pediatric pelvic exam video

The ambiance of the examining room may decrease the anxiety of the child if familiar and friendly objects such as childrens posters are present. You can also ask the child to cough in order todistract her and cause her hymen to open. These minor accidents result in injury because the genital tissues in children, without estrogen, are very thin and easily traumatized. Positive identification of gonorrhea or chlamydia in a child with premenarcheal vulvovaginitis is considered diagnostic of sexual abuse. 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. 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. 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. Philadelphia, PA, WB Saunders, 1981, 5. Learn how doctors should perform a bedside swallow evaluation! What Is The Specific Cause of This Patients Clubbing? Visualizing the hymen. If you put your stethoscope over this, what will you hear? Introduction to the Basic Pelvic Exam. This period of transition involves important physical and emotional changes. New patient encounter videos allow you to practice your clinical reasoning skills and review for exams. Historically, these masses were surgically removed, often involving removal of the entire ovary. If the predominant symptom is pruritus, then pinworms or an irritant/nonspecific vulvitis is the most likely diagnosis. Harsh soaps, shampoos, bubblebath, poorhygiene, and tight or wet clothing (bathing suits) are common culprits. However, it is when the pain gets progressively worse and occurs outside the menstrual cycle, that it might be time to consider a pathological cause, such as endometriosis. Gynecologic assessment of the prepubertal girl is an essential componentof preventive and diagnostic pediatric care. Obtaining cultures. 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. Your job will be easier if you adopt a relaxedand unhurried approach, which can help prevent anxiety in a child. 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. Experts in Children's Hospital Colorado's Department of Pediatric and Adolescent Gynecology are dedicated to advancing the field to improve the care and lives of all young females with gynecologic conditions. 12.1 ). It is important to give the child a sense that she will be in control of the examination process. These procedures are usually performed under anesthesia. 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. A pelvic exam is where a doctor or nurse practitioner looks at a girl's reproductive organs (both outside and internally). Thepediatrician may have the additional advantage of already having built arelationship with the child who requires a gynecologic examination. The source maybe the vulva, vagina, endometrium, and occasionally the urethra. 12.3 ). Children are not skilled historians and will often ramble, introducing many unrelated facts. Our specialists are nationally ranked and globally recognized for delivering the best possible care in pediatrics. This results from the anatomic proximity of the rectum and vagina coupled with the fact that, after toilet training, most youngsters are unsupervised when they defecate. This chapter considers gynecologic diseases of children from infancy through adolescence. Labial adhesions do not require treatment unless they are symptomatic or voiding is compromised. The vagina is 4 to 6 cm long , and the secretions in a prepubertal child have a neutral or slightly alkaline pH . For non-life-threatening medical needs when your pediatrician is unavailable, visit one of our urgent care locations. One of the most important principles to keep in mind when examining ayoung girl is to maintain her sense of control over the process. Adolescence is the period of life during which an individual physically matures and begins to transition psychologically from a child into an adult . 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. A girl who has nonspecific vaginitis shouldbe counseled to do the following: (1) practice good perineal hygiene; (2)urinate with her knees spread apart; (3) wear white cotton underpants andloose clothing; (4) take sitz baths once or twice a day; (5) avoid irritantssuch as bubble bath and use hypoallergenic soaps; and (6) apply a barrierointment such as A and D, Vaseline, or Desitin to the perineum. Puberty produces dramatic alterations in the external and internal female genitalia, as well as the adolescents hormonal milieu. Most pediatric visits are preventive in nature, but the pediatric gynecologic visit is usually problem oriented . Pay special attention to anatomic and pathophysiologic differences in the child. 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. The mostcommon foreign body encountered in prepubertal girls is a wad of toiletpaper, which appears as a small, gray mass. To successfully examine a child, one needs the cooperation of the patient, the parent, and a medical assistant. Most young children will prefer to have aparent--usually their mother--in the room at all times. A quantitative and qualitative examination of prepubescent female genital examination image interpretations provided insight into diagnostic challenges for this complex examination. There is nothing specific about the symptoms or signs of childhood vulvovaginitis. Chemicals that may be allergens or irritants, such as bubble bath, must be discontinued, and harsh soaps and chemicals should be avoided. Whats the diagnosis? Forunusually persistent cases, it is appropriate to prescribe a 10-day trialof antibiotics (amoxicillin, amoxicillin-clavulanate, or a cephalosporin)or occasionally a two- to three-week course of an estrogen cream. While the ulcers generally resolve on their own and most patients never experience another outbreak, about 25% will have subsequent occurrences. An Initiative of the Program for Bedside Medicine, Learn how we are healing patients through science & compassion, Stanford team stimulates neurons to induce particular perceptions in mice's minds, Students from far and near begin medical studies at Stanford. Heavy menstrual bleeding frequently interferes