Female Urethral Catheterization Male Urethral Catheterization Female Genital Exam Male Genital Exam Don't forget to watch the Why Urology video! An infant may be examined on her mothers lap. The pediatric gynecologic visit may be unique to both the child and the parent. Gynecologic diseases are uncommon in children, especially compared with the incidence and prevalence of diseases in women of reproductive age. Many young childrens primary contact with providers involves immunizations; children should be assured that this visit does not involve any shots. It is also helpful to assure the adult accompanying the child that speculums are not part of the examination. Chronic vaginal discharge, which can occur with a vaginal foreign bodyor vaginitis, also can lead to vulvitis, which is characterized by an erythematous,hyperpigmented, or hyperkeratotic line along the dependent portion of thelabia majora.9 Clitoral erythema and pruritus often is a symptomof a prior or current vulvitis, and may be caused by adhesions between theclitoral hood and the glans clitoris. 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. The color ranges from white or gray to yellow or green. The major factor in childhood vulvovaginitis is poor perineal hygiene. This short 1958 educational film from the American Cancer Society shows how to perform a routine pelvic examination and cytologic test for the detection of cancer of the uterus. It is important to give the child a sense that she will be in control of the examination process. This is referred to as nonspecific vulvovaginitis. 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. The components of a complete pediatric examination include a history, inspection with visualization of the external genitalia and noninvasive visualization of the vagina and cervix, and, if necessary, a rectal examination ( ). Pelvic Examination | NEJM Pelvic Exam The pelvic exam is a vital part of every woman's preventative care and is also important towards making a number of diagnoses when presenting with abdominal or pelvic complaints. In determining the diagnosis, it may be helpfulto inquire about persistently wet underwear, recurrent fevers, unexplainedUTI, and abdominal or lower back pain. A complete examination includes inspection of the external genitalia,visualization of the vagina and cervix, and rectoabdominal palpation. A specimen for Chlamydia culture can be obtained by using a Dacron maleurethral swab and scraping the lateral vaginal wall gently. An interesting illustration of the physical exam. A nurse retrieves the patient from the office and takes her to an exam room. There often are predisposing factors that lead to vulvar irritations, such as the use of perfumed soaps or the pressure from tight seams of jeans or tights, which create denudation, allowing the rectal flora to easily infect the irritated epithelium. This is to help girls understand that there is a doctor dedicated to their reproductive health. The genital examination of the infant through adolescence.Curr Opin Obstet Gynecol 1993;5:753, 11. Visualizing the hymen. The significance of the diameter of the hymenalorifice is controversial; a large orifice may be consistent with a historyof sexual abuse, but it is not an absolute criterion.7,8. Bates' Visual Guide features head-to-toe and systems physical exam videos completely reshot with an emphasis on clinical accuracy and patient care. Common Indications for Pelvic Examination in the Adolescent, Clinical Features of Children Presenting With Vulvovaginitis. In the office setting, the examination should be limited to external inspection only; speculum exams should not be performed in pediatric patients. This can be accomplished without the insertion of any instruments. You may need a pelvic exam sooner if you are experiencing problems with your period or have other symptoms, including: Pain in your lower abdomen or pelvic area. Your job will be easier if you adopt a relaxedand unhurried approach, which can help prevent anxiety in a child. We see more, treat more and heal more children than any hospital in our seven-state region. Vulvovaginitis: causes and management. Philadelphia, PA, Raven-Lippincott, 1998, 2. It is recommended that the examination start with the nongenital areas , such as listening to the heart and lungs; an abdominal examination and inspection of the skin should be performed. During a pelvic exam, a doctor evaluates your reproductive organs. Most young children can be examined in the frog-leg position; that is,supine with knees apart and feet touching in the midline. Blake J: Gynecologic examination of the teenager and young child.Obstet Gynecol Clin North Am 1992;19:27, 3. You can use this section to discover where and how this . The vagina of a child lacks glycogen, lactobacilli, and a sufficient level of antibodies to help resist infection. Polycystic ovary syndrome (PCOS) is one of the most common metabolic conditions affecting at least 10% of women of reproductive age. From AccessMedicine. All children should have a chance for a healthy future. An ectopic ureter can present as persistent wetnessor purulent discharge. Adolescence is the period of life during which an individual physically matures and begins to transition psychologically from a child into an adult . Diagnose this skin lesion with newest Stanford 25 video and topic. Treatment is the same as for labialadhesions. Except for the cervix, any mass discovered on rectal examination in a prepubertal examination should be considered abnormal. Other specific causes of vulvovaginitis may include systemic diseases and chickenpox and herpes simplex infection. If the issue is vaginal discomfort, pruritus, ordischarge, the differential diagnosis includes nonspecific or infectiousvulvovaginitis, vulvar skin disease, lichen sclerosis, and presence of aforeign body. First gynecological exam is about establishing care and a relationship not a pelvic exam. Whenever possible, addressquestions directly to the child. Some healthcare professionals listed on our website have medical privileges to practice at Childrens Hospital Colorado, but they are community providers. 14 mins, 33 secs. Candidal infection is uncommon in prepubertal children unless there isconcomitant antibiotic use, diabetes, immunosuppression, or occlusive diaperuse. Allowing the patient to see and touch the instruments also may assist in demystifying the examination and allow it to flow more smoothly. Childrens Hospital ColoradoAnschutz Medical Campus13123 East 16th AvenueAurora, CO 80045. One method is to use the knee-chest position (see Fig. Similar to their peers, they can experience problem periods, such as heavy and painful bleeding.

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