After inspection of the vagina and cervix, vaginal secretions may be obtained for microscopic examination and culture (the technique is described later). The Stanford Medicine 25 program for bedside medicine at the Stanford School of Medicine aims to promote the culture of bedside medicine to make current and . The most important technique to ensure cooperation is to involve the child as a partner. Bumps are usually a normal variant and are often attached to longitudinal ridges within the vagina. Many adolescent girls do not want other observers, such as mothers, in the examining room. Recurrent vulvovaginitis, persistent bleeding, suspicion of a foreign body or neoplasm, and congenital anomalies may be indications to perform a vaginoscopy and examine the inside of the vagina. The child can assist you by holding herlabia apart. If you put your stethoscope over this, what will you hear? Abraham Verghese Asks: Why Are We Doing This Teaching? 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. Treatment is the same as for labialadhesions. Leukorrhea may be present. Other commonly seen diagnoses at a pediatric gynecology visit include labial adhesions, vulvar lesions, suspicion of sexual abuse, and genital trauma. Pediatric and adolescent gynecology: Gynecologic Examination If the predominant symptom is pruritus, then pinworms or an irritant/nonspecific vulvitis is the most likely diagnosis. A specimen for Chlamydia culture can be obtained by using a Dacron maleurethral swab and scraping the lateral vaginal wall gently. What will bedside manner look like for new data-driven physicians? 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. Pelvic Exams (for Teens) - Cook Children's - KidsHealth The ambiance of the examining room may decrease the anxiety of the child if familiar and friendly objects such as childrens posters are present. Pelvic exam - Mayo Clinic For non-life-threatening medical needs when your pediatrician is unavailable, visit one of our urgent care locations. At the 44th National Association of Pediatric Nurse Practitioners Conference, guidelines for prescribing oral contraceptives were discussed. Am J Obstet Gynecol1987;157:950, 6. 12.1 , B ). Pads should be placed in the mothers lap because examination often is associated with urination. Pokorny SF: Configuration of the prepubertal hymen. These procedures are usually performed under anesthesia. Young girls should feel that they are participating in their examination , not that they are being coerced or forced to have a gynecologic exam. Vaginal bleeding is also associated with vulvovaginitis. Below is a collection of all our Stanford 25-generated videos also found throughout the website. The prepubertal vagina is narrower, thinner, and lacks the distensibility of the vagina of a woman in her reproductive years. Much of the history must be obtained from the parents . Genital Exam - Male (Pre- or Early Puberty) - Nationwide Children's Support teaching, research, and patient care. She also explains why it is important to check ferritin levels for iron deficiency and discusses the etiology of abnormal uterine bleeding, with most heavy menstrual bleeding in adolescents and young adults due to ovulatory dysfunction or inherited bleeding disorders. Ideally children should feel they are part of the examination rather than having an exam done to them.. Dealing with a foreign body. Children usually are asymptomatic,but they may present with secondary infection.
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