How often can you take ibuprofen for menstrual cramps?

Using ibuprofen for menstrual crampsI often joke with parents that my gynecologic knowledge is limited because most female adolescent patients prefer seeing a woman doctor. However, my daughter suffered with severe cramps, and I learned the following tip from my partner, Promise Ahlstrom, MD.

If your daughter has bad cramps, she should take 400 to 600 mg of ibuprofen as soon as her period starts. Then, she should repeat the dose every 4 hours for the first 24 hours of her period. The goal here is to “stay ahead of the pain.” If a girl takes the first does at 8am, she may be tempted to skip the noon dose if the cramps have subsided. This is a no-no. By missing a dose, the physiology that causes menstrual cramps will worsen. By the second day of her period, she can usually drop the dose to every 6 hours, but she should still take the medicine on schedule. By the third day of her period, she can take the ibuprofen as needed.

Three things can interfere with staying on course with this regimen. First, if a girl is at school, she may need to go to the nurse to get her medication. If the school has a strict policy about leaving class, a note from the doctor can help. Second, some girls forget to take their medicine. This can be overcome by putting reminders in her cell phone or getting a friendly text from mom at the right time. Third, her period may start right before bedtime. In this situation, I would consider waking her up for a dose of ibuprofen unless doing so would disturb her sleep and cause other problems the following day.

If this regimen doesn’t help, your daughter should see her pediatrician or a gynecologist to discuss other options.

What’s a retractile testicle?

Retractile TesticleIn my last blog, I mentioned that it takes 6 months for testicles to descend from the abdomen into the scrotum. If this process doesn’t occur properly, a baby will be born with an undescended testicle. (If the testicle can be felt in the inguinal canal, it’s referred to as a partially undescended testicle.) In many cases, an undescended testicle will drop to its normal position by 2 to 3 months of life. If this fails to occur, the baby will be referred to a pediatric urologist.

Prior to puberty, a boy’s testicle is roughly the size and shape of a peanut. This fact, combined with an active scrotal reflex, often pulls the testicle into the lower part of the inguinal canal. We call this a retractile testicle. It’s not the same as a partially undescended testicle. In pre-adolescents, testicles commonly “hide” when boys giggle during the genital exam.

The way doctors differentiate between a partially undescended testicle and a retractile testicle is to see what happens when the boy squats. During a squat, a retractile testicle will drop down so it can be easily pulled into the scrotum; a partially undescended testicle will not. If there is any question about this, your child will be referred to a pediatric urologist.

If your child can’t get through the genital exam because he’s ticklish, there is a way parents can identify a retractile testicle without seeing a urologist. Have your child sit in a warm bath for about 5 minutes. Because the testicles are meant to be cooler than the body, retractile testicles will almost always drop down into the scrotum, which itself gets “baggy” in warm water. If you see or feel the testicles in the lower scrotum, you don’t need an appointment with a urologist.

What’s a hydrocele?

hydrocele in chrildrenWhen I see boys for routine physicals, I always check their testicles for lumps or swelling. The most common problem I find in the first year of life is something called a hydrocele. A hydrocele is a collection of fluid around the testicle.

Hydroceles have an interesting history. Although a baby’s gender is decided at the moment of conception, both sexes develop along the same path until the third month of pregnancy. At that point, a group of cells in the lower abdomen develop into ovaries in females or testicles in males. If the baby is a girl, the ovaries are in the correct anatomic position. If the baby is a boy, the testicles need to descend into the scrotum. This process takes about six months. As the testicles move downward, they pass through the inguinal canal before reaching their proper position in the scrotum.

After the testicle enters the scrotum, the inguinal canal is supposed to fuse thereby separating the abdominal cavity from the scrotum. In some cases, this doesn’t happen and a small amount of fluid travels into the scrotum. Most of the time, this occurs before birth and the hydrocele will be detected at the baby’s first examination. In some cases, fluid moves into the scrotum after birth, in which case the hydrocele won’t be found until the baby is older. Most turn up between 1 and 4 months of age.

Hydroceles are not dangerous and usually resolve before a child’s first birthday. If they persist beyond a year, there’s a possibility the child also has an inguinal hernia. In this case, he should see a pediatric urologist or a general pediatric surgeon.

Frequent urination in children


About twice a month, I see a child who has been urinating very frequently during the day. It usually occurs in children under the age of eight, and the pattern is remarkably similar. Rather suddenly, the child starts making frequent trips to the bathroom to pee. She feels an urgent need to go but once she gets to the toilet, only a small amount of urine comes out. It doesn’t hurt when she pees. The child goes back to what she was doing only to feel the same urge five to ten minutes later. The feeling disappears when the child goes to sleep only to resume again the next morning.

The bladder is basically a pouch made of muscle. The lining of the bladder contains a complex system of nerves that’s designed to keep us dry and alert us when we need to go. Most of the time, the bladder signals that it’s time to urinate when it’s about halfway full. This is accomplished by “stretching” nerves that sense increased pressure within the bladder.

