(4) Sexually activity is a very private matter and can be embarrassing for a child to share this with their parent regardless how good of a relationship they have. At the risk of disappointing their parents or getting punished, children may go through many lengths to avoid talking about this subject. I am not recommending that all parents assume that their children are having sex, but to be realistic when dealing with children in this age group. Knowing the statistics it would be wise to be careful when interpreting a child's response to questioning. I
It is important to know that a teenager’s interpretation of what sexual activity is may be different from an adult’s. Many adolescents consider oral sex to be “safe sex” (5) and because of this, they may not feel the need to report it when questioned. When healthcare givers or parents ask teenagers about sexual activity, the teenagers frequently deny it because they may only consider sexual intercourse as sexual activity.(5)
Many children become sexually active during middle and late adolescence. Boys and girls from 15 to 19 years old have extraordinarily high rates of several STI’s. (6) In the year 2000, 48% of the 18.9 million new cases of Sexually Transmitted Diseases diagnosed in the United States were found in people from 15 to 24 years old (7) It would be a good idea to explain to teenagers that a person can develop a Sexually Transmitted Infection as the result of any type of sexual activity. Some Sexually Transmitted Diseases can be spread through skin-to-skin contact and are less effectively protected by male condoms.(8) Examples of these Sexually Transmitted Diseases include Genital Herpes, Human Papillomavirus and Syphilis.(8)
Genital Herpes can present with pain, burning and itching in an area where lesions eventually appear. The lesion that develops appears as a single vesicle or small group of vesicles which are typically quite painful and turn into ulcers over the next couple of days. Burning with urination and vaginal discharge are also common. (9)
Syphilis presents with a chancre approximately three weeks after exposure to a lesion on an infected partner. This STI is primarily seen in Metropolitan areas in men and women 20 to 35 years old. (10)
Human Papillomavirus (HPV) can also be spread via direct sexual other than sexual intercourse. The infection can live on the penile shaft, scrotum, vulva, vagina, cervix, anus and occasionally in the oral mucosa. Transmission occurs when the infected body part comes into contact with a partner’s genitals, anus or mouth. (11) Therefore, even when condoms are used, they do not provide adequate protection against HPV infection. (11)
Because of the alarming statistics about Sexually Ttransmitted Ddiseases, it is necessary that parents explain to their children the risk of acquiring an STD and the modes of transmission. A good approach reinforces the importance of maintaining health and preventing the spread of infection. Even though a child’s lifestyle choices may not agree with their parent’s expectations a child should be expected to respect their bodies and show responsibility for their actions. Avoiding activities that put oneself at risk for contracting a Sexually Transmitted Disease and screening for STD’s are two very important steps.
For more information about topics discussed read Pediatric Advice articles:
Sexualy Transmitted Diseases
Fever, Rash & Joint Pain
References:
(1)Kozier B, Erb G. Fundamentals of Nursing. Concepts and Procedures. 2nd Ed. Menlo Park, California: Addison-Wesley Publishing Company.1983: 1010-1011.
(2)Connelly E, Eichenfield L. Treatment Pearls for Managing Atopic Dermatitis. Pediatric Skin Care. 2004. Spring:16-18
(3)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:491.
(4)Grimshaw-Mulcahy L. Chlamydia: Diagnosing the hidden STD. The Clinical Advisor. 2006. March:32-42.
(5)Reitman D. Update o n Sexually Transmitted Diseases: Gonorrhea and Chlamydial Infections. Consultant for Pediatricians. 2006. March:155-160.
(6) Fortenberry JD. Clinic-based service programs for increasing responsible sexual behavior. J Sex Research. 2002. 39(1):63-66.
(7) Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6-10.
(8)Davidson M. Sexually Transmitted Infections. Clinician Reviews 2004. 14(6):56-60.
(9)Fortenberry J. Sexually Transmitted Infections. Pediatric Annals. 2005. 34(10):803-810.
(10) Burkhart C. Syphilis. The Clinical Advisor. 2006. April:66.
(11)Reitman D. Update on Sexually Transmitted Diseases: Human Papillomavirus Infection. Consultant for Pediatricians. 2006. June:353-360
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice for Parents withTeenagers
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