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J Natl Med Assoc
v.78(3); 1986 Mar
PMC2571264
J Natl Med Assoc. 1986 Mar; 78(3): 203β214.
Capraro VJ, Greenberg H. Adhesions of the labia minora. A study of 50 patients. Obstet Gynecol. 1972 Jan; 39 (1):65β69. [ PubMed ] [ Google Scholar ] Mor N, Merlob P, Reisner SH. Tags and bands of the female external genitalia in the newborn infant. Clin Pediatr (Phila) 1983 Feb; 22 (2):122β124. [ PubMed ] [ Google Scholar ]
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The premenarchal child's vulva should be assessed at each physician visit, even in the absence of symptoms. Vulvar problems (eg, hymenal lacerations, vulvovestibulitis, or labial adhesions) account for a significant percentage of pediatric outpatient diagnoses, yet related symptoms may not be volunteered by patient or parent, underlining the necessity for physical examination in order to have a complete data base. Despite the importance of the vulvar examination, it is omitted in a large percentage of cases, reflecting deficits in undergraduate and postgraduate medical training.
In order to facilitate the thorough examination of the premenarchal girl's vulva, the four premenarchal stages of development and the physical changes encountered at each stage are described. In addition, a checklist guide for the performance of the vulvar examination is included.
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PHOTOS: Teen Moms In The Philippines β A "National Emergency" : Goats and Soda Over a 10-year period, 1.2 million Filipina girls between the ages of 10 and 19 have had a child. The government is trying to change things. But the pandemic has made matters worse.
Goats and Soda
STORIES OF LIFE IN A CHANGING WORLD
PHOTOS: Why The Philippines Has So Many Teen Moms
Sisters Rose Ann, age 15, (right) and Ros Jane, age 17, hold their babies in the neighborhood where they live in Manila.
The girls are very close and rely on each other for support, raising their children as if they're siblings. Ros Jane is protective of her younger sister and worries she is not mature enough to take on the responsibilities of parenthood.
Sisters and teen moms Rose Ann (center) and Ros Jane (left) are seen in the canteen where their mother works as a cook in Manila. Ros Jane had just asked her mother for money to buy medicine for her son.
Ros Jane and her son in the room she shares with her sister and her child. While their situation is bleak, the sisters support each other, creating an ad-hoc safety net to face the challenges of teen motherhood.
Rose Ann in her mother's home with her baby. She gave birth a few days after turning 15.
Rose Ann, who has a young son, hangs out outside her home.
Ros Jane walks with her child by the railway near her home in Manila. She became pregnant at age 16.
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STORIES OF LIFE IN A CHANGING WORLD
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Joan Garcia became pregnant at 14 and gave birth at 15. She and her child travel by raft between the two shacks where they live in Navotas fish port on Manila Bay.
Hannah Reyes Morales for NPR
hide caption
Joan Garcia became pregnant at 14 and gave birth at 15. She and her child travel by raft between the two shacks where they live in Navotas fish port on Manila Bay.
Editor's note: Hannah Reyes Morales has been photographing teen moms since 2017. Aurora Almendral began reporting this story in October 2019.
At 12 years old, Joan Garcia liked leaping into the sea and racing the boys to the nearest pylon. She liked playing tag. When she started having sex at 13, she thought it was just another game. Joan was skipping across the pavement, playing a game with friends, when an older neighbor noticed her rounding belly.
Her daughter, Angela, is now a year old. Joan crouched on the floor, folding up her lanky teenage limbs and fed Angela fingers-full of steamed rice, crimped strands of instant noodles and fermented anchovies from the family's small communal bowl.
Sisters Joan (center) and Jossa Garcia (left), both teen mothers, hang out in a boat with their children and their younger sister. Each year, 1.2 million Filipina girls between the ages of 10 and 19 have a child.