The situation I described above is called daytime frequency syndrome. It’s not clear what causes the condition, but in some cases, it may be due to stress. The symptoms usually resolve in a week or two. There is no treatment for the problem other than to reassure children and let them go to the bathroom when they feel the urge. When I see kids in my office with this problem, I give them a quick anatomy lesson and then explain that their bladder is being silly by signaling them to go when it’s not full.

If you think your child has daytime frequency syndrome, you should talk to your doctor to make sure something else isn’t causing the problem. Doctors consider the following conditions anytime a child presents with frequent urination:

  • Urinary tract infection: If a child has a UTI, she will usually have a fever, abdominal pain or burning when she urinates.
  • Diabetes: If a child has diabetes, she will usually produce a normal to large amount of urine each time she goes. In addition, they commonly wake up at night to pee or start wetting the bed.
  • Constipation: Most parents don’t know what’s going on with their children’s bowel movements once they are toilet trained. Constipation can present with large, hard or infrequent stools that may or may not be associated with tummy aches. The only way to be sure your child isn’t having a poop problem is to look at her stools for a few days.

The problem with bubble baths

BathChildren love to have fun during bath time. Whether it’s playing with bath toys, surrounding themselves with bubbles or just splashing around, kids enjoy having fun in the tub. However, bubble baths can cause side effects in girls. The opening to a girl’s urethra (the tube urine comes out of) can become irritated after being exposed to the chemicals in bubble bath. This is true whether you’re using a popular brand or an organic product. As a result, girls may experience painful urination after taking bubble baths. The problem is not serious, and the symptoms usually resolve in a day or two. The problem is that painful urination can be a symptom of a urinary tract infection (UTI). So not only could your child be uncomfortable after the bath, but it may result in a doctor’s visit to check for a UTI.

The same symptoms can occur if a girl sits in soapy water for a long period of time. Therefore, it’s a good idea not only to avoid bubble baths, but also to have your kids play during the first part of the bath before you wash them and shampoo their hair.

If your child develops painful urination after a bath, there two things you can do to relieve the symptoms. Both approaches flush the chemicals from the urethral opening and should be done twice a day. If the symptoms don’t resolve promptly, make an appointment to see your doctor.

  • Fill the bathtub partway with warm water. Have your daughter lean back with her knees apart. Ask her to gently separate her outside vaginal lips. Fill a clean container with bath water and pour it over her vaginal tissues. If you don’t have a container, you can splash water in the same direction. Repeat two or three times.
  • Have your daughter sit on a toilet with her legs open. Ask her to gently separate her outside vaginal lips. Fill a bottle (the type that has a nozzle) with warm water. Hold the bottle a few inches in front of her vaginal tissues and squeeze. This may tickle, but it should not hurt. Repeat two or three times.

Extra foreskin in circumcised infants

A common finding in male infants is a circumcised penis that has some extra foreskin—it is most noticeable on the underside of the penis. When babies are circumcised, the person doing the procedure has to be careful not to remove too much foreskin. As a result, sometimes a little extra skin will remain behind the head of the penis (glans). It is very important to retract (pull back) this skin in the immediate post-circumcision period so it does not heal to the head of the penis, which could cause problems later. This is one of the things the doctor should check at your first post-hospital visit.

If the circumcision heals properly, the extra skin may develop a thin attachment to the back portion of the glans in early childhood. (Your doctor will be able to tell the difference between a post-circumcision scar and this thin attachment.) It is not necessary to do anything if your child’s penis has a thin attachment because it will resolve over time.

Hernias and other problems in teenage boys

This blog post is really for adolescent males. If you are a parent, copy the information or send a link to your son. Concerned aunts, uncles and grandparents can do the same thing.On May 14th, I wrote a blog about testicular torsion. [Link:] The purpose of the blog was to inform kids and parents about a serious condition that can happen at any age, but is more common in teens.

I educate all of my adolescent patients about testicular torsion so they will act quickly if they develop the sudden onset of testicular pain. I also encourage them to check their testicles on a monthly basis to look for other problems. They don’t always listen.A few months ago, I saw a 16-year-old for a routine checkup. During the genital exam, I found a large inguinal (groin) hernia. When I asked Jeremy (not his real name) how long the bulge had been present, he got quiet and said, “I’m not sure, four months maybe.”The reason Jeremy didn’t tell me about the swelling is because he had hoped it would go away. This is an example of denial, something that can happen to anyone. Males of all ages, but especially teenagers, are reluctant to report problems in this particular location.

I referred Jeremy to a surgeon who repaired the hernia without complications. But the take-home message is clear. If something else had been causing the swelling, such as testicular cancer, not telling anyone about it for months might have had a different outcome.

Although testicular cancer is rare (5.4 cases per 100,000 males), it is the most common cancer in males aged 15 to 39. Because the incidence of testicular cancer is low, there is disagreement among medical professionals regarding the value of monthly screening. That being said, the survival rate for Stage 1 testicular cancer is better than advanced disease.

