Dr. Diana Hristova graduated in medicine at the Sofia University. He is a specialist in obstetrics and gynecology with extensive experience in the field of pediatric and adolescent gynecology. Since 2017, he has been an assistant in our largest university obstetrics and gynecology hospital “Mother’s House” – Sofia. She defended a dissertation in the field of pediatric-adolescent gynecology on the topic “Hormonal status and bone health in normal pubertal-adolescent girls and various hypomenstrual disorders” (2020). He has a postgraduate qualification in ultrasound diagnostics in obstetrics and gynecology, Doppler diagnosis of high-risk pregnancy, colposcopy and destructive treatment of cervical precancers and pediatric gynecology. Author and co-author of numerous scientific publications in Bulgarian and foreign medical publications. He is a member of BLS, BDAG, EURAPAG. – Dr. Hristova, what are the most common problems and diseases of the reproductive system in adolescent girls? In child-adolescent gynecology, three main periods are distinguished: newborn period – from birth to the 28th day of it, followed by a sexually calm period – from the end of the newborn period to the beginning of puberty, and then the pubertal-adolescent period. During each of the three periods, a specific pathology originating from the anatomical-physiological characteristics of the newborn, the child and the adolescent girl is observed. In the newborn period, the most common problems are related to various malformations of the external genitalia, intersex conditions, as well as “hormonal crisis of the newborn”, which is manifested by mucous, sometimes mixed with bloody veins discharge from the vagina. This condition is not a medical problem. It is due to transplacentally passed maternal hormones to the fetus, which are gradually emitted by the body of the newborn. In the sexually quiescent period, the most common gynecological problems are inflammation of the vulva and vagina and fluoride, often associated with impaired hygiene, more frequent respiratory infections and unintentional transfer of pathogens through the hands, synechiae of the labia minora – adhesion of the free surface of labia minora, trauma and, rarely, foreign bodies, genital bleeding associated with precocious puberty and tumors, which are very rare in childhood. In the pubertal-adolescent period – in this period, the child’s organism anatomically and physiologically approaches its condition in a woman of reproductive age. The most common pathology at this age is inflammation of the vagina, menstrual disorders, congenital diseases, polycystic ovarian disease, ovarian cysts. – Why should regular check-ups with an obstetrician-gynecologist be carried out and when should they start? How often should teenagers visit the office? And the little girls? prevention,early diagnosis and adequate treatment of diseases in each period in child-adolescent gynecology are extremely important to prevent serious problems in adulthood – menstrual disorders, infertility, sterility, impaired quality of life. The best time for the first examination is a few weeks after birth. At this time, it is necessary to explain to the parents – the correct hygiene in the ano-genital area, to pay attention to the most common pathology, in which they should seek an obstetrician-gynecologist. An important role in this period is played by pediatricians, and rather general practitioners, who refer children for a gynecological examination when a pathological process is detected. An examination by a gynecologist should be carried out in the presence of complaints such as vaginal discharge or soiling of the underwear, complaints of the child himself, related to burning, pinching or other type of discomfort. The need for preventive examinations is generally once every 2-3 years, in the absence of complaints. – How common are menstrual cycle problems among teenagers nowadays and what are the main factors that lead to it? The frequency of menstrual disorders is about 10-20% of the patients who have passed in the “Mother’s Home” SBALAG. While 5 years ago there was a higher rate of absence of menstruation – primary and secondary amenorrhea associated with various eating disorders, now menometrorrhagia or heavy, prolonged periods with disturbed regularity are more common. During the first 2 to 4 years of the first menstruation in life, called menarche, menstrual disorders are more common. This is due to the immaturity of the regulatory mechanisms in the adolescent organism and the higher frequency of anovulatory menstrual cycles – lack of ovulation in the first year after menarche. Eating disorders, stress and extreme physical exertion are also among the most common causes of menstrual disorders. – What is the risk for girls of the human papilloma virus? Human papillomavirus HPV infection is a viral infection that is primarily transmitted sexually through direct contact with an infected person. It is the most common sexually transmitted infection worldwide. There are more than 100 types of HPV. About 40 of them can affect the genitals. At least 14 types of HPV classified as “high risk” can cause cancer, such as cervical cancer in women. “High-risk” types of HPV can also cause anal and genital cancers, as well as some head and neck cancers, in both men and women. “Low-risk” types of HPV can cause genital and anal warts and warts by being transmitted through physical contact/touching. Sexually active adolescents are at high risk of HPV infection, with between 50-80% contracting it in the first 2 to 3 years. Most infections are transient and self-clearing, do not lead to pathological changes.However, in a small percentage of adolescents, the infection persists, which is associated with an increased risk of neoplastic processes later in life. Human