pediatric pelvic exam video

When is it best to reassure, and when is it necessary to evaluate? This provider either practices in a department or specialty that we currently do not survey, or does not have at least 10 ratings in the last 12 months. This will give the child a sense of control and divert the childs attention if she is ticklish or is squirming. Physiologic leukorrheacan be confused with vulvovaginitis. Uterine bleeding that is coming more often than every three weeks, lasting longer than seven days in a row, or resulting in excessive product use and frequent bleeding through clothes should be evaluated. A mounding of hymeneal tissue is often called a bump. 11 mins, 28 secs. EMANS is Chief, Adolescent Division, Children's Hospital, and Associate Professor of Pediatrics, Harvard Medical School, Boston. Most pediatric visits are preventive in nature, but the pediatric gynecologic visit is usually problem oriented . The rash of atopic dermatitis is typically maculopapular, pruritic, anderythematous. A handheld mirror may help in some instances when discussing specifics of genital anatomy. Chemicals that may be allergens or irritants, such as bubble bath, must be discontinued, and harsh soaps and chemicals should be avoided. When you give to Children's Colorado, you're helping us to reimagine children's health through patient care, education, research and advocacy. In some cases, however,it is helpful to spend time alone with the child during the interview, andto ask whether she prefers to be alone for the examination. A pelvic exam is where a doctor or nurse practitioner looks at a girl's reproductive organs (both outside and internally). 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. Last updated on April 26, 2013 @3:30 pm Feedback: How useful was the above information? The majority of cases of persistent or recurrent nonspecific vulvovaginitis respond to improved hygiene and treatment of irritation resulting from trauma or irritating substances. A patient in early adolescence (aged 12 to 14 years) may behave similarly and need similar support as those in the prepubertal stages. 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"). Pelvic Exam | Stanford Medicine 25 | Stanford Medicine Using this approach for a 2-week period should resolve most symptoms in patients with nonspecific vulvovaginitis. Vaginal foreignbodies, particularly wads of toilet paper, often are found in girls whohave a bloody, foul-smelling, or persistent vaginal discharge. 12.3 ). After obtaining samples, perform a gentle rectoabdominalexamination with the patient either in stirrups or supine. 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. Using a hand mirror can be usefulto promote education, distract a child, and allow her to participate moreactivelyin the examination. Bumps are usually a normal variant and are often attached to longitudinal ridges within the vagina. In this video, pediatric and adolescent gynecologist Veronica Alaniz, MD, discusses the indications, proper technique and risks of vaginoscopy and hysteroscopy. How To do a Pediatric Physical Exam - YouTube If the interaction is poor during the first visit, the negative experience will detract from future physician-patient interactions ( ). They may have septums, microperforations, or fingerlike extensions or be completely imperforate. She discusses how diagnosis requires both ovulatory dysfunction and hyperandrogenism, and she shares recommendations for PCOS treatment from lifestyle changes to possible medications. 25:50. Genital Exam - Male (Pre- or Early Puberty) - Nationwide Children's N gonorrhoeaerarely persists beyond the newborn period without symptoms. Your patient gets this rash, whats the diagnosis? The examination also allows a period of opportunity to counsel children, in an age-appropriate manner, about potential sexual abuse. The child should be instructed to void with her knees spread wide apart (even while facing the toilet to improve urine draining) and taught to wipe from front to back after defecation. Once the child is positioned, the vulvar area and introitus should be inspected. The vaginal epithelium of the prepubertal child appears redder and thinner than the vaginal epithelium of a woman in her reproductive years. The surgical therapy of an ovarian neoplasm in a child should have two goals: the appropriate surgical removal of the neoplasm and the preservation of future fertility. What Is The Specific Cause of This Patients Clubbing? A patient presents with foot pain and these chronic findings? The extent of labial adhesions and associated symptoms are variable (seefigure "B"). Thepediatrician may have the additional advantage of already having built arelationship with the child who requires a gynecologic examination. You can also ask the child to cough in order todistract her and cause her hymen to open. After your examination is complete, congratulate the child for her cooperationand bravery. Asking the child to pretend to blow out candles on a birthday cake may facilitate the process. It is important to give the child a sense that she will be in control of the examination process. Finally, trauma, either accidental or due to sexualabuse, may cause significant bleeding. When Do Teens Need a Gynecologist? > News > Yale Medicine Despite widespread belief, mycotic (yeast) vaginal infections are not common in prepubertal children because the alkaline pH of the vagina does not support fungal growth. 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. 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. Usingthis position and an otoscope head for magnification and light, you willbe able to visualize the lower vagina, and usually the upper vagina andcervix, in 80% to 90% of prepubertal girls.3. Video Gallery | Stanford Medicine 25 | Stanford Medicine The entire exam takes about only 5 minutes. If you cannot fully visualize the hymen, ask thechild to cough or take a deep breath, or pull the labia gently forward anddown or laterally yourself so that you can see the hymen and the anteriorvagina. Using Google Glass to Examine the Hand with Dr. Verghese. Those in middle or late adolescence (aged 15 to 19 years) may be more accepting of the idea of an examination and more likely to cooperate with the proper counseling and in the appropriate setting. 4:40. With a five-year survival rate of 84%, there are 100,000 annual survivors of reproductive age. Other findings includeecchymoses and "blood blisters," which often develop after mildtrauma such as riding a bicycle. 