with a patients physical, social and emotional health and negatively impacts their quality of life. This patient presents with chest pain. Ovarian tumors constitute approximately 1% of all neoplasms in premenarcheal children. Vulvovaginitis also may be associated with aspecific infectious agent. The introitus will gape open with gentle pressure downward and outward on the lower thigh or undeveloped thigh or labia majora area ( traction ) ( Fig. An Emphasis on the Bedside May Prevent Physician Burnout, Artificial Intelligence as a Partner in Patient Care, Physical Exam Can Sort Out - And Treat - Common Type of Vertigo, Bedside Medicine Training Benefits New and Established Physicians, Benefits of Bringing Doctors Back to the Bedside, UMKC Case Highlights the Importance of Thorough Physical Exam, Register Now for the 4th Annual Bedside Teaching Symposium, Using Art to Teach the Human Side of Medicine, Journal Dedicates Entire Issue to Enduring Value of Bedside Medicine, The Basics vs. Technology Debate: When They Work Together Everyone Wins, Abraham Verghese Shares Story of the EHRs Negative Consequences With Broader Audience, The 4th Annual Stanford 25 Bedside Teaching Symposium, Compassion, Patience and Bedside Manner Improve Patient Satisfaction, Technology Doesnt Have to Be the Antithesis of Humanity, AI to Complement Not Compete With Physicians Diagnostic Skills, The Tradition of Daily Bedside Clinical Care, How Technology May Lead to Greater Human Connection at the Bedside, As Prices Drop, Point-of-Care Ultrasound May Spark Evolution of Physical Exam, Empathy and the Physical Exam Remain Essential Components of Medicine, AI is Doing More to Help Keep Doctors at the Bedside, Medical Students Recognize Importance of Bedside Manner, Announcing the 2017 Stanford 25 Skills Symposium, Dr. Abraham Verghese Interviews Dr. Jerome Kassirer on New Book, conversation-about-bedside-medicine-gains-momentum. Menstrual pain and cramps are very common in women and affect 50% to 90% of female teens. 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. It is critical to have all tools, culture tubes, and equipment within easy reach during a pediatric genital examination. Ultrasound should be used as the initial diagnostic imaging technique for the evaluation of the pelvis in children and adolescents. From AccessMedicine. Labial adhesions, also common, usually are asymptomaticand are more likely to be noticed by a parent or found on routine pediatricexamination. However, young children can help define their exact symptoms on direct questioning. The critical factors surrounding the pelvic examination of an adolescent girl are different from those of examinations of children 2 to 8 years old. Signs of acute trauma from sexual abuse includehematomas, abrasions, lacerations, hymenal transections, and vulvar erythema.These conditions usually resolve within ten to fourteen days. A handheld mirror may help in some instances when discussing specifics of genital anatomy. Event marketing. Thus, a positivevaginal culture should be considered evidence of sexual abuse in the child.Likewise, C trachomatis rarely persists beyond age 2 to 3 years, and mostinfants and toddlers have been treated since birth with an antibiotic thatwould treat Chlamydia. Intestinal parasitic invasion with pruritus. 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. Newborns will exhibit maternal estrogen effects:the labia majora, labia minora, and clitoris will be relatively large, theepithelium a dull pink color, and the hymen often thick and redundant. 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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. 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. 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. Vulvarskin disorders are common, and often easily recognizable on exam. Young children may be examined in the frog leg position, and children as young as 2 to 3 years of age may be examined in the lithotomy position with use of stirrups, although this is generally used for girls aged 4 to 5 years and older. A gentle, patient approach is important when examining a prepubertal girl. 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. Discuss the results of the examination and your diagnosis andmanagement plan with the child and her parents after she is dressed. It is estimated that 80% to 90% of outpatient visits of children to gynecologists involve the classic symptoms of vulvovaginitis: introital irritation and discharge. 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 vagina of a child is 4 to 5 cm long and has a neutral pH. 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. This is especiallyimportant in girls who have persistent vaginal discharge, bleeding, or pelvicpain because it often is possible for an examiner to express vaginal discharge,palpate a foreign body, and detect masses. If extensive labial adhesions are present, you maynot be able to adequately examine the hymen and vagina and will need toreexamine the child after she has successfully completed treatment withlocal hygiene measures and topical estrogen (see Sidebar, "Common gynecologicfindings in the prepubertal girl"). In addition, periods may exacerbate other medical issues or they may prefer to have no periods due to hygiene or other concerns. Emans SJ, Lanfer MR, Goldstein DP: Pediatric and Adolescent Gynecology,4th ed. Slang terminology for speculums among teens includes the threatening label the clamp. Teens should be assured that although the examination may include mild discomfort, it should not be painful . The hymen and vagina usually can be seen adequately when a child is inthe supine position, with her legs flexed on her abdomen. After the history has been obtained, the parents and the child should be reassured that the examination will not hurt . Your first pelvic exam is usually after you become sexually active or when you turn 21, whichever comes first. Support teaching, research, and patient care. Office evaluation of the child and adolescent. 