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So your daughter comes to you and says, "It hurts to pee." Is it automatically a urinary tract infection? Not so fast. Girl parts are super-sensitive, especially between the ages of potty-training to puberty, and there could be a few things going on. So how do you know what the problem is?
Diagnosing UTIs in Children

First, your daughter would need to be seen. We cannot diagnose urinary tract infections in girls over the phone. We need them to actually come into the office and pee so we can do a urinalysis test. That will show if she has a UTI or if she's dehydrated and her burning with urination is due to concentrated urine.

It will also show if there is blood in the urine or any signs of diabetes as well, which doesn't cause burning with urination, but does cause frequent urination, which is another sign of a possible UTI.
Treatments for UTIs in Children

If your daughter does have a UTI, we can treat her with antibiotics while sending her urine off to get a culture at the lab and find out what type of bacteria is causing her UTI and make sure she's on the correct antibiotic.

If your daughter does not have a UTI, then we need to ask a few more questions, like is she drinking enough water? Does she take bubble baths? Is she wiping too hard? Is she wiping at all? Is she wiping in the right direction? Does she have any vaginal symptoms? And yes, we have to ask if anyone has touched her inappropriately down there.

Based on those answers, we can talk about treatments. Will drinking more water help? What about cranberry juice? Which may or may not help, depending on what's going on. Does she need any special creams for her private area? Does she need to work on better hygiene? If she is sexually active, do we need to test for chlamydia or gonorrhea? Is this not a urinary issue but more a vaginal issue?
What NOT to do for Your Child's UTI

Everything is in such a small space in that area that it can be hard to figure out what is going on and what the correct treatment is.

I've had parents ask me about certain home remedies that I can tell you, you should not do. Don't do the following. Don't have your daughter douche to clear out the UTI.

Similarly, I had one mom tell me that she was told to soak a tampon in probiotic kefir and insert it in her vagina to treat a UTI. Neither of those will help because a UTI is in the urinary system and inserting something into the genital system won't help. Just because they're in close proximity doesn't mean that they are treated the same.

Don't put random creams in or on your daughter's privates without finding out what the main cause of her symptoms are. Sometimes, that will make the problem worse.

And don't give antibiotics that were left over from a previous infection, because not all antibiotics will treat urinary tract infections.

So if your daughter has girl-part issues, please bring them in to be seen by their pediatrician. We can help you figure out exactly what is going on and what is best to help them feel better.

Dr. Jones: The mammalian miracle of growing babies inside you is amazing. Yeah, that's a lot of M's in one sentence, but what do we know and what don't we know about implantation? And what do couples do and doctors do to try to make it work better?

Announcer: Covering all aspects of women's health, this is the "Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: In humans, eggs are sort of squished out of the follicle, and that's the cyst that has the egg in it in the ovary when ovulation occurs. Okay. It usually works. It's not too hard to understand, and we can study it in other mammals like lab mice. The fallopian tube picks up the egg, which is surrounded by a cloud of sticky cells, and moves the egg and its cells into the tube. Okay. I got that.

Sperm, which were deposited in the vagina, swim up the cervix, uterus, and out the tube and meet the egg. Okay. That seems hard and a long way for the tiny guys, but there are so many of them. The egg and sperm recognize each other as human, and only one sperm gets in the egg. Now, that's amazing, and there are so many of them. And the egg gets fertilized.

Okay. We understand that mostly, and we can watch it happen in the IVF lab with human eggs and sperm. We do know that a lot of eggs and sperm and a lot of fertilized eggs are not normal, so there are lots of time that the process doesn't go much farther than this. But if things are normal enough, the fertilized egg starts to divide, wanders down the fallopian tube with a little help of tiny little fingers on the cells of the fallopian tube and arrives in the uterus at the time that the embryo has developed enough to have over 100 cells and specialized cells that can settle into the uterus lining and start to burrow under the lining. And, after that, we really don't have a clue as to what happens at all.

The human process of implantation is not necessarily like mice or cows. We actually are much less efficient. Removing the uterus of women at various stages of implantation to study what's going on is not going to be done. The primates that we share our genes and our reproductive biology with are increasingly rare and are protected from this kind of research. Implantation, the process of the embryo burrowing under the uterus lining, capturing some of the blood supply of the uterus lining, and growing enough to make a placenta, which then grows to feed the embryo and fetus, is mostly a mystery.

