pediatric pelvic exam video

Once the child is positioned, the vulvar area and introitus should be inspected. 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. Dr. It is recommended that the examination start with the nongenital areas , such as listening to the heart and lungs; an abdominal examination and inspection of the skin should be performed. Not sure if you need urgent or emergency care? Your pediatrician will describe each step of the exam. Emans SJ, Woods ER, Flagg NT, et al: Genital findings in sexuallyabused symptomatic and asymptomatic girls. 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. 12.3 ). The major factor in childhood vulvovaginitis is poor perineal hygiene. Common Indications for Pelvic Examination in the Adolescent, Clinical Features of Children Presenting With Vulvovaginitis. However, many infants are infected with Chlamydia trachomatis during birth and remain infected for up to 2 to 3 years in the absence of specific antibiotic therapy. What Is The Specific Cause of This Patients Clubbing? A specimen for Chlamydia culture can be obtained by using a Dacron maleurethral swab and scraping the lateral vaginal wall gently. Cultures for C trachomatis are recommended because of the possibilityof false-positive test results with indirect and slide immunofluorescenttests and insufficient data on tests that utilize polymer chain reactionand ligase chain reaction techniques. Newborns and pubescent girls sometimeshave significant vaginal secretions because of estrogen effect. A nurse retrieves the patient from the office and takes her to an exam room. You can use this section to discover where and how this . Patient has this new skin finding, what should you worry about? Pay special attention to anatomic and pathophysiologic differences in the child. Learn Peds Genitourinary 04 Genital Exam Intro from UBC Learn Pediatrics on Vimeo. In the period surrounding the time of puberty, children often develop a physiologic discharge secondary to the increase in circulating estrogen levels. 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. Most young children can be examined in the frog-leg position; that is,supine with knees apart and feet touching in the midline. 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. The atrophymay distort the anatomy of the labia and clitoris. Early identification and treatment can lead to improved quality of life for individuals with PCOS and prevention of diabetes and cardiovascular disease. Culture for N gonorrhoeae should be plated on modified Thayer-Martin-Jembecmedium. The critical factors surrounding the pelvic examination of an adolescent girl are different from those of examinations of children 2 to 8 years old. Menstrual bleeding in adolescents can be chaotic. Am J Obstet Gynecol1987;157:950, 6. Emphasize that the most important part of the examination is just looking and there will be conversation during the entire process. From Blythe MJ, Thompson L. Premenarchal vulvovaginitis. 25:50. Power your marketing strategy with perfectly branded videos to drive better ROI. Making the examination a positive experience, ifpossible, therefore is critical.2. Stanford ENT Free Oral Screening November 2nd. In addition, she reviews the potential for ovarian torsion, including signs and symptoms, evaluation and management. In this video, pediatric and adolescent gynecologist Veronica Alaniz, MD, discusses the indications, proper technique and risks of vaginoscopy and hysteroscopy. Here we cover each aspect of the pelvic exam and demonstrate both in text and in our video how this done. Can you diagnose the cause of the patients lymphedema? After you have established a rapport with the child and taken her history,you should explain the gynecologic examination to both the child and herparent. The child lies prone and places her buttocks in the air with legs wide apart. The normal vagina of a prepubertal child is colonized by an average of nine different species of bacteria: four aerobic and facultative anaerobic species and five obligatory anaerobic species. Having a relationship with a pediatric gynecologist can help girls take . Urethral prolapse also can present with bleeding. 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. Children are not skilled historians and will often ramble, introducing many unrelated facts. If necessary, small amounts of daily topical estrogen to the labia may be used for treatment. The tape is subsequently examined under the microscope. Pads should be placed in the mothers lap because examination often is associated with urination. Draping for the gynecologic examination may produce more anxiety than it relieves and is unnecessary in the preadolescent child. 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. Palpate the abdomen for masses and the inguinal areasfor a hernia or gonad. Breast budding is a reliable sign that the vaginal pH is shifting to an acidic environment. It is important to give the child a sense that she will be in control of the examination process. The vulvar skin of children may also be affected by systemic skin diseases, including lichen sclerosus, seborrheic dermatitis, psoriasis, and atopic dermatitis. In a primary care setting, nonspecific vulvovaginitis accounts for the majority of vulvovaginitis cases. This period of transition involves important physical and emotional changes. There are both physiologic and behavioral reasons why a child is susceptible to vulvar infection. In addition to your doctor, there will be a nurse or an assistant in the room during . When alone withan examiner, a child may disclose abuse or other concerns, and allowingher to be interviewed or examined alone may give her a greater sense ofcontrol and responsibility for her own health. In: Emans SJ, Laufer MR, Goldstein DP, eds. However, young children can help define their exact symptoms on direct questioning. The evaluation of young girls is age dependent. Leukorrhea may be present. Clinical manifestations includepruritus, vaginal discharge and odor, vaginal bleeding, dysuria, and vulvarredness and irritation. Finally, trauma, either accidental or due to sexualabuse, may cause significant bleeding. This includes the process for diagnosis and considerations for work-up, evaluation and treatment, such as support and counseling. 