pediatric pelvic exam video

While the ulcers generally resolve on their own and most patients never experience another outbreak, about 25% will have subsequent occurrences. Even though ovarian neoplasms are rare in children, this diagnosis must be considered in a young girl with abdominal pain and a palpable mass. There are both physiologic and behavioral reasons why a child is susceptible to vulvar infection. If you still cannot locate a hymenal opening, the child mayhave an imperforate hymen or vaginal agenesis. The vagina will then fill with air, aiding the evaluation. Acute genital bleeding in girls is most caused by accidental trauma, such as straddling a bicycle or falling on playground equipment. A nasal speculum or otoscope can also be used, but they are usually too short for older girls and thus are less than optimal. Philadelphia, PA, Raven-Lippincott, 1998, 2. Sometimes doctors do pelvic exams if they think there's a problem. A major factor in childhood vulvovaginitis is poor perineal hygiene ( Box 12.2 ). Sources of accidental trauma areusually straddle injuries. The vulvar and vaginal epithelium lack the protective effects of estrogen and thus are sensitive to irritation or infection . An adolescent gynecology exam is done to help make sure that your reproductive organs and system are healthy. Pokorny SF: Configuration of the prepubertal hymen. What Stands in the Way of Bedside Teaching? Finally, issues of privacy and confidentiality are essential considerationswhen examining older children. The prepubertal vagina is neutral or slightly alkaline. Vaginoscopy is a diagnostic procedure that can be used to evaluate the inside of the vagina and is recommended for girls who are too young for a speculum exam or cannot tolerate one. Bacterial causes include group A, b-hemolyticStreptococcus, Haemophilus influenzae, Staphylococcus aureus, Branhamellacatarrhalis, Streptococcus pneumoniae, Neisseria meningitidis, and Shigella.Sexually transmitted infections include Neisseria gonorrhoeae, Chlamydiatrachomatis, herpes simplex virus, Trichomonas, and human papillomavirus.It is important to note that these organisms also can be vertically transmittedat birth and herpes can be transmitted by nonsexual contact. After viewing, providers will be better able to counsel patients and their families on treatment methods as well as provide them with updated resources on this topic. Affiliated with the University of Colorado School of Medicine. Change gloves, lubricate the rectum, and then gently . It is importantto be aware that the gynecologic examination can influence her future attitudetoward gynecologic care. If youidentify a specific pathogen, appropriate antibiotic therapy is indicated,in addition to the measures previously described. If you identify and remove a foreign body, recommend that the child takesitz baths for two weeks. Prepubertal vulvovaginopathies. 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. So this is the scariest picture weve got! Older unestrogenized girls have thin, nonelastic hymens with significant signs of vascularity. Caring pediatric nurses are available 24/7 to help answer your questions. A specimen for Chlamydia culture can be obtained by using a Dacron maleurethral swab and scraping the lateral vaginal wall gently. Options covered in the video include: the levonorgestrel IUD, norethindrone acetate, the subdermal implant, combined hormonal contraception and depot medroxyprogesterone acetate. Management is dictatedby the diagnosis: antibiotics and hygiene measures for infectious vulvovaginitis,surgical repair of trauma if necessary, biopsy of polyps or suspected tumors,removal of foreign bodies, further investigation for sexual abuse if itis suspected by exam or history or if condylomata are found, sitz bathsand estrogen cream for urethral prolapse, and further investigationinto the etiology of precocious puberty. 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. Children usually are asymptomatic,but they may present with secondary infection. If on vaginal examination you visualizea foreign body, you may be able to remove it with a cotton-tipped applicatoror by lavaging the vagina with saline or warm water after anesthetizingthe introitus with viscous lidocaine. If a child is scheduled to be seen in the middle of a busy clinic, the staff needs to be alerted that the pace and general routine will be different during her visit. The vaginal epithelium of the prepubertal child appears redder and thinner than the vagina of a woman in her reproductive years. A mounding of hymeneal tissue is often called a bump. However, if the reason for the visit is urgent, such assignificant vaginal bleeding, and a child is uncooperative, you may haveto perform the exam under anesthesia. The typical location is the anterior vaginalwall near the cervix. Labial adhesions, also common, usually are asymptomaticand are more likely to be noticed by a parent or found on routine pediatricexamination. Both parent and child should be instructed that the vulvar skin should be kept clean, dry, and cool and irritants should be avoided. Most pediatric visits are preventive in nature, but the pediatric gynecologic visit is usually problem oriented . 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. N gonorrhoeaerarely persists beyond the newborn period without symptoms. If you need to visualize the vagina and cervix and the child is olderthan 2 years, the knee-chest position may be useful. Happy Halloween! A visit with a pediatric clinician is an ideal time to ensure that a teenager knows the correct information, has the opportunity to make certain contraceptive choices, and instill the knowledge that the pediatric office is a safe place to come for help. OB/GYN - Physical Examination Resources - University of Iowa Bumps are usually a normal variant and are often attached to longitudinal ridges within the vagina. Mycotic vaginal infections may be seen in immunosuppressed prepubertal girls such as those with human immunodeficiency syndrome (HIV) or diabetes or on chronic steroid therapy. 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. 0:38. The vulvar skin of children may also be affected by systemic skin diseases, including lichen sclerosus, seborrheic dermatitis, psoriasis, and atopic dermatitis. Am J Obstet Gynecol 1987;156:581. Many if not most of these conditions may eventually require an examination to determine the cause of the problem. 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. Abraham-Vergheses-TED-Talk:-Over-one-million-views! Ultrasound should be used as the initial diagnostic imaging technique for the evaluation of the pelvis in children and adolescents. 