Affecting approximately one in every 4,500 newborn girls, Mayer-Rokitansky-Kster-Hauser (MRKH) syndrome can be challenging to treat both medically and psychologically, due to the potential loss of fertility. W Webcam. Although rare, it isimportant to recognize sarcoma botryoides, or embryonal rhabdomyosarcoma.Such a tumor can present as a lower abdominal mass or as vaginal bleedingor passage of part of the tumor. Dr. Appiah also reviews the expert consensus position statements that provide guidance on how providers should care for this population, including informing patients about options for fertility preservation and future reproduction prior to treatment. For non-life-threatening medical needs when your pediatrician is unavailable, visit one of our urgent care locations. The majority of childrens gynecologic problems are treated by medical , rather than surgical, means . This is referred to as nonspecific vulvovaginitis. A parent may stay in the room during the exam if the child does not mind ( Picture 1 ). Huffman JW, Dewhurst CJ, Capraro VJ: The Gynecology of Childhood andAdolescence. In: Emans SJ, Laufer MR, Goldstein DP, eds. Pay special attention to anatomic and pathophysiologic differences in the child. Observation alone is appropriate for small adhesions. The evaluation of childrens gynecologic problems involves considerations of physiology, psychology, and developmental issues that are different from those of adult gynecology . Urethritis can be caused by an infectiousagent, irritation, or trauma. Visualization of the introitus is better achieved using the previously described traction and the Valsalva maneuver than separation because it gives a deeper view of the structures and partial visualization of the vagina. Watch the video to learn the differences between primary and second dysmenorrhea and how to diagnose and treat endometriosis. A discharge that is both bloody and purulent is likely not from vulvovaginitis but from a foreign body (see Vaginoscopy for Prepubertal Bleeding without Signs of Puberty later in this chapter), although patients infected with some pathogens, particularly Shigella boydii, often present with a bloody or blood-tinged discharge . The extent of labial adhesions and associated symptoms are variable (seefigure "B"). What Stands in the Way of Bedside Teaching? The typical location is the anterior vaginalwall near the cervix. Thefinding of genital herpes type 2 is a strong indication of sexual abuse.Coexisting primary oral and genital herpes type 1 may occur in young children,but a finding of type 1 in the genital area alone should prompt an evaluationbecause this is more likely to be acquired by abuse.14Trichomonaswill rarely cause symptoms in the newborn period and spontaneously resolveswith waning of estrogen levels. Acute genital bleeding in girls is most caused by accidental trauma, such as straddling a bicycle or falling on playground equipment. A patient presents with foot pain and these chronic findings? Removal under anesthesia may be necessaryif a foreign body has become imbedded into the vaginal mucosa. Children's Hospital Colorado partners with NRC Health to gather star ratings and reviews from patients, residents and family survey data. The results of the vaginal culture may demonstrate a single organism that is a respiratory, intestinal, or sexually transmitted disease pathogen. The most common malignancy in preadolescent girls is a germ cell tumor. 0:31. An organized stepwise approach in a nonthreatening environment is more likely to result in a successful evaluation of the genitalia. Approximately 20% of female children infected with pinworms (Enterobius vermicularis) develop vulvovaginitis. A foreign object and the cervix may be visualized using this technique. 14 mins, 33 secs. Cultures for other organisms shouldbe done by placing the Calgiswab into a transport Culturette II with medium,or by sending the aspirated fluid to the bacteriology laboratory for directplating. Includes speculum and bimanual exams. At the end of the examination, use your fingerto "milk" the vagina and assess for discharge or, very rarely,polypoid tumors. It is important to give the child a sense that she will be in control of the examination process. Slang terminology for speculums among teens includes the threatening label the clamp. Teens should be assured that although the examination may include mild discomfort, it should not be painful . Many gynecologic conditions in children may be diagnosed by inspection . Abdominal or upper pelvic masses that are palpable mayrepresent ovarian tumors. A hand lens or otoscope often is helpful. 4:40. In addition, while obtaining a history, an opportunity exists to educate the child on vocabulary to describe the genital area. Caring pediatric nurses are available 24/7 to help answer your questions. Your patient gets this rash, whats the diagnosis? For girls olderthan 2 years, the knee-chest position also permits excellent visualizationof the vagina and cervix without instrumentation.3 If necessary,an experienced examiner or pediatric gynecologist may use a small vaginoscope,cystoscope, hysteroscope, or flexible fiberoptic scope with water insufflationof the vagina to improve visualization. The introduction of any instrument into the vagina of a young child takes skillful patience. NSGUs are caused by an autoimmune response following a viral illness and are unrelated to sexual activity. Vulvitis and vulvovaginitis usually are characterized by vulvar rednessand irritation, which may be associated with vulvar discomfort, vaginaldischarge and odor, vaginal bleeding, dysuria, or pruritus. These procedures are usually performed under anesthesia. The ideal pediatric endoscope is a cystoscope or hysteroscope because the accessory channel facilitates the retrieval of foreign bodies while at the same time allowing a vaginal lavage to be performed. Learn Peds Genitourinary 04 Genital Exam Intro from UBC Learn Pediatrics on Vimeo. Introduction to the Basic Pelvic Exam. If the child'ssymptoms of vulvovaginitis persist, you should review your diagnosis. Discuss the results of the examination and your diagnosis andmanagement