This is a difficult decision and is based on the extent of the childs anxiety in relation to the severity of the clinical symptoms. The vulvar and vaginal epithelium lack the protective effects of estrogen and thus are sensitive to irritation or infection . Once the child is positioned, the vulvar area and introitus should be inspected. That's why we conduct research to advance care techniques that can be used for our patients and kids anywhere. 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. Or your doctor might recommend a pelvic exam if you have symptoms such as unusual vaginal discharge or pelvic pain. She also discusses the preferred diagnostic modality and when to consider surgery. Learn about our mission and more, or search for opportunities to join our team. Contemporary Pediatrics Resident Writer Program, Food Insecurity and the Dangers of Infant Formula Dilution, Getting into the Roots of Childhood Atopic Dermatitis, Opt-Out Chlamydia Screening in Adolescent Care, The Role of the Healthcare Provider Community in Increasing Public Awareness of RSV in All Infants, Choose article sectionPrinciples of gynecologic assessmentTaking the historyBeginning the examinationExamining the external genitaliaExamining the vaginaConcluding the examinationSIDEBAR: Common gynecologic findings in the prepubertal girlVulvovaginitisVaginal bleedingLabial adhesions, | Obstetrics-Gynecology & Women's Health, | Contemporary Pediatrics Resident Writer Program, | Food Insecurity and the Dangers of Infant Formula Dilution, | Getting into the Roots of Childhood Atopic Dermatitis, | Opt-Out Chlamydia Screening in Adolescent Care, | The Role of the Healthcare Provider Community in Increasing Public Awareness of RSV in All Infants, | Update in Pediatric COVID-19 Vaccines. The pelvic exam doesn't change whether you are a virgin. Tables 1 and 2 list the differentialdiagnoses of vulvovaginitis and vaginal bleeding. They may have septums, microperforations, or fingerlike extensions or be completely imperforate. Dr. Huguelet also reviews the basic embryology and treatment approach for these conditions and explains when the best time is to perform surgery. Even though ovarian neoplasms are rare in children, this diagnosis must be considered in a young girl with abdominal pain and a palpable mass. The history shouldassess the child's growth and development; signs of puberty such as breastdevelopment, axillary hair, pubic hair, growth spurt, and leukorrhea; genitaltrauma; vaginal discharge; and a history of foreign body insertion. The device is commercially availableas the Pediatric Vaginal Aspirator from Cook Ob/Gyn (Spencer, IN.). 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. This easily assembled adaptation uses a No. The pathophysiology of the majority of instances of vulvovaginitis in children involves a primary irritation of the vulva, which may be accompanied by secondary involvement of the lower one-third of the vagina. The history and examination usually clinch the diagnosis of vulvovaginitisand vaginal bleeding, but selected laboratory tests such as culture arehelpful in some cases. Addressing the Youth Mental Health Crisis, Department of Pediatric and Adolescent Gynecology, Fertility Preservation and Reproductive Late Effects Program, Mayer-Rokitansky-Kster-Hauser (MRKH) syndrome, Insurance, billing and payment information. A handheld mirror may help in some instances when discussing specifics of genital anatomy. The hymen of a prepubertal child exhibits a diverse range of normal variations and configurations ( Fig. 12.4 ). Explain to the child that the most important part of the examinationis "looking," and that it is important for her to communicatewith you during the examination. Teens don't usually get pelvic exams. The classic perianal figure eight or hourglass rash is indicative of lichens sclerosus with white patches and in some cases local trauma. Urethral prolapse, a mucosal inversion at the urethral meatus, may beasymptomatic but it also can become inflamed and cause dysuria, perinealdiscomfort, and bleeding. 12 red rubber bladder catheter for the outer catheter and the hub end of an intravenous butterfly catheter for the inner catheter ( Fig. Pelvic pain is common in adolescent girls. For a small childwho is fearful of the exam, it may be best to have the mother sit on thetable in a semireclined position (feet in or out of stirrups) with the child'slegs straddling her thighs (Figure 3). The pediatric gynecologic visit may be unique to both the child and the parent. Using this approach for a 2-week period should resolve most symptoms in patients with nonspecific vulvovaginitis. If patients are going to be treated with antibiotics, one should attempt to collect a sample of the vulvovaginal discharge for culture before initiation of the antibiotics . Thegynecologic examination of the prepubertal child can be challenging, butit