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). Having a relationship with a pediatric gynecologist can help girls take . The genital examination of the infant through adolescence.Curr Opin Obstet Gynecol 1993;5:753, 11. She should be allowed to visualize and handle any instruments that will be used. There are no reported cases of congenital absence of the hymen. In addition to your doctor, there will be a nurse or an assistant in the room during . Vaginalcultures will reflect normal flora, including lactobacilli, Staphylococcusepidermidis, diphtheroids, Streptococcus viridans, enterococci, and enterics(Streptococcus faecalis, Klebsiella species, Proteus species, Pseudomonasspecies). The rash of atopic dermatitis is typically maculopapular, pruritic, anderythematous. 25:50. Leukorrhea may be present. Interruptions should be avoided. Risk factors for vulvovaginitis in theprepubertal child include hypoestrogenism, which can lead to an atrophicvaginal mucosa; close proximity of the vagina and anus; lack of protectivehair and labial fat pads; poor hygiene; use of irritants such as bubblebath; and contact with nonabsorbent clothing. The mostcommon foreign body encountered in prepubertal girls is a wad of toiletpaper, which appears as a small, gray mass. The most important technique to ensure cooperation is to involve the child as a partner. A handheld mirror may help in some instances when discussing specifics of genital anatomy. 1 A vaginal self-exam is not the same as a vulvar examination. Female Urethral Catheterization Male Urethral Catheterization Female Genital Exam Male Genital Exam Don't forget to watch the Why Urology video! That's why we conduct research to advance care techniques that can be used for our patients and kids anywhere. Because the pubertal changes are often a cause of concern for adolescent girls and their parents, the gynecologist must offer the adolescent patient an empathetic, kind, knowledgeable, and gentle approach. In a microperforate hymen, it may be difficult to identify an opening.To establish its presence, try squirting a small amount of warm water orsaline with a syringe or angiocath, placing the girl in the knee-chest position,or probing with a small urethral catheter, feeding tube, or nasopharyngealCalgiswab moistened with saline or vaginal lubricant (Figure 8). The pediatric gynecologic visit may be unique to both the child and the parent. Lichen sclerosus may present as vulvar discomfort or pruritus.It is characterized by atrophy of the vulvar skin, which causes the labiaand clitoral hood to appear thin, white, and parchment-like. They may be discovered due to symptoms, during a routine physical exam or incidentally through imaging studies. 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 . With a five-year survival rate of 84%, there are 100,000 annual survivors of reproductive age. However,new onset of genital warts in the older prepubertal child is associatedwith sexual contact. Pelvic Exam, The | Advanced Pediatric Associates | Pediatricians in Treatment is the same as for labialadhesions. This will give the child a sense of control and divert the childs attention if she is ticklish or is squirming. Instructing patients to use nonmedicated, nonscented wipes rather than toilet paper may prevent the self-inoculation of the vagina with small pieces of toilet paper, which can initiate a chronic discharge. The majority of childrens gynecologic problems are treated by medical , rather than surgical, means . Home | Bates' Visual Guide Exam Videos - IAFN - forensic nurses 1. Most episodes of childhood vulvovaginitis are cured solely by improved local hygiene. 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. Not sure if you need urgent or emergency care? Vaginoscopy in a prepubertal child most often requires sedation with a brief inhalation or intravenous anesthetic, but in select circumstances it can also be performed in the office with older, cooperative children. If you put your stethoscope over this, what will you hear? Urethral prolapse also can present with bleeding. The extent of labial adhesions and associated symptoms are variable (seefigure "B"). Huffman JW, Dewhurst CJ, Capraro VJ: The Gynecology of Childhood andAdolescence. She provides an overview of the physiology and evaluation of AUB, including recommendations on when to consider referring patients to our Spots and Dots Clinic. Non-sexually acquired genital ulcers (NSGUs) in adolescent females are uncommon, painful skin lesions on the mucous membranes of the vulva and vaginal structures, unrelated to sexual activity. What is it? Thus the office visit and the gynecologic physical examination are performed differently in a prepubertal child compared with an adolescent girl or a mature reproductive-age woman. Examination of the vagina under anesthesia may be necessary if culturesdo not identify a pathogen, the child has a persistent discharge or bleedingand adequate examination is not possible, or you suspect a foreign body.Referral should be made to a gynecologist with experience in pediatric gynecology. An interesting illustration of the physical exam. By Jessica Annette Kahn, MD, and S. Jean Emans, MD. 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. The child can assist you by holding herlabia apart. Pediatric Head-to-Toe Physical Exam - video Dailymotion A historyof behavioral changes and somatic symptoms, including recurrent or chronicabdominal pain, headaches, and enuresis, may signal abuse. New patient encounter videos allow you to practice your clinical reasoning skills and review for exams. Ideally children should feel they are part of the examination rather than having an exam done to them.. In this video, Veronica Alaniz, MD, MPH, talks about the types of Mllerian agenesis associated with MRKH. Finding the source of this pain in adolescent females and diagnosing the condition can also be particularly challenging. In noncooperative children, treatment should not be withheld if a specimen cannot be collected and empiric treatment may be started., many techniques have been described for attempting to collect a specimen, including the use of a very slim urethral Dacron swab moistened with nonbacteriostatic saline (used for collection of male urethral cultures). In determining the diagnosis, it may be helpfulto inquire about persistently wet underwear, recurrent fevers, unexplainedUTI, and abdominal or lower back pain. In perimenarchal girls, the vagina is 8 cm long, andthe vaginal mucosa and hymen are thicker. 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.
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