pediatric pelvic exam video

When this intervention fails, there should be greater suspicion of bacterial colonization; in this case a reasonable approach is the use of broad-spectrum oral antibiotics such as amoxicillin or trimethoprim/sulfamethoxazole given for 10 to 14 days. Whats the diagnosis? In this video, Stephen Scott, MD, MPH, emphasizes the fact that pain originates from nerve signaling and uses this understanding to help him identify the source of pain and its cause. (From Emans SJ. These are the organs related to your monthly menstrual cycles, to sexual activity, and to pregnancy and childbirth. The examination can be a positive experience when conducted without pressure and approached as a normal part of routine young women's health care. In addition, she reviews the potential for ovarian torsion, including signs and symptoms, evaluation and management. A genital examination might be indicated in relation to suspected or alleged: Sexually transmissible infection Pregnancy Pelvic pain or other genital symptoms or concerns Sexual assault Foreign body Cervical cytology screening is not 5currently recommended until the age of 25 years. Pokorny has described another method for collecting fluid from a childs vagina using a catheter within a catheter ( ). If thechild is anxious, you may need to leave the room and return when she feelsready to be examined; in some cases, the procedure may have to be postponedfor several days. A history of trauma--whetheraccidental, intentional (for example, scratching due to pinworm infection)or caused by sexual abuse--also should be elicited. 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. Nonspecific vulvovaginitis often is associatedwith an alteration in vaginal flora, which may be due to a change in theaerobic flora or overpopulation with fecal aerobes and anaerobes. Pokorny SF. The ideal pediatric endoscope is a cystoscope or hysteroscope because the accessory channel facilitates the retrieval of foreign bodies while at the same time allowing a vaginal lavage to be performed. Managing vulvovaginitis. 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. Abdominal or upper pelvic masses that are palpable mayrepresent ovarian tumors. A gentle, patient approach is important when examininga prepubertal girl. A patient presents with foot pain and these chronic findings? If the interaction is poor during the first visit, the negative experience will detract from future physician-patient interactions ( ). Candidal infection is uncommon in prepubertal children unless there isconcomitant antibiotic use, diabetes, immunosuppression, or occlusive diaperuse. That's why we conduct research to advance care techniques that can be used for our patients and kids anywhere. Emphasize that the most important part of the examination is just looking and there will be conversation during the entire process. 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). The work-up for vaginal bleeding includes a careful inspection of thevulva and vagina, wet preparation and bacterial cultures, and cultures forsexually transmitted infections if indicated. This is an important step toward reinforcing the child's sense ofcontrol over the examination. Draping for the gynecologic examination may produce more anxiety than it relieves and is unnecessary in the preadolescent child. 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 | Stanford Medicine 25 | Stanford Medicine What questions should PNPs consider related to womens health? A hand lens or otoscope often is helpful. Urethral prolapse, a mucosal inversion at the urethral meatus, may beasymptomatic but it also can become inflamed and cause dysuria, perinealdiscomfort, and bleeding. Findingson genital examination are normal, however, in most girls with a historyof substantiated sexual abuse. During a pelvic exam, a doctor evaluates your reproductive organs. The color ranges from white or gray to yellow or green. Childrens Hospital ColoradoAnschutz Medical Campus13123 East 16th AvenueAurora, CO 80045. However,new onset of genital warts in the older prepubertal child is associatedwith sexual contact. Specific vulvovaginitis. Pelvic pain is common in adolescent girls. Gynecologic assessment of the prepubertal girl is an essential componentof preventive and diagnostic pediatric care. Routine gynecologic examinationof infants and children can help prevent future health problems such asvulvovaginitis by giving the clinician the opportunity to educate parentsabout perineal hygiene.1 During the annual genital inspection,the pediatrician also may discover such significant abnormalities as clitoromegaly,signs of early puberty, vulvar dermatoses, or rarely hymenal or vaginaltrauma. The classic symptom of pinworms (Enterobius vermicularis) is nocturnal vulvar and perianal itching, the treatment for which is the anthelmintic agent mebendazole. One of the most important principles to keep in mind when examining ayoung girl is to maintain her sense of control over the process. ObstetGynecol 1971;37:462, 13. Finally, issues of privacy and confidentiality are essential considerationswhen examining older children. 3 simple steps. 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. This allows one to establish a rapport and mimics the traditional visits the child has with the pediatrician. Learn how doctors should perform a bedside swallow evaluation! 