The best time to do the exam is after a shower when the scrotum is relaxed.

  • Examine one testicle at a time.
  • Using gentle pressure, roll each testicle between your thumb and fingers. Testicles are egg-shaped and should feel smooth and firm. One may be slightly bigger than the other, but they should be about the same weight and consistency.
  • Feel for small lumps, swelling, hardness or other changes in the shape of the testicle.
  • The epididymis is a spongy, tube-like structure that is attached to the top and back of each testicle. It is a normal finding.
  • If you notice a change in either testicle, see your doctor promptly.

A Modified Sitz Bath Helps With Mild Vaginal Irritation

A common symptom in preteen girls is pain with urination. Although it is important to consider a urinary tract infection (UTI) in this situation, the following conditions can cause painful urination because they irritate the tissues around a child’s urinary opening. These conditions are more common than UTIs. 

  • poor hygiene (or wiping in the wrong direction)
  • bubble baths
  • prolonged bathing where a child washes herself and then sits in a soapy tub
  • staying in a wet bathing suit for long periods of time during the summer

If your child has mild urinary symptoms without fever, vomiting or abdominal pain, you can consider trying to relieve her vaginal irritation by cleansing her bottom before taking her to the doctor. (Although it is helpful for dads to know about this problem, moms should usually be the ones to assist their daughters with treatment.) 

Fill an 8- to12-ounce plastic bottle with warm water (it is important that the bottle has a “nozzle” on top to so it will produce a stream of water when squeezed). Have your child sit on a toilet with her legs spread and her labia majora pulled to the side. Position the bottle a few inches from the vagina and gently shower the tissues with water. Do the procedure twice a day for a couple of days. If the symptoms increase or do not improve quickly, see your doctor. 

Boys need to be examined standing up

Doctor’s visits can be unsettling for children so I usually examine infants and toddlers on the parent’s lap. However, once boys reach the age of three or four, it’s important to do the testicular examination while they are standing.

Prior to adolescence, the main problem we look for is an inguinal hernia. Although parents may notice a bulge in their child’s groin before the checkup, the finding can be missed if a child isn’t standing when he’s examined. The reason for this is because an inguinal hernia is the result of a small opening between the abdominal cavity and the scrotum. If a person is standing, gravity “pushes” intestinal contents downward making the hernia easier to find.

Doctors look for inguinal hernias in adolescents as well, but this age group can also develop something called a varicocele. A varicocele is a painless swelling in the scrotum due to enlarged veins. (It feels like the scrotum is partially filled with worms or cooked spaghetti.) Like hernias, the problem can be missed if the testicles are examined when a person is lying down because the swelling goes away in this position.

If your child’s genital exam isn’t done while he’s standing, tell the doctor you know someone whose hernia or varicocele wasn’t found until he was checked in this position. Also, because adolescents usually ask parents to leave during the genital exam, make sure your son knows about the importance of being examined while standing.

Although inguinal hernias are much more common in boys, they can occur in girls as well. Therefore, it’s a good idea to do a brief genital check in girls when they are standing.

Reuse Pull-Ups And Be Environmentally Conscious

Lots of kids continue to wet the bed at night even though they are successfully using the potty during the day. (Even at six years of age, 12% of kids wet the bed.) Most parents use Pull-Ups during this period of nighttime wetness to make the morning routine easier for everyone. However, most kids become dry gradually and many of them will still be in Pull-Ups even though they are dry three or four nights per week. If your child is dry at night, you do not need the Pull-Up away the next morning. In most cases, a child can reuse a dry Pull-Up five or six times before it gets so tattered or baggy that it needs to be thrown away.

Have You Ever Heard Of Testicular Torsion?

Most parents know that certain symptoms that can be associated with serious medical conditions. The most common ones are as follows:

  • stiff neck may mean meningitis
  • abdominal pain may mean appendicitis
  • bad cough may mean pneumonia

Testicular torsion is a rare condition that most parents have never heard of. However, as with the problems noted above, it is important to get urgent medical attention for the condition. Although testicular torsion can occur at any age, it is most common in 12- to 18-year-olds.

In order to prevent the testicles from twisting, they are anatomically anchored within the scrotum. Sometimes, this anchoring is in the wrong place, which allows the testicle to twist 360 degrees. If this happens, the artery that supplies blood to the testicle will twist thereby cutting off its blood supply. Shortly after this occurs, a child will experience pain and swelling because the testicle is being deprived of oxygen. Although this is not a life-threatening condition, the testicle itself may die if the problem is not diagnosed and treated within eight to ten hours.

Although doctors know about the importance of diagnosing and treating testicular torsion as soon as possible, lay people don’t. In addition, since adolescents may be reluctant to discuss genital symptoms with their parents, further delays can occur before the diagnosis is made. You can remedy this situation by asking your doctor to discuss the problem at your next checkup. If a teenager knows that testicular pain is an emergency, he will hopefully be more proactive reporting the problem to his parents.