plan with the child and her parents after she is dressed. Older childrencan be placed in adjustable stirrups (Figures 1 and 2). A history of trauma--whetheraccidental, intentional (for example, scratching due to pinworm infection)or caused by sexual abuse--also should be elicited. Asking the child whether anyone hasever touched her in a way that made her feel uncomfortable often is helpfulin drawing out this information. Other commonly seen diagnoses at a pediatric gynecology visit include labial adhesions, vulvar lesions, suspicion of sexual abuse, and genital trauma. A vaginal self-examination is a way to look at your vulva and vagina to better understand your body and to spot problems that may need medical attention. Once the child is positioned, the vulvar area and introitus should be inspected. A nasal speculum or otoscope can also be used, but they are usually too short for older girls and thus are less than optimal. They may have septums, microperforations, or fingerlike extensions or be completely imperforate. After your examination is complete, congratulate the child for her cooperationand bravery. Physiologic leukorrheacan be confused with vulvovaginitis. The surgical therapy of an ovarian neoplasm in a child should have two goals: the appropriate surgical removal of the neoplasm and the preservation of future fertility. Whats the diagnosis? There is nothing specific about the symptoms or signs of childhood vulvovaginitis. By Jessica Annette Kahn, MD, and S. Jean Emans, MD. Dr. Ahmed Darwish - Pediatrics: General Examination - YouTube 0:00 / 15:07 Dr. Ahmed Darwish - Pediatrics: General Examination Dr. Ahmad Darwish 13.1K subscribers Subscribe 1.5K 114K views 5. This is often the most distressing aspect of the examination and may be omitted, depending on the childs symptoms. It can also present as a chronic colonization (diaper rash) in patients using diapers. Support Lucile Packard Children's Hospital Stanford and child and maternal health. 12.4 ). Questions about caretakers, behavioral changes,fears, and somatic symptoms may help to diagnose sexual abuse.
Pelvic exam - Mayo Clinic Urethral prolapse also can present with bleeding. However,new onset of genital warts in the older prepubertal child is associatedwith sexual contact. Diagnosing and treating PCOS in adolescents. If extensive labial adhesions are present, you maynot be able to adequately examine the hymen and vagina and will need toreexamine the child after she has successfully completed treatment withlocal hygiene measures and topical estrogen (see Sidebar, "Common gynecologicfindings in the prepubertal girl"). Diagnosis can befacilitated by performing the tape test: press a piece of cellophane againstthe child's perineum in the morning, affix the tape to a slide, and examineit under the microscope for the characteristic eggs. Your questions should address the onset of symptoms; the type,frequency and timing of discharge; associated bleeding, pain, or pruritus;foreign body insertion; perineal hygiene; recent infections in the patientor her family (such as streptococcal pharyngitis or pinworms); recent antibiotictherapy; masturbation; and a history of sexual abuse. The film opens with a woman sitting in an office of a physician. This places the teen in control of the tempo and allows her to anticipate the next element of the examination. The hymen of a prepubertal child exhibits a diverse range of normal variations and configurations ( Fig.
The vagina of a child lacks glycogen, lactobacilli, and a sufficient level of antibodies to help resist infection. Join Childrens Hospital Colorado pediatric experts for a virtual Were passionate about providing answers, treatment and care for the full range of female reproductive health concerns, from infancy through adolescence and into adulthood. With a five-year survival rate of 84%, there are 100,000 annual survivors of reproductive age. Etiologic Factors of Premenarcheal Vulvovaginitis, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Pediatric and adolescent gynecology: Gynecologic Examination, Infections, Trauma, Pelvic Mass, Precocious Puberty, Benign gynecologic lesions: Vulva, Vagina, Cervix, Uterus, Oviduct, Ovary, Ultrasound Imaging of Pelvic Structures, Reproductive anatomy: Gross and Microscopic Clinical Correlations, Pelvic organ prolapse, abdominal hernias, and inguinal hernias: Diagnosis and Management, Malignant diseases of the ovary, fallopian tube, and peritoneum, Neoplastic diseases of the vulva and vagina, Primary and secondary amenorrhea and precocious puberty, Congenital abnormalities of the female reproductive tract: Anomalies of the Vagina, Cervix, Uterus, and Adnexa, Anal incontinence: Diagnosis and Management. When alone withan examiner, a child may disclose abuse or other concerns, and allowingher to be interviewed or examined alone may give her a greater sense ofcontrol and responsibility for her own health. Forpersistent cases, prescribe a one- to three-month course of a low-potencytopical steroid preparation, such as hydrocortisone 1% or 2.5%, followedby careful hygiene and use of emollients. Pediatricians are uniquely qualified to perform an appropriate clinicalassessment because of their expertise in examining young children and knowledgeof many anatomic and pathophysiologic conditions specific to children. (From Emans SJ. Similar to their peers, they can experience problem periods, such as heavy and painful bleeding. After inspection of the vagina and cervix, vaginal secretions may be obtained for microscopic examination and culture (the technique is described later). Many if not most of these conditions may eventually require an examination to determine the cause of the problem. A helpful technique is to place the childs hand on top of the physicians hand as the abdominal examination is being performed and to give her some choices, such as having a doll, an electronic tablet, or a toy with her. A patient with signs of trauma, such as abrasions, lacerations, or contusions,should be evaluated for suspected sexual abuse. After the history has been obtained, the parents and the child should be reassured that the examination will not hurt .