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. Or your doctor might recommend a pelvic exam if you have symptoms such as unusual vaginal discharge or pelvic pain. Etiologic Factors of Premenarcheal Vulvovaginitis, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Pediatric and adolescent gynecology: Gynecologic Examination, Infections, Trauma, Pelvic Mass, Precocious Puberty, Benign gynecologic lesions: Vulva, Vagina, Cervix, Uterus, Oviduct, Ovary, Ultrasound Imaging of Pelvic Structures, Reproductive anatomy: Gross and Microscopic Clinical Correlations, Pelvic organ prolapse, abdominal hernias, and inguinal hernias: Diagnosis and Management, Malignant diseases of the ovary, fallopian tube, and peritoneum, Neoplastic diseases of the vulva and vagina, Primary and secondary amenorrhea and precocious puberty, Congenital abnormalities of the female reproductive tract: Anomalies of the Vagina, Cervix, Uterus, and Adnexa, Anal incontinence: Diagnosis and Management. Pelvic Examination | NEJM 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. Visualization of the introitus is better achieved using the previously described traction and the Valsalva maneuver than separation because it gives a deeper view of the structures and partial visualization of the vagina. Obtaining cultures. Online Teaching Videos - Department of Urology Pelvic pain is common in adolescent girls. If you put your stethoscope over this, what will you hear? McCann J, Wells R, Simon M, et al: Genital findings in prepubertalgirls selected for nonabuse: A descriptive study. Common Indications for Pelvic Examination in the Adolescent, Clinical Features of Children Presenting With Vulvovaginitis. Menstrual bleeding in adolescents can be chaotic. This may create considerable and understandable anxiety in the child and parent. Candidal infection is uncommon in prepubertal children unless there isconcomitant antibiotic use, diabetes, immunosuppression, or occlusive diaperuse. Emphasize that the most important part of the examination is just looking and that there will be conversation during the entire process. 5 Minute Pelvic Exam Video | The Brookside Associates 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. Then an otoscope or ophthalmoscope is used as a magnifying instrument and light source but is not inserted into the vagina. Blake J: Gynecologic examination of the teenager and young child.Obstet Gynecol Clin North Am 1992;19:27, 3. Dealing with a foreign body. If necessary, small amounts of daily topical estrogen to the labia may be used for treatment. 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. Employee communication. A more thorough gynecologic examination is warranted for the evaluationof vaginal bleeding, vaginal discharge, trauma, or pelvic pain. From Pierce AM, Hart CA. 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. In this setting it may be helpful to use the extinction phenomenon, in which the examiner provides pressure on the perineum lateral to the introitus before insertion of the speculum. 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. Because of compassion and empathy, the gynecologist may underestimate the extent of the anatomic injuries. Polycystic ovary syndrome (PCOS) is one of the most common metabolic conditions affecting at least 10% of women of reproductive age. 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. In addition, she reviews the potential for ovarian torsion, including signs and symptoms, evaluation and management. At the 44th National Association of Pediatric Nurse Practitioners Conference, guidelines for prescribing oral contraceptives were discussed. Considerable effort should be devoted to gaining the childs confidence and establishing rapport. The critical factors surrounding the pelvic examination of an adolescent girl are different from those of examinations of children 2 to 8 years old. 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. Constipation or bladder problems can present as pelvic pain, so I also ask patients about bowel habits and urinary symptoms. Past medical history should include information about congenital anomalies,systemic disorders with dermatologic manifestations, and growth and development.Congenital anomalies, and particularly renal anomalies, may be associatedwith gynecologic anatomic abnormalities. For non-life-threatening medical needs when your pediatrician is unavailable, visit one of our urgent care locations. This places the teen in control of the tempo and allows her to anticipate the next element of the examination. A successful gynecologic examination of a child demands that the physician employ an exam pace that conveys both gentleness and patience with the time spent, without seeming to be hurried or rushed. In some cases, nonspecific vulvovaginitis may be caused by carrying viral infections from coughing into the hands directly to the abraded vulvar epithelium. Have the child resther head to one side on her folded arms and support her weight on bent knees,which are six to eight inches apart. The prepubertal vagina is also narrower, thinner, and lacks the ability to distend like that of the vagina of a reproductively mature woman. 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. 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 Ovarian tumors constitute approximately 1% of all neoplasms in premenarcheal children. View a sample video Occasionally, an adhesion will require separation, which canbe done either in the office or under anesthesia. In rare circumstances, it may be necessary to use continuous intravenous conscious sedation or general anesthesia to complete an essential examination. Ideally children should feel they are part of the examination rather than having an exam done to them.. An ectopic ureter can present as persistent wetnessor purulent discharge. This video demonstrates how to perform a comprehensive pelvic examination, including an examination of the external genitalia, a Papanicolaou test to screen for cervical dysplasia, a bimanual exami. The examination can be a positive experience when conducted without pressure and approached as a normal part of routine young women's health care. Urethral prolapse, a mucosal inversion at the urethral meatus, may beasymptomatic but it also can become inflamed and cause dysuria, perinealdiscomfort, and bleeding. Dr. Baldeep Singh filming for a new set of "Approach to Low Back Pain" & "Approach for Hip Pain" videos. Diagnose this skin lesion with newest Stanford 25 video and topic. Small follicular cysts in preadolescent girls are usually self-limiting. 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). Bacterial causes include group A, b-hemolyticStreptococcus, Haemophilus influenzae, Staphylococcus aureus, Branhamellacatarrhalis, Streptococcus pneumoniae, Neisseria meningitidis, and Shigella.Sexually transmitted infections include Neisseria gonorrhoeae, Chlamydiatrachomatis, herpes simplex virus, Trichomonas, and human papillomavirus.It is important to note that these organisms also can be vertically transmittedat birth and herpes can be transmitted by nonsexual contact.

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