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. The entire exam takes about only 5 minutes. Your questions should address the onset of symptoms; the type,frequency and timing of discharge; associated bleeding, pain, or pruritus;foreign body insertion; perineal hygiene; recent infections in the patientor her family (such as streptococcal pharyngitis or pinworms); recent antibiotictherapy; masturbation; and a history of sexual abuse. Teens don't usually get pelvic exams. Accidental genital trauma often produces extreme pain and overwhelming anxiety for the child and her parents. The genital examination of the infant through adolescence.Curr Opin Obstet Gynecol 1993;5:753, 11. Making the examination a positive experience, ifpossible, therefore is critical.2. That's why we conduct research to advance care techniques that can be used for our patients and kids anywhere. 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. Watch the video to learn the differences between primary and second dysmenorrhea and how to diagnose and treat endometriosis. Using Google Glass to Examine the Hand with Dr. Verghese. 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. How To do a Pediatric Physical Exam Zachys 1.48K subscribers Subscribe 2.8K Share 1.1M views 7 years ago Today Nurse Lindsey demonstrates how to give a proper pediatric physical exam. Common Indications for Pelvic Examination in the Adolescent, Clinical Features of Children Presenting With Vulvovaginitis. The vaginal epithelium of the prepubertal child appears redder and thinner than the vaginal epithelium of a woman in her reproductive years. Videos : Exams. Stanford 25 YouTube Channel Abdominal Examination Examination of the Spleen (Stanford Medicine 25) Percussion of the Spleen (Stanford Medicine 25) Diagnosis Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) with Carnett's Sign - Abdominal Pain Ankle Brachial Index Ankle Brachial Index (ABI) Test: How to Perform Venous Testing Bedside Ultrasound Vulvitis, or vulvar inflammation, can occur alone or in combination withvaginitis, or vaginal inflammation. Vaginalagenesis is characterized by thick vestibular tissue, and often there isa dimple surrounded by a vulvar depression where the hymen should be.6, Acquired hymenal abnormalities usually are caused by sexual abuse andrarely by accidental trauma. ObstetGynecol 1971;37:462, 13. One way to describe genital area and breasts is to call them private areas and define this as meaning areas that are covered by a bathing suit. 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. The American Academy of Pediatrics (AAP) promotes the inclusion of the pelvic examination in the primary care setting within the medical home. Vaginal bleeding is also associated with vulvovaginitis. 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. The child lies prone and places her buttocks in the air with legs wide apart. Patient has this new skin finding, what should you worry about? Many adolescent girls do not want their mother, guardian, or other observers in the examining room, and in many adolescent gynecology visits, a full pelvic examination is unnecessary ( ). Caring pediatric nurses are available 24/7 to help answer your questions. Help me decide. Asking the child whether anyone hasever touched her in a way that made her feel uncomfortable often is helpfulin drawing out this information. In addition, while obtaining a history, an opportunity exists to educate the child on vocabulary to describe the genital area. Cleveland Clinic reexamines syphilis testing strategies after rise in cases. Bates' Visual Guide features head-to-toe and systems physical exam videos completely reshot with an emphasis on clinical accuracy and patient care. A discharge that is both bloody and purulent is likely not from vulvovaginitis but from a foreign body (see Vaginoscopy for Prepubertal Bleeding without Signs of Puberty later in this chapter), although patients infected with some pathogens, particularly Shigella boydii, often present with a bloody or blood-tinged discharge . All-New Assessment Videos! When you give to Children's Colorado, you're helping us to reimagine children's health through patient care, education, research and advocacy. 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 ) ( ). The evaluation of childrens gynecologic problems involves considerations of physiology, psychology, and developmental issues that are different from those of adult gynecology . 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. 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. 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. There is no significant geographic barrier between the vagina and anus. The child should be warned that the rectal examination will feel similar to the pressure of a bowel movement. PCOS occurs due to a complex interaction of genetic and environmental factors can affect the menstrual cycle, hair growth, skin, weight and the ability to have children. 12 red rubber bladder catheter for the outer catheter and the hub end of an intravenous butterfly catheter for the inner catheter ( Fig. A gentle, patient approach is important when examininga prepubertal girl. Bacterial vaginosis during pregnancy may lead to increased risks for preterm birth, preterm delivery, and spontaneous abortion, according to new research in the Archives of Gynecology and Obstetrics. 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. Vaginal foreign bodiesare a common cause of bleeding, but children often are reluctant to admitto foreign body insertion. N gonorrhoeaerarely persists beyond the newborn period without symptoms. Chronic pelvic and abdominal pain can be debilitating for a young girl. Physical Assessment of the Newborn: A Comprehensive Approach to the Art of Physical Examination. A specimen for Chlamydia culture can be obtained by using a Dacron maleurethral swab and scraping the lateral vaginal wall gently. In this video, adolescent gynecologist Eliza Buyers, MD, reviews options for menstrual suppression, how they work, and various considerations for teens with complex medical issues.

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