papillomavirus is responsible for around 26,800 new cancer cases and 15,000 deaths per year in the EU. Cervical cancer is the second most common cancer after breast cancer in women aged 15-44. – Can we protect young women from the risk of cervical cancer? Would you advise getting a vaccine? In the period 2006-2009, two different vaccines against the human papilloma virus (HPV) were licensed for use – quadrivalent – qHPV-vaccine and bivalent – bHPV-vaccine. Both vaccines contain non-infectious, inactive subunits and protect against high-risk HPV types 16 and 18, which are responsible for over 70% of cervical cancers. Application begins from the age of 9, for the prevention of premalignant anogenital lesions – cervical, vulvar, vaginal and anal, causally related to certain oncogenic types of the human papillomavirus HPV. From 9 to 14 years of age, two doses are administered, the second being between 5 and 13 months after the first application. After the age of 15, the doses are three – respectively at 0, 1 and 6 months. A necessary condition is that they should be applied before starting sexual life, but if indicated, they can also be applied afterwards. Such conditions are difficult to influence and recurrent condylomas, papillomas with different localizations, not only in the genital area. Barrier protection means – condoms – are used to protect not only from HPV infection, but also from other sexually transmitted infections, as well as from unwanted pregnancy. – What advice would you give girls and their parents about their sexual health? My advice is to inculcate proper hygiene habits in their children from an early age. Don’t put off talking about sex life, STDs and pregnancy risk. Spending enough time with your children, understanding their problems and gaining their trust so that they feel safe and comfortable to share about problems not only related to sexual health. Up to a certain age, parents must also take the responsibility of taking their children to preventive examinations. *** At SBALAG “Mother’s Home”, free preventive examinations will be carried out for girls up to 16 years of age, in the period between March 7 and 11. Any girl is welcome, and they must be accompanied by a parent or guardian who can present an ID and birth certificate. For this purpose, it is necessary to make an appointment in advance by calling 02/ 9172 442 between 2:00 PM and 4:30 PM on a weekday.Cervical cancer is the second most common cancer after breast cancer in women aged 15-44. – Can we protect young women from the risk of cervical cancer? Would you advise getting a vaccine? In the period 2006-2009, two different vaccines against the human papilloma virus (HPV) were licensed for use – quadrivalent – qHPV-vaccine and bivalent – bHPV-vaccine. Both vaccines contain non-infectious, inactive subunits and protect against high-risk HPV types 16 and 18, which are responsible for over 70% of cervical cancers. Application begins from the age of 9, for the prevention of premalignant anogenital lesions – cervical, vulvar, vaginal and anal, causally related to certain oncogenic types of the human papillomavirus HPV. From 9 to 14 years of age, two doses are administered, the second being between 5 and 13 months after the first application. After the age of 15, the doses are three – respectively at 0, 1 and 6 months. A necessary condition is that they should be applied before starting sexual life, but if indicated, they can also be applied afterwards. Such conditions are difficult to influence and recurrent condylomas, papillomas with different localizations, not only in the genital area. Barrier protection means – condoms – are used to protect not only from HPV infection, but also from other sexually transmitted infections, as well as from unwanted pregnancy. – What advice would you give girls and their parents about their sexual health? My advice is to inculcate proper hygiene habits in their children from an early age. Don’t put off talking about sex life, STDs and pregnancy risk. Spending enough time with your children, understanding their problems and gaining their trust so that they feel safe and comfortable to share about problems not only related to sexual health. Up to a certain age, parents must also take the responsibility of taking their children to preventive examinations. *** At SBALAG “Mother’s Home”, free preventive examinations will be carried out for girls up to 16 years of age, in the period between March 7 and 11. Any girl is welcome, and they must be accompanied by a parent or guardian who can present an ID and birth certificate. For this purpose, it is necessary to make an appointment in advance by calling 02/ 9172 442 between 2:00 PM and 4:30 PM on a weekday.Cervical cancer is the second most common cancer after breast cancer in women aged 15-44. – Can we protect young women from the risk of cervical cancer? Would you advise getting a vaccine? In the period 2006-2009, two different vaccines against the human papilloma virus (HPV) were licensed for use – quadrivalent – qHPV-vaccine and bivalent – bHPV-vaccine. Both vaccines contain non-infectious, inactive subunits and protect against high-risk HPV types 16 and 18, which are responsible for over 70% of cervical cancers. Application begins from the age of 9, for the prevention of premalignant anogenital lesions – cervical, vulvar, vaginal and anal, causally related to certain oncogenic types of the human papillomavirus HPV. From 9 to 14 years of age, two doses are administered, the second being between 5 and 13 months after the first application. After the age of 15, the doses are three – respectively at 0, 1 and 6 months. It is a necessary condition that they be applied before starting sexual life, but if indicated, they can be applied afterwards. Such conditions are difficult to influence