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.2, Another important consideration when performing a gynecologic assessmentis providing anticipatory guidance to the patient and her parents. Opening questions can include inquiriesabout the family structure and recent changes, school, friends (such aswhether she has a best friend), and the types of activities she enjoys.It is important to assess who cares for the child and to uncover--both fromthe parent and from the child--information about any history of sexual abuseor current concerns in that regard. Tables 1 and 2 list the differentialdiagnoses of vulvovaginitis and vaginal bleeding. Sources of accidental trauma areusually straddle injuries. Tricia Huguelet, MD, Chief of Pediatric and Adolescent Gynecology, describes the typical presentation of hymen imperforations in adolescents and young adults, as well as obstructing and non-obstructing mllerian anomalies. The majority of symptoms improve with hygienic changes and sitz baths (warm water, no soaps or chemicals). Capraro VJ, Capraro EJ: Vaginal aspirate studies in children. Physiologic leukorrheacan be confused with vulvovaginitis. N gonorrhoeaerarely persists beyond the newborn period without symptoms. Power your marketing strategy with perfectly branded videos to drive better ROI. 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. Ovarian torsion should be managed conservatively with untwisting and preservation of the adnexa, regardless of the appearance. A patient with signs of trauma, such as abrasions, lacerations, or contusions,should be evaluated for suspected sexual abuse. 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 . That's why we conduct research to advance care techniques that can be used for our patients and kids anywhere. OB/GYN - Physical Examination Resources - University of Iowa
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