It is thought that about one in five fertilized eggs goes on to make a baby to viability in fertile couples. In infertile couples, it doesn't happen that often, and sometimes we don't know why or what to do about it. So many couples who are not getting pregnant move to in vitro fertilization. It is thought about 1% of all the babies born in the U.S. were conceived with IVF, and that makes about a million babies in the U.S. over the years. Hundreds of thousands of cycles of IVF are done each year in the U.S. But you can put lovely looking embryos into the uterus of a woman and not get pregnant for no good reason.

This leads doctors and patients to try to come up with strategies to increase the chance of implantation. In the old days, we had a woman in bed tipped upside down for a day after putting the embryo in her uterus with hopes that it wouldn't fall out. Then we had women rest for hours, then an hour, then 15 minutes, and then not at all because randomized trials showed that laying down flat after an embryo transfer didn't seem to make a difference in implantation. Some people have tried acupuncture with the hope that it might help implantation through some ancient wisdom that we understand about as well as we understand implantation. Randomized trials showed that acupuncture didn't work better than fake acupuncture and implantation, but doctors and patients were desperate to make this very expensive and life-consuming process work.

Some years ago, someone came up with the idea that if you disrupted the uterus lining the month before IVF, maybe it would cause a reaction in healing that might increase the chance of implantation. Given that we have no clue about implantation, it seemed like an idea. And some early studies suggested it might have a small effect, increasing the likelihood that the embryo would successfully implant and grow. Now, this isn't like gardening where you scratch the earth and then put the seeds down in hopes that they will grow better than just dropping the seeds on the ground, although it sort of sounds like that.

The endometrial disruption called endometrial scratching actually happens the month before the IVF cycle. It can be done in several ways, but the most common is to put a small tube with a sharp edge at the tip into the uterus, through the cervix, and move it around back and forth, sort of scuffing up or scratching the uterus lining. So does it work? Some people thought it did. Some studies suggested it might, and patients and doctors were desperate.

In a widely read medical journal, the "New England Journal of Medicine," a large randomized trial of endometrial scratching versus no scratching before an IVF cycle reported that it didn't help. There was no difference. Not exactly a surprise. At least it didn't hurt. Well, actually, it did hurt. Putting a tube in the uterus and swirling it around is uncomfortable to most women. And for doctors who charge for this procedure, it could be 200 to 600 bucks, so scratch that. Well, no, don't scratch that.

Lots of things have been tried. Word gets out on the web, and patients request some intervention or another that might increase the chance of getting pregnant. I will admit to some magical thinking of my own that I did after putting embryos back in the uterus of patients undergoing IVF in my years as an IVF doctor. There are a couple of minutes between putting a tiny drop of fluid with embryos, or better one embryo, into the top of the uterus. And when the embryologist in the lab checks the tube and makes sure that the embryos are gone, it's a couple of minutes. I would practice deep breathing and imagine the embryo in the uterus happy and implanting, and growing, and seeing children at our IVF picnic. I didn't tell patients that I did this little exercise, but it seemed like a good use of a few quiet minutes. Magical thinking. What I really wanted was some kind of tissue super glue, but somebody actually tried that, and it didn't work.

So what do we do when we don't know what to do? The world of infertility and early pregnancy loss has been filled with well-meaning therapies to try to help people have the children that they hope for. Most, at least, haven't been harmful -- acupuncture to increase IVF implantation, aspirin to prevent miscarriage, and many others. But before we suggest it or offer it to patients who want it, we should at least know that it won't hurt physically, emotionally, or financially. Large, well-done randomized trials are very expensive, and in the IVF world, usually not funded by our government, but they need to be done. As patients and consumers of reproductive health care, we should try to get the best information from our physicians and take a deep breath and do the best we can. And thanks for joining us on The Scope.

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Interviewer: Considering a career in medicine, but aren't sure exactly what area would be right for you? We'll discuss what it's like to be an OB-GYN, next, on The Scope.

