Most young children will prefer to have aparent-usually their mother-in the room at all times. 1įinally, issues of privacy and confidentiality are essential considerationswhen examining older children. You canmodel for parents appropriate ways to discuss gynecologic issues with theirchild, and help parents and children understand the importance of discussingissues related to reproductive healthand sexuality during the prepubertalyears. 2Īnother important consideration when performing a gynecologic assessmentis providing anticipatory guidance to the patient and her parents. 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. One of the most important principles to keep in mind when examining ayoung girl is to maintain her sense of control over the process. Thisarticle focuses on setting the stage so that the examination is a positiveexperience for the patient and her family, describes specific techniquesand strategies for performing an appropriate and non-traumatic examination,and reviews diagnosis of disorders commonly found in prepubertal children. Thepediatrician may have the additional advantage of already having built arelationship with the child who requires a gynecologic examination. Pediatricians are uniquely qualified to perform an appropriate clinicalassessment because of their expertise in examining young children and knowledgeof many anatomic and pathophysiologic conditions specific to children. Making the examination a positive experience, ifpossible, therefore is critical. It is importantto be aware that the gynecologic examination can influence her future attitudetoward gynecologic care. A more thorough gynecologic examination is warranted for the evaluationof vaginal bleeding, vaginal discharge, trauma, or pelvic pain. 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. 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. Gynecologic assessment of the prepubertal girl is an essential componentof preventive and diagnostic pediatric care. Emphasize setting the stage to make the examinationa positive experience for your young patient. Pay special attention to anatomic and pathophysiologicdifferences in the child. Jean Emans, MDĪ gentle, patient approach is important when examininga prepubertal girl. Choose article section.Principles of gynecologic assessmentTaking the historyBeginning the examinationExamining the external genitaliaExamining the vaginaConcluding the examinationSIDEBAR: Common gynecologic findings in the prepubertal girlVulvovaginitisVaginal bleedingLabial adhesionsīy Jessica Annette Kahn, MD, and S.

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