and recurrent condylomas, papillomas with different localizations, not only in the genital area. Barrier protection means – condoms – are used to protect not only from HPV infection, but also from other sexually transmitted infections, as well as from unwanted pregnancy. – What advice would you give girls and their parents about their sexual health? My advice is to inculcate proper hygiene habits in their children from an early age. Don’t put off talking about sex life, STDs and pregnancy risk. Spending enough time with your children, understanding their problems and gaining their trust so that they feel safe and comfortable to share about problems not only related to sexual health. Up to a certain age, parents must also take the responsibility of taking their children to preventive examinations. *** At SBALAG “Mother’s Home”, free preventive examinations will be carried out for girls up to 16 years of age, in the period between March 7 and 11. Any girl is welcome, and they must be accompanied by a parent or guardian who can present an ID and birth certificate. For this purpose, it is necessary to make an appointment in advance by calling 02/ 9172 442 between 2:00 PM and 4:30 PM on a weekday.for the prevention of premalignant anogenital lesions – cervical, vulvar, vaginal and anal, causally related to certain oncogenic types of the human papillomavirus HPV. From 9 to 14 years of age, two doses are administered, the second being between 5 and 13 months after the first application. After the age of 15, the doses are three – respectively at 0, 1 and 6 months. A necessary condition is that they should be applied before starting sexual life, but if indicated, they can also be applied afterwards. Such conditions are difficult to influence and recurrent condylomas, papillomas with different localizations, not only in the genital area. Barrier protection means – condoms – are used to protect not only from HPV infection, but also from other sexually transmitted infections, as well as from unwanted pregnancy. – What advice would you give girls and their parents about their sexual health? My advice is to inculcate proper hygiene habits in their children from an early age. Don’t put off talking about sex life, STDs and pregnancy risk. Spending enough time with your children, understanding their problems and gaining their trust so that they feel safe and comfortable to share about problems not only related to sexual health. Up to a certain age, parents must also take the responsibility of taking their children to preventive examinations. *** At SBALAG “Mother’s Home”, free preventive examinations will be carried out for girls up to 16 years of age, in the period between March 7 and 11. Any girl is welcome, and they must be accompanied by a parent or guardian who can present an ID and birth certificate. For this purpose, it is necessary to make an appointment in advance by calling 02/ 9172 442 between 2:00 PM and 4:30 PM on a weekday.for the prevention of premalignant anogenital lesions – cervical, vulvar, vaginal and anal, causally related to certain oncogenic types of the human papillomavirus HPV. From 9 to 14 years of age, two doses are administered, the second being between 5 and 13 months after the first application. After the age of 15, the doses are three – respectively at 0, 1 and 6 months. A necessary condition is that they should be applied before starting sexual life, but if indicated, they can also be applied afterwards. Such conditions are difficult to influence and recurrent condylomas, papillomas with different localizations, not only in the genital area. Barrier protection means – condoms – are used to protect not only from HPV infection, but also from other sexually transmitted infections, as well as from unwanted pregnancy. – What advice would you give girls and their parents about their sexual health? My advice is to inculcate proper hygiene habits in their children from an early age. Don’t put off talking about sex life, STDs and pregnancy risk. Spending enough time with your children, understanding their problems and gaining their trust so that they feel safe and comfortable to share about problems not only related to sexual health. Up to a certain age, parents must also take the responsibility of taking their children to preventive examinations. *** At SBALAG “Mother’s Home”, free preventive examinations will be carried out for girls up to 16 years of age, in the period between March 7 and 11. Any girl is welcome, and they must be accompanied by a parent or guardian who can present an ID and birth certificate. For this purpose, it is necessary to make an appointment in advance by calling 02/ 9172 442 between 2:00 PM and 4:30 PM on a weekday.not only related to sexual health. Up to a certain age, parents must also take the responsibility of taking their children to preventive examinations. *** At SBALAG “Mother’s Home”, free preventive examinations will be carried out for girls up to 16 years of age, in the period between March 7 and 11. Any girl is welcome, and they must be accompanied by a parent or guardian who can present an ID and birth certificate. For this purpose, it is necessary to make an appointment in advance by calling 02/ 9172 442 between 2:00 PM and 4:30 PM on a weekday.not only related to sexual health. Up to a certain age, parents must also take the responsibility of taking their children to preventive examinations. *** At SBALAG “Mother’s Home”, free preventive examinations will be carried out for girls up to 16 years of age, in the period between March 7 and 11. Any girl is welcome, and they must be accompanied by a parent or guardian who can present an ID and birth certificate. For this purpose, it is necessary to make an appointment in advance by calling 02/ 9172 442 between 2:00 PM and 4:30 PM on a weekday.