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Interviewer: Each field of medicine comes with its own challenges and benefits. We have Dr. Kirtly Parker Jones, an OB-GYN at University of Utah Health, here to talk about a career in Obstetrics & Gynecology. First, how did you get into reproductive medicine?

Dr. Jones: Well, it's a long story, and students who are anxious because they don't know exactly what path to take, you need to realize, I didn't ever think I was going to go into medicine until I was a senior in college. So it's often someone who shines a bright light on a choice. A job as a basic biology scientist was probably not going to be very well-funded. So my mentor, who was a chairman in the department said, "Go to medicine." And so I was going into medicine thinking I was going to do genetics, but issues at the beginning of life are so compelling.

So I think medical students often, as they're thinking about a career, are looking for something that is egosyntonic. It's a wonderful word that means "sings with their soul." Some people are great with their hands. Some people like to play video games, and they like to do things with images. Some people are really bonded to the storytelling of individual patient care. And so people tend to find, as they go through medical school, the topic or the area that sings with their soul. And for me, as a biologist, as someone who loved the beginnings of life as a biologist, OB-GYN was a natural. A lot of drama and a lot of blood, but I was okay with that.

Interviewer: So what do you like most about your job?

Dr. Jones: Well, it turned out that what I liked wasn't what I thought I was going to like. So I thought I was going to like fixing things because I used to sew for a living, and I thought, "I can cut and sew, and so the surgery's going to be fun, and the baby thing is fun." As I grew in my work, what I really loved was women's stories. I loved the stories about their lives and anything I could do to help them be happier with themselves. Women carry a burden of inadequacy. They don't think they're pretty enough, or smart enough, or, you know, sexy enough, or whatever enough they may not be, but they actually are all those things.

So helping women be happy with their stories or get over a really hard story, that ended up being the most rewarding in the long run and the thing that I remember most. Of course, I remember the days that someone nearly bled to death and our team saved them, but I remember my ladies and how brave they were, and how funny they are, and how beautiful their stories are. And that's the best.

Interviewer: So what's the hardest part then?

Dr. Jones: Well, the hardest part is when you can't help someone get over a bad story. So there are women who feel that they are victims, and they had been victims. But moving past that victimhood, just survivorship, whether they're victims of rape, or emotional abuse, or cancer, or infertility, helping women move with the love in their heart for the thing that they lost, but helping them move beyond that. And women who can't do that, women who are addicted and can't move beyond, women whose grief is so long, then I need help. I need a professional. I need a psychologist.

Interviewer: What does your typical day look like?

Dr. Jones: Well, I'm in academic medicine. There is no typical day. So there are several days of the week when I have clinic in the morning, and I might have lectures with students in the afternoon. I might have one day a week where I operate. I have a week when I do administrative work, meaning I design educational programs for students and for residents. So, in academic medicine, you are never, ever bored. You're always steep on your learning curve, and students keep you that way.

For docs out in private practice, they might have three days a week when they do clinic, so they're in their clinic. They have one day a week when they operate. They have a day a week they try to catch up. And, of course, they're running back and forth to do deliveries which aren't always scheduled. So if you're going to be an OB-GYN, you have to tolerate a lot of chaos in your schedule. If you think you're always going to do this and get this done at a certain time, then you need to do something else.

Interviewer: Can you tell me a story or a favorite memory you have, being an OB-GYN?

Dr. Jones: Well, I would say there are a group of stories that come with patients who are going to have bone marrow transplants. So, for many years, I saw most of the women who were going to have a bone marrow transplant, usually for a life-threatening cancer. They were young women, and their future was going to be ending if they did not cure this cancer.

Bone marrow transplantation, at the time, is bringing someone almost to death with chemotherapy, and then snatching them back with someone else's bone marrow. And for these women, to watch them face a life-threatening cure from a life-threatening disease, watching their eyes as they hear that their fertility will be taken from them because the chemotherapy will take away their eggs, and seeing them afterwards, six months later and a year later, and watching them get on to their lives, they were the heroes for me.

There are so many women who've suffered from their infertility, from a rape, from abuse, from some awful surgery, but those women were, I think, examples of courage, and humor, and willingness to go forward in the face of uncertainty. And they shared it with me, and that was a privilege.

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