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. Rectoabdominal exam. A tape testmay be useful for suspected pinworm. Questions about caretakers, behavioral changes,fears, and somatic symptoms may help to diagnose sexual abuse. 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. The vagina will then fill with air, aiding the evaluation. 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 (From Emans SJ. 3 simple steps. This is an important step toward reinforcing the child's sense ofcontrol over the examination. The classic symptom of pinworms is nocturnal vulvar and perianal itching. The mostcommon foreign body encountered in prepubertal girls is a wad of toiletpaper, which appears as a small, gray mass. 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. The vagina of a child lacks glycogen, lactobacilli, and a sufficient level of antibodies to help resist infection. Vulvovaginitis and vaginal bleeding often are found on gynecologic examinationof prepubertal girls. A gentle, patient approach is important when examining a prepubertal girl. Many dermatologic disorders, suchas atopic dermatitis, seborrhea, and psoriasis, can manifest as vulvitisor vulvovaginitis. Health providers are the key source of accurate information on puberty and menstrual periods and can offer safe and effective treatment. Show Transcript. Many gynecologic conditions in children may be diagnosed by inspection . If the child'ssymptoms of vulvovaginitis persist, you should review your diagnosis. 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If you put your stethoscope over this, what will you hear? Specific vulvovaginitis. If the interaction is poor during the first visit, the negative experience will detract from future physician-patient interactions ( ). This allows one to establish a rapport and mimics the traditional visits the child has with the pediatrician. Yuwoko. Dr. Huguelet also reviews the basic embryology and treatment approach for these conditions and explains when the best time is to perform surgery. Both parent and child should be instructed that the vulvar skin should be kept clean, dry, and cool and irritants should be avoided. A patient in early adolescence (aged 12 to 14 years) may behave similarly and need similar support as those in the prepubertal stages. This can be accomplished without the insertion of any instruments. The usual cause of genital trauma during childhood is an accidental fall. At the 44th National Association of Pediatric Nurse Practitioners Conference, guidelines for prescribing oral contraceptives were discussed. The foundation of treating childhood vulvovaginitis is the improvement of local perineal hygiene. Treatment for extensivelabial adhesions is topical estrogen cream applied along the adhesion withgentle pressure twice a day for three weeks, then at bedtime for three weeks.Once the adhesion has resolved, a barrier ointment should be used to preventrecurrence. The lesions are often mistaken for bacterial cellulitis or lesions associated with other viral infections, such as herpes simplex virus. Finally, it isimportant to remember that urethritis can cause dysuria or hematuria, whichmay be mistaken for vaginal bleeding. It is critical to have all tools, culture tubes, and equipment within easy reach during a pediatric genital examination. Chronic vaginal discharge, which can occur with a vaginal foreign bodyor vaginitis, also can lead to vulvitis, which is characterized by an erythematous,hyperpigmented, or hyperkeratotic line along the dependent portion of thelabia majora.9 Clitoral erythema and pruritus often is a symptomof a prior or current vulvitis, and may be caused by adhesions between theclitoral hood and the glans clitoris. 0:31. This is a difficult decision and is based on the extent of the childs anxiety in relation to the severity of the clinical symptoms. 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. The relative size ratio of cervix to uterus is 2:1 in a child, in contrast to the opposite ratio in an adult. Your doctor checks your vulva, vagina, cervix . The labia minora are thin, and the vulvar skin is red because the abundant capillary network is easily visualized in the thin skin. Abraham-Vergheses-TED-Talk:-Over-one-million-views! The child is told to have her abdomen sag into the table. Most pediatric visits are preventive in nature, but the pediatric gynecologic visit is usually problem oriented . Blake J: Gynecologic examination of the teenager and young child.Obstet Gynecol Clin North Am 1992;19:27, 3. After observing an increase in the rate of syphilis cases, the Cleveland Clinic Ob/Gyn & Womens Health Institute has partnered with the Center for Pediatric Infectious Diseases to evaluate the effectiveness of current testing strategies. Ovarian torsion should be managed conservatively with untwisting and preservation of the adnexa, regardless of the appearance. However, if the reason for the visit is urgent, such assignificant vaginal bleeding, and a child is