Hannah Reyes Morales for NPR
hide caption
Sisters Joan (center) and Jossa Garcia (left), both teen mothers, hang out in a boat with their children and their younger sister. Each year, 1.2 million Filipina girls between the ages of 10 and 19 have a child.
Joan, now 16 years old, said that since she became a mother, she's embarrassed to play kids' games, then paused for a moment. "Sometimes I still play tag in the water with my brothers," she admitted.
Over a 10-year period, 1.2 million Filipina girls between the ages of 10 and 19 have had a child. That's a rate of 24 babies per hour.
And the rate of teenage pregnancy is rising. According to the most recent data, collected every 10 years, in 2002, 6.3 percent of teenagers were pregnant; by 2013 it had gone up to 13.6 percent.
Last August, the Philippines' economic development agency declared the number of teenage pregnancies a "national social emergency."
Joan Garcia (right) and her baby take a boat ride home. Garcia says she's embarrassed to play kids' games now that she's a mother β but admits "sometimes I still play tag in the water with my brothers."
Hannah Reyes Morales for NPR
hide caption
The pandemic has made the situation worse. With Manila under a strict lockdown β including limited access to medical facilities, no public transportation and harshly enforced rules on not going out β access to birth control has been severely curtailed, particularly for teenagers, said Hope Basiao-Abella, adolescent reproductive health project coordinator for Likhaan, a nongovernmental organization that works on women's health and access to contraception.
The University of the Philippines Population Institute is predicting a baby boom in 2021 β an estimated 751,000 additional unplanned pregnancies because of the conditions created by the pandemic.
The main reasons for the high rate of teenage pregnancies are inadequate sex education (some girls do not know that having sex can result in pregnancy or fully consider the responsibility of having children) and a lack of access to birth control.
Contraceptive access has long been a complicated, divisive issue in the Philippines. Despite a constitutional separation of church and state, Catholic morals dominate Philippine law. For more than a decade, reproductive health activists and legislators fought a bitter battle with the Catholic Church and conservative politicians to pass a law that would allow the government to distribute contraceptives to those who could not afford them and require comprehensive sex education in public schools.
Outside the Quiapo Church in Manila, some vendors sell herbs, roots and bottled pills used to induce abortion β which is illegal in all circumstances in the majority-Catholic country.
Hannah Reyes Morales for NPR
hide caption
The Philippine Catholic church has long opposed birth control in the country where about 80% of people are Catholics. In the past, the Catholic Bishops Council of the Philippines preached β in public statements, on the pulpit and through allied lawmakers β against a bill to widen access to birth control on moral grounds, calling it "anti-life" and "a major attack on authentic human values and on Filipino cultural values."
The Philippines passed a reproductive health bill into law in 2012. But years of Supreme Court challenges and delays in implementation continue to this day. Among the concessions to conservatives was a provision requiring parental consent for minors to buy contraceptives or receive them for free.
The Jose Fabella Memorial Hospital serves low-income communities in Manila, where the rates of teen pregnancy are high. Locals call it the "baby factory" Γ’ΒΒ and the maternity ward is typically very busy.
Hannah Reyes Morales for NPR
hide caption
The Jose Fabella Memorial Hospital serves low-income communities in Manila, where the rates of teen pregnancy are high. Locals call it the "baby factory" Γ’ΒΒ and the maternity ward is typically very busy.
"It was one step back [for] adolescent health," said Dr. Juan Perez III , executive director for the Philippine Commission on Population and Development. The law improved access to birth control for women, but it became harder for teenagers to get birth control.
To address the resulting uptick in adolescent pregnancies, lawmakers have introduced bills improving access to contraception, supporting sex education and making it illegal to expel girls from school should they become pregnant. None have become law so far.
Perez said a teenage pregnancy has a significant impact on perpetuating poverty. "They cannot recover from being a child mother," he said.
