pediatric pelvic exam video pediatric pelvic exam video
Vaginal orcervical polyps or tumors also can present with symptoms of vaginitis. For example, if a girl complains of . An organized stepwise approach in a nonthreatening environment is more likely to result in a successful evaluation of the genitalia. In this video, Tricia Huguelet, MD, provides an overview of normal menstrual flow, screening for heavy menstrual flow in teens, and identifying red flags for an underlying bleeding disorder. The history is critical in terms of making a diagnosis, but it also providestime for you to establish rapport with the patient and elicit her understandingof her symptoms and expectationsof the visit. Pediatric Head-to-Toe Physical Exam - video Dailymotion Both parent and child should be instructed that the vulvar skin should be kept clean, dry, and cool and irritants should be avoided. The most common vaginal foreign body in preadolescent girls is a wad of toilet tissue. 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. What Stands in the Way of Bedside Teaching? Gidwani GP. Thepediatrician may have the additional advantage of already having built arelationship with the child who requires a gynecologic examination. If the issue is "vaginal" bleeding, the differential diagnosisincludes condyloma acuminatum, urethral prolapse, vascular lesions, precociouspuberty, hormonal medications, and (rarely) sarcoma botryoides, in additionto vulvovaginitis, foreign body, and lichen sclerosus. The history and examination usually clinch the diagnosis of vulvovaginitisand vaginal bleeding, but selected laboratory tests such as culture arehelpful in some cases. A childs reaction will depend on her age, emotional maturity, and previous experience with health care providers. Children often cannot hold still for long intervals while instruments are being located. 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. There is nothing specific about the symptoms or signs of childhood vulvovaginitis. 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. Contemporary Pediatrics Resident Writer Program, Food Insecurity and the Dangers of Infant Formula Dilution, Getting into the Roots of Childhood Atopic Dermatitis, Opt-Out Chlamydia Screening in Adolescent Care, The Role of the Healthcare Provider Community in Increasing Public Awareness of RSV in All Infants, Choose article sectionPrinciples of gynecologic assessmentTaking the historyBeginning the examinationExamining the external genitaliaExamining the vaginaConcluding the examinationSIDEBAR: Common gynecologic findings in the prepubertal girlVulvovaginitisVaginal bleedingLabial adhesions, | Obstetrics-Gynecology & Women's Health, | Contemporary Pediatrics Resident Writer Program, | Food Insecurity and the Dangers of Infant Formula Dilution, | Getting into the Roots of Childhood Atopic Dermatitis, | Opt-Out Chlamydia Screening in Adolescent Care, | The Role of the Healthcare Provider Community in Increasing Public Awareness of RSV in All Infants, | Update in Pediatric COVID-19 Vaccines. 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). Similarly, a child with an upper respiratory tract infection may autoinoculate her vulva, especially with specific organisms (see Box 12.2 ). This chapter considers gynecologic diseases of children from infancy through adolescence. Last updated on April 26, 2013 @3:30 pm Feedback: How useful was the above information? 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 ). A pelvic exam is where a doctor or nurse practitioner looks at a girl's reproductive organs (both outside and internally). Philadelphia, PA, WB Saunders, 1981, 5. In perimenarchal girls, the vagina is 8 cm long, andthe vaginal mucosa and hymen are thicker. The child lies prone and places her buttocks in the air with legs wide apart. If you suspect candidal vulvovaginitis, obtain apotassium hydroxide (KOH) preparation; a Gram stain may be useful if thedischarge is purulent. During the physical examination, including rectal examination, of the prepubertal child, no pelvic masses except the cervix should be palpable. A more thorough gynecologic examination is warranted for the evaluationof vaginal bleeding, vaginal discharge, trauma, or pelvic pain. 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. Interruptions should be avoided. Join Childrens Hospital Colorado pediatric experts for a virtual Were passionate about providing answers, treatment and care for the full range of female reproductive health concerns, from infancy through adolescence and into adulthood. In addition, she reviews the potential for ovarian torsion, including signs and symptoms, evaluation and management. Next, examine the child's vulva and anus, observingfor hygiene, erythema, excoriation, labial adhesions, signs of trauma, andanatomic abnormalities. The child should be warned that the rectal examination will feel similar to the pressure of a bowel movement. The hymen of a prepubertal child exhibits a diverse range of normal variations and configurations ( Fig. Many youngsters wipe their anus from posterior to anterior and thus inoculate the vulvar skin with intestinal flora. In determining the diagnosis, it may be helpfulto inquire about persistently wet underwear, recurrent fevers, unexplainedUTI, and abdominal or lower back pain. The presence of sexually transmitted organisms in a child is usually a strong indication that sexual abuse may have taken place, and appropriate referral and follow-up is necessary (see Chapter 9 ). It is critical to have all tools, culture tubes, and equipment within easy reach during a pediatric genital examination. Includes speculum and bimanual exams. Pediatrics 1980;65:758, 4. When you give to Children's Colorado, you're helping us to reimagine children's health through patient care, education, research and advocacy. 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. 12.3 ). 