OF CHILDREN AND ADOLESCENTS
Rodríguez MJ, Hernández I, Parera N.
During childhood gynecological pathology is rare,
but inspection of the external genitalia and
palpation of the breast should always be part of
systematic physical examination by a pediatrician.
It is also necessary to detect any abnormality
in the external configuration of thegenitals and the hymen as many diagnostic errors are caused by the omission of exploration.
At puberty we will find reasons
specific query: delayed onset of menstruation,
cycle disturbances, metrorrhagia, ... and with
another problem again. This is currently due to
more tolerant social attitudes, the influence of
media,etc. Is frequent starting
sex, to be associated with a certainbehavior patterns that favor STIs and
The physician's role, especially in adolescence, not
be limited to the assessment, diagnosis and treatment the problem by consulting the teenager, but should go further towards a preventive and educational.
The lack of sensitivity to the concerns and needs
the girl can turn an event
potentially instructive experience
physically and emotionallytraumatic attitudes will condition to doctors, especially to the gynecologist, will persist the rest of his life.
GYNECOLOGICAL MEDICAL CONSULTATION
In childhood the questioning usually leads to
parents, but it is important to seek the assistance of
the patient. Never be in a hurry: making trust
by the child is going to facilitate later
physical examination. Sometimes, itmust
even postponed for a second visit if the child shows
The presence of a companion, usually
mother, is essential in the case of the younger girls,
not only to provide the information that she
can give us, and also as a reassuring
to help the scan.
For older girls and adolescents, the presence
the mother can be both helpful and coercive.
Therefore, before starting the anamnesis,we need to establish the presence or absence of the mother,
inviting her to leave if it is the desire of young
then, at the end of our performance, re-pass
to be informed.
The pelvic examination is detailed by
prospective parents and the patient. It is important to stress
that both maneuvers as the material used
will be appropriate to the age of the child and
noway going to hurt.
The only special tool which is used in these patients
is vaginoscope (fig. 1), endowed small speculum
a light source that enables viewing
vagina and cervix. If we do not have it, its function
can play an otoscope or a colposcope.
The proper position for scanning can be both
the lithotomy (for older girls) like "frog" in
supine with legs abducted and flexed
and solesof the feet together. In younger girls,
the mother sit on the exam table and
which she will hold onto her thighs keeping the child
posture or hiperflexionando described the
girl's thighs on the abdomen. It also allows
genupectoral good viewing position.
You should assess the existence of pubic hair, see
the size of the clitoris, hymen settings, the presence
signs ofestrogenization and perineal hygiene.
The hymen is opened when the child is asked to cough or breathe
deeply, allowing you to see the third lower
the vagina, if it does not, what provoke pulling
of the labia majora inferiorly and laterally. of
this shape is scanned in search of vaginal secretion, bleeding,etc.(fig.2). Overall assessment of a child only gynecological inspecting comprises genitalswithout
The general physical examination of the adolescent understands determination of pubertal development according to
Tanner, inspection of the breasts and the
External genital and pelvic examination.
During the examination of the breasts can instruírsele
about breast self-examination. Breast cancer does not is a disease of teenagers, so this self
takes place only to...