One excellent technique is for the physician to sit, not stand, during the initial encounter. Local anesthesia of the vestibule may be obtained with 2% topical viscous lidocaine (Xylocaine) or longer-acting products such as lidocaine/prilocaine cream. Learn Peds Genitourinary 04 Genital Exam Intro from UBC Learn Pediatrics on Vimeo. 12 red rubber bladder catheter for the outer catheter and the hub end of an intravenous butterfly catheter for the inner catheter ( Fig. The history should include the quality of the discharge(color, odor, presence of blood), hygiene, medications, irritants such assoaps and bubble bath, anal pruritus, enuresis, the possibility of a foreignbody or sexual abuse, any recent infections, and a history of systemic ordermatologic conditions. Vaginal bleeding is also associated with vulvovaginitis. Chemicals that may be allergens or irritants, such as bubble bath, must be discontinued, and harsh soaps and chemicals should be avoided. Volume 90% Video Chronic Pelvic Pain and Endometriosis: Part 2 Jeannette Lager, MD, describes a directed pelvic examination for chronic pelvic pain, including a general pelvic exam, Q-Tip test for vulvodynia, abdominal exam (including testing for Carnett's Sign), an exam of the pelvic floor muscles and an assessment of myofascial trigger points. 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. Noninfectious causes of vulvovaginitis also are common. In this video, Stephen Scott, MD, provides an overview of how to properly identify and manage NSGUs and the timeline for healing. Common Indications for Pelvic Examination in the Adolescent, Clinical Features of Children Presenting With Vulvovaginitis. Emphasize that the most important part of the examination is just looking and there will be conversation during the entire process. Obtaining a history from a child is not an easy process. Providers can counsel patients that they will inform them of each step in the process and then ask the teen if she is ready before performing each step. 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. In addition to your doctor, there will be a nurse or an assistant in the room during . Your First Pelvic Exam - Texas Children's Hospital The foundation of treating childhood vulvovaginitis is the improvement of local perineal hygiene. Interruptions should be avoided. Bates' Visual Guide features head-to-toe and systems physical exam videos completely reshot with an emphasis on clinical accuracy and patient care. 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. Vulvovaginitis in children may also be caused by a variety specific pathogens such as group A or group B b-hemolytic streptococci, Haemophilus influenzae, and Shigella boydii ; Neisseria gonorrhoeae, Trichomonas vaginalis, and Chlamydia trachomatis may also be responsible in cases associated with abuse but are significantly less common. All children should have a chance for a healthy future. Except for the cervix, any mass discovered on rectal examination in a prepubertal examination should be considered abnormal. Vaginal foreign bodiesare a common cause of bleeding, but children often are reluctant to admitto foreign body insertion. The normal prepubertal uterus and ovaries are nonpalpable on rectal examination. When you give to Children's Colorado, you're helping us to reimagine children's health through patient care, education, research and advocacy. Ovarian torsion should be managed conservatively with untwisting and preservation of the adnexa, regardless of the appearance. Genital Exam | Learn Pediatrics - University of British Columbia This includes feeling a girl's uterus and ovaries to be sure everything's normal. This includes feeling a girl's uterus and ovaries to be sure everything's normal. The dischargeis usually white and not malodorous, and wet preparation demonstrates multipleepithelial cells without polymorphonuclear cells. Children often cannot hold still for long intervals while instruments are being located. 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. The vaginal epithelium of the prepubertal child appears redder and thinner than the vaginal epithelium of a woman in her reproductive years. Breast budding is a reliable sign that the vaginal pH is shifting to an acidic environment. 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). Begin the procedure with relevant elements of the general pediatric exam,including height and weight and examination of the thyroid, neck, breasts,lungs, heart, and abdomen. Gynecologic Examination for Adolescents in the Pediatric Office Setting Last updated on April 26, 2013 @3:30 pm Feedback: How useful was the above information? Obtaining a history from a child is not an easy process. The examination can be a positive experience when conducted without pressure and approached as a normal part of routine young women's health care. Vaginal burning, itching or foul-smelling discharge. Procedures such as vaginoscopy can be used for the diagnosis of gynecologic conditions in prepubertalgirls. Finally, pinworms may present as perineal