12.1 ). After you have examined the external genitalia, you should visualizethe vagina if the child complains of discharge or bleeding that may be vaginalin origin, or if you suspect a tumor, ectopic ureter, or vaginal foreignbody.6 In premenarchal girls, the vagina is 4 to 5 cm long withthin, red epithelium. It's also not true that the pelvic exam is a "test" to see if you are a virgin. A handheld mirror may help in some instances when discussing specifics of genital anatomy. Finding the source of this pain in adolescent females and diagnosing the condition can also be particularly challenging. One excellent technique is for the physician to sit, not stand, during the initial encounter. Your doctor checks your vulva, vagina, cervix . Most young children will prefer to have aparent--usually their mother--in the room at all times. Diagnosis can befacilitated by performing the tape test: press a piece of cellophane againstthe child's perineum in the morning, affix the tape to a slide, and examineit under the microscope for the characteristic eggs. If you identify and remove a foreign body, recommend that the child takesitz baths for two weeks. A hand lens or otoscope often is helpful. Chemicals that may be allergens or irritants, such as bubble bath, must be discontinued, and harsh soaps and chemicals should be avoided. In 2019, there were over 1.7 million new cases of cancer, with 10,270 cases occurring among children ages 0 to 14 years of age and 70,000 occurring in adolescents and young adults. The normal prepubertal uterus and ovaries are nonpalpable. In some cases, nonspecific vulvovaginitis may be caused by carrying viral infections from coughing into the hands directly to the abraded vulvar epithelium. Topics for the pediatric nurse practitioner to be aware of. What questions should PNPs consider related to womens health? 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. Urethral prolapse, a mucosal inversion at the urethral meatus, may beasymptomatic but it also can become inflamed and cause dysuria, perinealdiscomfort, and bleeding. Adult pinworms maybe visible at night. The major factor in childhood vulvovaginitis is poor perineal hygiene. . 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 . It may appear as a brightly erythematous, annular,periurethral mass (see figure "A"). In this video, Stephen Scott, MD, provides an overview of how to properly identify and manage NSGUs and the timeline for healing. A KOH preparationor Biggy agar culture is useful to rule out candidal infection. In some patients, particularly those with difficult to feel pelvic masses, a combined rectovaginal exam is useful. Dr. Ahmed Darwish - Pediatrics: General Examination - YouTube Options covered in the video include: the levonorgestrel IUD, norethindrone acetate, the subdermal implant, combined hormonal contraception and depot medroxyprogesterone acetate. Because the child lacks the labial fat pads and pubic hair of the adult, when a child squats, the lower one-third of the vagina is unprotected and open. For example, if a girl complains of . Watch the gynecology medical education videos below for protocols and research from our experts to help improve the care of your patients. Physiologic leukorrheacan be confused with vulvovaginitis. 4:40. Many gynecologic conditions in children may be diagnosed by inspection . Macleod's Physical Examination - Head, Eyes and Ears Examination - OSCE Guide 2017. Can you guess the cause of the patients bleed? Event marketing. 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. Findingson genital examination are normal, however, in most girls with a historyof substantiated sexual abuse. 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. Hysteroscopy is performed in the operating room under general anesthesia. 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. From AccessMedicine. 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. The examination can be a positive experience when conducted without pressure and approached as a normal part of routine young women's health care. Acute genital bleeding in girls is most caused by accidental trauma, such as straddling a bicycle or falling on playground equipment. If a child's symptoms are severe,a one- to four-week course of a moderate-potency ointment can be recommended,followed by a lower-potency preparation. Happy Halloween! There is also a video, which demonstrates a technique for doing a thorough female pelvic exam and a module for the male genital exam. Am J Obstet Gynecol 1987;156:581. The hymen and vagina usually can be seen adequately when a child is inthe supine position, with her legs flexed on her abdomen. These data can be used to inform the design of teaching interventions to improve skill in this area. 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. Then an otoscope or ophthalmoscope is used as a magnifying instrument and light source but is not inserted into the vagina. Each adolescent is at a different stage of development, and the approach to the examination may require variations that fit her developmental stage . A helpful technique is to place the childs hand on top of the physicians hand as the abdominal examination is being performed and to give her some choices, such as having a doll, an electronic tablet, or a toy with her. Accidental genital trauma often produces extreme pain and overwhelming anxiety for the child and her parents. Small follicular cysts in preadolescent girls are usually self-limiting. Over the last decade, however, the management of ovarian masses has shifted toward a more conservative approach with the goal of ovarian preservation. 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. 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. So this is the scariest picture weve got! Vulvovaginitis: causes and management. After obtaining samples, perform a gentle rectoabdominalexamination with the patient either in stirrups or supine. An exam of your child's genitals (JEN-ah-tuls) is done to check for possible disease, injury or abnormality. An older child should be asked whom she prefersto have in the room during the examination. Your first pelvic exam is usually after you become sexually active or when you turn 21, whichever comes first. The child's buttocks will now be heldup in the air and her back and abdomen will fall downward (Figure 4). A vaginal self-examination is a way to look at your vulva and vagina to better understand your body and to spot problems that may need medical attention. The extent of labial adhesions and associated symptoms are variable (seefigure "B").