can also be quite rewarding for a clinician who understands the uniqueanatomic and physiologic characteristics of a prepubertal child and approachesthe examination with patience, gentleness, and respect. Includes menu so you can select the portion of the video most applicable to you. If the predominant symptom is pruritus, then pinworms or an irritant/nonspecific vulvitis is the most likely diagnosis. Dr. Vaginalcultures will reflect normal flora, including lactobacilli, Staphylococcusepidermidis, diphtheroids, Streptococcus viridans, enterococci, and enterics(Streptococcus faecalis, Klebsiella species, Proteus species, Pseudomonasspecies). Treatment for extensivelabial adhesions is topical estrogen cream applied along the adhesion withgentle pressure twice a day for three weeks, then at bedtime for three weeks.Once the adhesion has resolved, a barrier ointment should be used to preventrecurrence. The Pelvic Exam. Bacterial vaginosis during pregnancy may heighten risk of preterm birth, pregnancy loss. PCOS occurs due to a complex interaction of genetic and environmental factors can affect the menstrual cycle, hair growth, skin, weight and the ability to have children. Each adolescent is at a different stage of development, and the approach to the examination may require variations that fit her developmental stage . There will also be an extra sheet you can use to cover yourself. They may ask for their mothers to be there, be fearful of the examination concept, and need more than one visit to achieve the goals of the visit. The relative size ratio of cervix to uterus is 2:1 in a child, in contrast to the opposite ratio in an adult. The history is critical in terms of making a diagnosis, but it also providestime for you to establish rapport with the patient and elicit her understandingof her symptoms and expectationsof the visit. A pelvic exam is where a doctor or nurse practitioner looks at a girl's reproductive organs (both outside and internally). An adolescent gynecology exam is done to help make sure that your reproductive organs and system are healthy. What questions should PNPs consider related to womens health? Common indications for a pelvic examination in an adolescent are listed in Box 12.1 . A foreign object and the cervix may be visualized using this technique. . Childrens Hospital Colorado providers are faculty members of the University of Colorado School of Medicine. A patient with signs of trauma, such as abrasions, lacerations, or contusions,should be evaluated for suspected sexual abuse. Draping for the gynecologic examination may produce more anxiety than it relieves and is unnecessary in the preadolescent child. Specific vulvovaginitis. If youidentify a specific pathogen, appropriate antibiotic therapy is indicated,in addition to the measures previously described. Vulvovaginitis is the most common gynecologic problem in prepubertal girls. Many gynecologic conditions in children can be diagnosed by inspection alone. Vulvovaginitis also may be associated with aspecific infectious agent. In addition to your doctor, there will be a nurse or an assistant in the room during . 12.1 ). This allows one to establish a rapport and mimics the traditional visits the child has with the pediatrician. Genital bleeding should always be assessed thoroughly. Managing vulvovaginitis. Office evaluation of the child and adolescent. Inspect the child's breasts and palpate themfor signs of puberty. So this is the scariest picture weve got! The relative size ratio of cervix to uterus is 2:1 in a child. After obtaining samples, perform a gentle rectoabdominalexamination with the patient either in stirrups or supine. Loose-fitting cotton undergarments should be worn. Both parent and child should be instructed that the vulvar skin should be kept clean, dry, and cool and irritants should be avoided. The last step in the pelvic examination may be a rectal examination. This video demonstrates how to perform a comprehensive pelvic examination, including an examination of the external genitalia, a Papanicolaou test to screen for cervical dysplasia, a bimanual exami. Vaginal burning, itching or foul-smelling discharge. Seborrheicdermatitis is characterized by erythema of the vulva, often associated withyellow scales and crusting. If vaginalcultures are not needed, lidocaine jelly can be used to decrease the child'sdiscomfort. View a sample video One of the most important principles to keep in mind when examining ayoung girl is to maintain her sense of control over the process. Cultures from the vagina indicate normal rectal flora or Escherichia coli. HPV is also verticallytransmitted and lesions may appear in the first few years of life. Next, examine the child's vulva and anus, observingfor hygiene, erythema, excoriation, labial adhesions, signs of trauma, andanatomic abnormalities.
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