Prepubescent Female Genital Examination Images: Evidence - PubMed 5 Minute Pelvic Exam Video | The Brookside Associates Physical Assessment of the Newborn: A Comprehensive Approach to the Art of Physical Examination. The vulva and anus. This canbe accomplished by establishing rapport with the child, keeping the paceunhurried, proceeding from less to more intrusive examinations and askingfor consent before proceeding, and allowing the child to be an active participantin the process as much as possible.2, Another important consideration when performing a gynecologic assessmentis providing anticipatory guidance to the patient and her parents. 12.2 ). Adolescents often come for examinations with the preconceived idea that it will be very painful. Local anesthesia of the vestibule may be obtained with 2% topical viscous lidocaine (Xylocaine) or longer-acting products such as lidocaine/prilocaine cream. These data can be used to inform the design of teaching interventions to improve skill in this area. When this intervention fails, there should be greater suspicion of bacterial colonization; in this case a reasonable approach is the use of broad-spectrum oral antibiotics such as amoxicillin or trimethoprim/sulfamethoxazole given for 10 to 14 days. Will the Healing Touch Go Out the Door With the Stethoscope? Other findings includeecchymoses and "blood blisters," which often develop after mildtrauma such as riding a bicycle. A parent or caretaker is usually present during the examination of ayoung child, and most children are comfortable with the parent sitting closeby or holding their hand. Change gloves, lubricate the rectum, and then gently . Other specific causes of vulvovaginitis may include systemic diseases and chickenpox and herpes simplex infection. If vaginalcultures are not needed, lidocaine jelly can be used to decrease the child'sdiscomfort. Cystic ovarian masses commonly occur in infants, children and adolescents. A vaginal discharge that is both bloody and foul-smelling strongly suggests the presence of a foreign body. Hysteroscopy is performed in the operating room under general anesthesia. In some cases, however,it is helpful to spend time alone with the child during the interview, andto ask whether she prefers to be alone for the examination. The child should be warned that the rectal examination will feel similar to the pressure of a bowel movement. If the bleeding is unexplainedor you suspect a foreign body or tumor and the vagina cannot be fully visualized,an exam under anesthesia by a gynecologist is necessary.
When Do Teens Need a Gynecologist? > News > Yale Medicine What questions should PNPs consider related to womens health? Because of compassion and empathy, the gynecologist may underestimate the extent of the anatomic injuries. The normal vagina of a prepubertal child is colonized by an average of nine different species of bacteria: four aerobic and facultative anaerobic species and five obligatory anaerobic species. Medical Forensic Exam Videos Adult/Adolescent Sexual Assault Medical Forensic Exam This 58 minute video includes: History Taking Discussion of HIV Prophylaxis Full anogenital exam with evidence collection Demonstration of Foley catheter technique Demonstration of toluidine blue dye application Photography Pediatric History Taking This 63 minute video uses unscripted interactions with children . In this video, adolescent gynecologist Eliza Buyers, MD, reviews options for menstrual suppression, how they work, and various considerations for teens with complex medical issues. Children usually are asymptomatic,but they may present with secondary infection. The outer catheter serves as an insulator, and the inner catheter is used to instill a small amount of saline and aspirate into the vaginal fluid. Childrens clothing is often tight fitting and nonabsorbent, which keeps the vulvar skin irritated, warm, moist, and at risk for vulvovaginitis. A handheld mirror may help in some instances when discussing specifics of genital anatomy. Capraro VJ, Capraro EJ: Vaginal aspirate studies in children. A patient in early adolescence (aged 12 to 14 years) may behave similarly and need similar support as those in the prepubertal stages. Endocrinologic issues, such asneonatal bleeding due to maternal estrogen withdrawal, precocious puberty,exogenous hormone preparations, and hypothyroidism should be ruled out.Dermatoses such as lichen sclerosus can cause bleeding.