uncooperative, you may haveto perform the exam under anesthesia. In this video, Stephen Scott, MD, provides an overview of how to properly identify and manage NSGUs and the timeline for healing. If patients are going to be treated with antibiotics, one should attempt to collect a sample of the vulvovaginal discharge for culture before initiation of the antibiotics . Recurrent vulvovaginitis, persistent bleeding, suspicion of a foreign body or neoplasm, and congenital anomalies may be indications to perform a vaginoscopy and examine the inside of the vagina. This is often the most distressing aspect of the examination and may be omitted, depending on the childs symptoms. Vaginoscopy in a prepubertal child most often requires sedation with a brief inhalation or intravenous anesthetic, but in select circumstances it can also be performed in the office with older, cooperative children. What will bedside manner look like for new data-driven physicians? A childs reaction will depend on her age, emotional maturity, and previous experience with health care providers. The vaginal epithelium of a prepubertal child has a neutral or slightly alkaline pH, which provides an excellent medium for bacterial growth. If you need to visualize the vagina and cervix and the child is olderthan 2 years, the knee-chest position may be useful. You might have a pelvic exam as part of your regular checkup. It is not diagnostic since few vaginal diseases can be diagnosed visually. Because of compassion and empathy, the gynecologist may underestimate the extent of the anatomic injuries. With puberty , the prepubertal vagina becomes acidic under the influence of bacilli dependent on a glycogenated estrogen-dependent vagina. 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. An exam of your child's genitals (JEN-ah-tuls) is done to check for possible disease, injury or abnormality. Thegynecologic examination of the prepubertal child can be challenging, butit can also be quite rewarding for a clinician who understands the uniqueanatomic and physiologic characteristics of a prepubertal child and approachesthe examination with patience, gentleness, and respect. The quantity of discharge can vary greatly, from minimal to copious. 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. Non-sexually acquired genital ulcers (NSGUs) in adolescent females are uncommon, painful skin lesions on the mucous membranes of the vulva and vaginal structures, unrelated to sexual activity. Puberty produces dramatic alterations in the external and internal female genitalia, as well as the adolescents hormonal milieu. Addressing the Youth Mental Health Crisis, Department of Pediatric and Adolescent Gynecology, Fertility Preservation and Reproductive Late Effects Program, Mayer-Rokitansky-Kster-Hauser (MRKH) syndrome, Insurance, billing and payment information. What Stands in the Way of Bedside Teaching? Gidwani GP. A pelvic exam usually lasts only a few minutes. A vaginal self-examination is a way to look at your vulva and vagina to better understand your body and to spot problems that may need medical attention. The child's buttocks will now be heldup in the air and her back and abdomen will fall downward (Figure 4). The source maybe the vulva, vagina, endometrium, and occasionally the urethra. Whats the diagnosis? Young girls should feel that they are participating in their examination , not that they are being coerced or forced to have a gynecologic exam. Seborrheicdermatitis is characterized by erythema of the vulva, often associated withyellow scales and crusting. In this video, pediatric and adolescent gynecologist Veronica Alaniz, MD, discusses the indications, proper technique and risks of vaginoscopy and hysteroscopy. A child should never be restrained for a gynecologic examination . It's also not true that the pelvic exam is a "test" to see if you are a virgin. There is also a video, which demonstrates a technique for doing a thorough female pelvic exam and a module for the male genital exam. A complete examination includes inspection of the external genitalia,visualization of the vagina and cervix, and rectoabdominal palpation. Capraro VJ: Gynecologic examination in children and adolescents.Pediatr Clin North Am 1972;19:511, 12. She should be allowed to visualize and handle any instruments that will be used. Pinworms are another cause of vulvovaginitis in prepubertal children. The most important technique to ensure cooperation is to involve the child as a partner. 0:38. Hymens in newborns are estrogenized, resulting in a thick, pink, elastic redundancy. 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. Teens don't usually get pelvic exams. The American Academy of Pediatrics (AAP) promotes the inclusion of the pelvic examination in the primary care setting within the medical home. An ectopic ureter emptying into the vagina may only intermittently release a small amount of urine; thus this rare congenital anomaly should be considered in the differential diagnosis in young children. Last updated on April 26, 2013 @3:30 pm Feedback: How useful was the above information? In determining the diagnosis, it may be helpfulto inquire about persistently wet underwear, recurrent fevers, unexplainedUTI, and abdominal or lower back pain. Huffman JW, Dewhurst CJ, Capraro VJ: The Gynecology of Childhood andAdolescence. Stanford Medicine 25 Clinical Pearl Award, Measuring Central Venous Pressure with the Arm, Resident Education: Internist Physical Exams, Body as Text: Teaching Physical Examination Skills | Stanford Medicine 25.

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pediatric pelvic exam video

pediatric pelvic exam video