or perianal pruritus, witherythema and often excoriations in the perirectal area. W Webcam. The critical factors surrounding the pelvic examination of an adolescent girl are different from those of examinations of children 2 to 8 years old. The majority of cases of persistent or recurrent nonspecific vulvovaginitis respond to improved hygiene and treatment of irritation resulting from trauma or irritating substances. An adolescent gynecology exam is done to help make sure that your reproductive organs and system are healthy. It may appear as a brightly erythematous, annular,periurethral mass (see figure "A"). Occasionally, an adhesion will require separation, which canbe done either in the office or under anesthesia. They may have septums, microperforations, or fingerlike extensions or be completely imperforate. You can use this section to discover where and how this . These are the organs related to your monthly menstrual cycles, to sexual activity, and to pregnancy and childbirth. Emans SJ, Goldstein DP: The gynecologic examination of the prepubertalchild withvulvovaginitis: Use of the knee-chest position. Classifications of hymenalconfiguration include posterior rim (crescent), annular, or redundant (Figures6 and 7).5 Congenital anomalies, including imperforate, microperforate,and septate hymen, also can occur. For example, the physical presence of the mother often may facilitate examining a 4-year-old girl but may inhibit the cooperation of a 14-year-old adolescent. Clinical manifestations includepruritus, vaginal discharge and odor, vaginal bleeding, dysuria, and vulvarredness and irritation. A history of trauma--whetheraccidental, intentional (for example, scratching due to pinworm infection)or caused by sexual abuse--also should be elicited. Presence or absence of Doppler flow in the ovary on ultrasound is not diagnostic of ovarian torsion, and the decision to pursue surgical intervention should be based on the level of clinical suspicion. A mounding of hymeneal tissue is often called a bump. For non-life-threatening medical needs when your pediatrician is unavailable, visit one of our urgent care locations. 12.1 ). She discusses how diagnosis requires both ovulatory dysfunction and hyperandrogenism, and she shares recommendations for PCOS treatment from lifestyle changes to possible medications. 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. Most cases involve an irritation of the vulvar epithelium by normal rectal flora or chemical irritants . Pay special attention to anatomic and pathophysiologic differences in the child. The child is told to have her abdomen sag into the table. 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. The child should be warned that the rectal examination will feel similar to the pressure of a bowel movement. Tell the child that the examination willnot hurt, and if you are going to use instruments, that these tools areall specially designed for little girls.1Let the child look atand touch the instruments to be used, such as an otoscope or a hand lens.When talking with parents, it is important to carefully explain that thechild's hymen will not be altered in any way by the examination, becausemany parents do not fully understand the anatomy of the vagina and hymen.Basic diagrams of the anatomy may be helpful. It is estimated that 80% to 90% of outpatient visits of children to gynecologists involve the classic symptoms of vulvovaginitis: introital irritation (discomfort/pruritus) or discharge ( Table 12.1 ) ( ). Watch the video to learn how Dr. Scott teams up with specialists from urinary and gastrointestinal medicine to develop a holistic approach to identifying and managing chronic pelvic pain in adolescent girls. Stanford Medicine 25 Skills Symposium 2015, Approach to Spinal Disease by Dr. Rick Hodes. Vulvovaginitis: causes and management. Not every variant of hymen is normal, and transections between 3 and 9 oclock should raise a suspicion for abuse because these are likely acquired rather than congenital (discussed further in Chapter 9 ). Physical Assessment of the Newborn: A Comprehensive Approach to the Art of Physical Examination. Early identification and treatment can lead to improved quality of life for individuals with PCOS and prevention of diabetes and cardiovascular disease. Before puberty, the girls reproductive organs are in a resting, dormant state. This includes the process for diagnosis and considerations for work-up, evaluation and treatment, such as support and counseling. A vaginal discharge that is both bloody and foul-smelling strongly suggests the presence of a foreign body. 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. An assistant pulls upward and outward on the labia majora on one side while the examiner does the same with the nondominant hand on the contralateral labia. Nonspecific vulvovaginitis. 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. 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. The foundation of treating childhood vulvovaginitis is the improvement of local perineal hygiene.