0:38. Considerable effort should be devoted to gaining the childs confidence and establishing rapport. 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 ( ). 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 gynecology medical education videos below for protocols and research from our experts to help improve the care of your patients. Learn about our mission and more, or search for opportunities to join our team. Cultures from the vagina indicate normal rectal flora or Escherichia coli. These data can be used to inform the design of teaching interventions to improve skill in this area. 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. Symptoms of vulvovaginitis can occur if an adhesionis extensive enough to cause pooling of urine above the agglutinated tissue.If that is the case, a child may have symptoms of urethritis or a historyof urinary tract infections. Pay special attention to anatomic and pathophysiologic differences in the child. 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. 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 . Ovarian tumors constitute approximately 1% of all neoplasms in premenarcheal children. This is to help girls understand that there is a doctor dedicated to their reproductive health. New patient encounter videos allow you to practice your clinical reasoning skills and review for exams. This places the teen in control of the tempo and allows her to anticipate the next element of the examination. Heavy menstrual bleeding is common in adolescents, with about 15% to 40% of teens experiencing heavy bleeding, but many teens dont recognize that their bleeding is abnormal. The source maybe the vulva, vagina, endometrium, and occasionally the urethra. Examination of the Female Genitourinary System. Philadelphia, PA, Raven-Lippincott, 1998, 2. Many if not most of these conditions may eventually require an examination to determine the cause of the problem. The importance of patient/family preference along with individualization based on medical history and treatment goals is reviewed. The prepubertal vagina is narrower, thinner, and lacks the distensibility of the vagina of a woman in her reproductive years. For non-life-threatening medical needs when your pediatrician is unavailable, visit one of our urgent care locations. This technique is generally successful in cooperative children unless there is a very high crescent-shaped hymen, in which case it is too difficult to shine the light into the small aperture of the vaginal introitus. 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. The medical history should be guided by the presenting complaint anddifferential diagnosis. Pediatric and adolescent gynecology: Gynecologic 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. Have the child resther head to one side on her folded arms and support her weight on bent knees,which are six to eight inches apart. Systemic illnesses that can cause vulvovaginitis include measles, varicella,scarlet fever, mononucleosis, Kawasaki disease and Crohn's disease. 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). See a listing of all our Childrens Hospital Colorado locations including inpatient, outpatient, therapy, surgery facilities and more. 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. Small follicular cysts in preadolescent girls are usually self-limiting. Childrens Hospital Colorado providers are faculty members of the University of Colorado School of Medicine. Includes speculum and bimanual exams. It is important to give the child a sense that she will be in control of the examination process. Occasionally it is best to defer the genital examination until a second visit . 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. 25:50. 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. Here we cover each aspect of the pelvic exam and demonstrate both in text and in our video how this done. In severe cases, clobetasol (Temovate)may be useful, applied twice daily for two weeks and then gradually taperedover the next several weeks, but this requires expertise and careful supervisionwith frequent follow-up. If you still cannot locate a hymenal opening, the child mayhave an imperforate hymen or vaginal agenesis. The atrophymay distort the anatomy of the labia and clitoris. Home | Bates' Visual Guide You can use this section to discover where and how this . Buyers also reviews treatment options, including menstrual suppression, with a focus on key counseling points to help patients and families decide which method is best for them. Caring pediatric nurses are available 24/7 to help answer your questions. Affiliated with the University of Colorado School of Medicine. For example, if a girl complains of . Treatment is the same as for labialadhesions. 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. Gynecologic Examination with Pap Smear. Vaginal foreign bodiesare a common cause of bleeding, but children often are reluctant to admitto foreign body insertion. 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. A pelvic exam usually lasts only a few minutes. Many gynecologic conditions in children can be diagnosed by inspection alone. A KOH preparationor Biggy agar culture is useful to rule out candidal infection.

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