That was the finding of a 2016 study by the United Nations Population Fund. By age 20, a teenage girl in the Philippines who gets pregnant and drops out of school earns 87 percent of the average 20-year-old woman's pay. Perez said the lower income continues further into adulthood.
Joan lives with 16 relatives on a small raft of bamboo poles and scavenged wood, tied to a broken cement pylon, bobbing behind a row of steel shipping vessels docked in Manila's fish port β a patchwork of spaces no larger than two king-size mattresses. Two of her sisters' babies and a kitten nap on a pile of rumpled sheets against a particle board barrier to keep them from falling into the murky, gray water.
Sisters Joan (left) and Jossa Garcia (right), both teen mothers, are seen in their home in the Navotas fish port with their children, Angela and JM, respectively.
Hannah Reyes Morales for NPR
hide caption
Sisters Joan (left) and Jossa Garcia (right), both teen mothers, are seen in their home in the Navotas fish port with their children, Angela and JM, respectively.
Like Joan, her older sisters had babies when they were young and left school before they graduated. No woman close to her has ever had a good job. Her mother occasionally finds a day of work cleaning mussels on the concrete floor of the fish port. Her father brings in some money doing odd jobs at the port. The family is often hungry and thirsty, and survives by begging sailors for food and water.
Joan can't imagine a different kind of life.
Yet the current government wants to see changes. "We made a decision in this country that population is a problem," said Perez. The government now believes that the country's birthrate of 2.92 births per woman β among the highest in Asia β is holding back economic development. So after decades of policies that limited access to contraception informed by a Catholic ethos to procreate, government agencies are now acting with a new urgency to bring the birthrate down.
If households have fewer children, Perez said, it will improve the family members' chances of getting out of the mire of poverty.
Yet the reproductive health laws in the Philippines β aimed at stemming population growth β are yet to have that impact. And the people who suffer are the urban poor. Sen. Risa Hontiveros knows the limits of the laws, the complexity of the issue and the danger of losing hope.
The work of improving access to birth control, Hontiveros said, "were passed on to us by those who came before us, they struggled, and they fought. They won some, and they lost probably more, but they passed on to us better situations that they started out with."
"So the least we can do β the least I can do β is to keep fighting."
Joy Villanueva dropped out of high school when she got pregnant at 14, in seventh grade. Her boyfriend, four years older, wooed her with afternoons out, buying her fried quail eggs on a stick and paying for rounds on the karaoke machine at a local hangout.
Joy Villanueva, 15, holds her baby. The slums where her family lived had burned down; they hope to build a new shack to replace the home they lost.
Hannah Reyes Morales for NPR
hide caption
Joy Villanueva, 15, holds her baby. The slums where her family lived had burned down; they hope to build a new shack to replace the home they lost.
He was tall and handsome, and she liked that he did chores around the house and washed the dishes for his mother. Soon she was living with him. "He really wanted a baby," Joy said, "so no one else would court me."
For her boyfriend, getting Joy pregnant was a mark of ownership. Joy resisted, but he persuaded her to have sex. By the time she gave birth, he was in jail for theft, and she was raising the baby with help from his mother. The day we met, the three of them were living together in a makeshift home of little more than a tarp supported by planks of wood β they had set it up after their slum had burned down a week before.
At 15, Joy dreamed of finishing high school, going to college and becoming a police officer. That was what her late father wanted for her when she was a little girl. She said that any day now, she'll move in with her mother, who will take care of the baby while she goes to class.
Joy Villanueva said she hopes to fulfill her father's dream for her and becoming a police officer β but later admitted that's an impossible dream for a poor teenage mom.
Hannah Reyes Morales for NPR
hide caption
Joy Villanueva said she hopes to fulfill her father's dream for her and becoming a police officer β but later admitted that's an impossible dream for a poor teenage mom.
If Joy is able to complete her schooling, she said she wants to own a big house made of concrete with air conditioning and glass windows. She wants to have a nanny to take care of her kids so she can wake up every morning, check her uniform i
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