Children and adolescents presenting with common and rare gynaecological conditions are described in this chapter. Communication needs to be sensitive and appropriate for age and development to retrieve as much information as possible.

Puberty heralds the development of secondary sexual characteristics, gonadal maturation, and start of reproductive capacity. Pubertal disorders can be divided into precocious and delayed puberty. Menarche is an important marker of puberty and menstruation should be seen as a vital sign. Oligomenorrhoea is pathological over time and most girls with oligomenorrhoea develop polycystic ovary syndrome (PCOS).

Sex development in the human is the result of a complex interaction involving production and response to sex hormones which is regulated by genetic and environmental factors. Disorders of sex development occur when an individual’s sex development takes a different path.

A 21-year-old nulligravid woman presents complaining of vulvar pain and irritation noted during exercise and with tampon insertion. She is an avid cyclist and rides approximately 75 miles per week as her routine. Her gynecologic history is unremarkable, but upon further questioning, she notes frequent friction and a “pulling sensation” with sexual activity. She has no medical or surgical history and uses a levonorgestrel intrauterine system for contraception. She takes no medication and has no allergies.