Gynecologic Examination for Adolescents in the Pediatric Office Setting

Abstract

The American Academy of Pediatrics promotes the inclusion of the gynecologic examination in the primary care setting within the medical home. Gynecologic issues are commonly seen by clinicians who provide primary care to adolescents. Some of the most common concerns include questions related to pubertal development; menstrual disorders such as dysmenorrhea, amenorrhea, oligomenorrhea, and abnormal uterine bleeding; contraception; and sexually transmitted and non-sexually transmitted infections. The gynecologic examination is a key element in assessing pubertal status and documenting physical findings. Most adolescents do not need an internal examination involving a speculum or bimanual examination. However, for cases in which more extensive examination is needed, the primary care office with the primary care clinician who has established rapport and trust with the patient is often the best setting for pelvic examination. This report reviews the gynecologic examination, including indications for the pelvic examination in adolescents and the approach to this examination in the office setting. Indications for referral to a gynecologist are included. The pelvic examination may be successfully completed when conducted without pressure and approached as a normal part of routine young women's health care. Pediatrics 2010;126: 583-590 INTRODUCTIONGynecologic issues are commonly seen by clinicians who provide primary care to adolescents. Some of the most common problems include questions related to pubertal development; menstrual disorders such as dysmenorrhea, amenorrhea, oligomenorrhea, and abnormal uterine bleeding; contraception; and sexually transmitted infections (STIs) and non-STIs. Approximately one-half of adolescents attending high school have been sexually active, which places them at risk for STIs and pregnancy. 1 Younger adolescents often have questions about pubertal development, and the gynecologic examination is a key element in assessing pubertal status and documenting physical findings.The American Academy of Pediatrics (AAP) promotes the inclusion of the pelvic examination in the primary care setting within the medical home. The examination can be a positive experience when conducted without pressure and approached as a normal part of routine young women's health care. At a minimum, examination of the external genitalia should be included as part of the annual comprehensive physical examination of children and adolescents of all ages. Routinely explaining and including this examination normalizes the experience rather

Contraception for Adolescents

“…Studies in both adolescents 77 and adults 78 suggest that weight gain status at 6 months is a strong predictor of future excessive weight gain with ongoing DMPA use, but that weight gain does not occur in all patients. 79,80 DMPA causes reductions in bone mineral density (BMD), [81][82][83] 91 no gynecologic examination is needed to determine eligibility for COC use. Like other combined methods including the contraceptive vaginal ring and transdermal patch, COCs can be started on the same day as the visit ("quick start") in healthy, nonpregnant adolescents.…”

The Evaluation of Children in the Primary Care Setting When Sexual Abuse Is Suspected

“…46 In many cases, a speculum examination is not needed in the absence of signs or symptoms of genital disease but is usually indicated after acute vaginal sexual assault to document injuries and to collect forensic specimens. 47 Girls should receive their first cervical cytologic examination (Papanicolaou test) at 21 years of age unless there are special circumstances, such as immune suppression or infection with HIV.…”

“…47 Girls should receive their first cervical cytologic examination (Papanicolaou test) at 21 years of age unless there are special circumstances, such as immune suppression or infection with HIV. 46,48 For boys, the examination of the genitals consists of inspection of the penis and scrotum, documenting any noted trauma or scarring and any other abnormalities.…”

Hematocolpos Causing Urinary Retention in 10 Years Old. Uncommon Presentation.

“…However, in spite of the recommendations for inspection of the external genitalia during the neonatal and early childhood period, variations in hymenal anatomy commonly escape diagnosis until the time of menarche. Anatomic anomalies that can be confused with imperforate hymen in the differential diagnosis should be considered (3,4) .…”