9. Adolescent Gynaecology Flashcards
How is Adolescent Gynaecology different?
- Usually a Family Consultation
- Can be 3 Generations Present
- Sometimes just with Father
- Ethnic Minorities - Child may Speak English but Parents not
- Anxieties about Confidentiality
- Consultation often Directed at PArents
What changes occur in Adolescent Gynaecology?
- Physiological Changes
- Developing Sexuality
- Independence from Parents
- Peer Acceptance
- Descisions over the Future
How do Presentations Vary between in Adolescent Gynaecology?
- Embarrassment / Secrecy
- Identify whos problem it is
- Confusion
- May talk to Parents and Friends
Who do Adolescent Gynaecology cases often present to?
- School Nurses
- Family Planning Clinics
- G.P. / A&E
What is Gillick Competence?
A Child younger than 16 can give / withhold consent if a doctor feels she fully understands what is involves in an intervention
Note - In certain situations parents can override the girls wishes
What is Fraser Competence?
Contraceptive Advice to under 16 year old girls
What is needed in Fraser Competence?
- Mature enough to understand the advice / implications
- Girl likely to begin / continure to have sex with / without treatment
- Doctor tried to persuade girl to inform parents
- Girls health would suffer without treatment / advice
- In girls best interest to give treatment / advice
What is included in the important Gynaecological History?
- Gynaecological - Age of Menarche / Cycle / Pain
- Sexual - Sexual Activity / Contraception
- Weight Gain / Loss
- Exercise
What is included in a Gynaecological Examination?
- General Examination
- Breasts
- Gynaecological
Note - This is never done in the 1st visit
What is the Self-Staging method used?
Tanner Stages
What is Ammenorrhoea?
Absence of Menstruation
When are investigations carries out for Primary Ammenorrhoea and:
- Normal Secondary Sexual Characteristics?
- Absent Secondary Sexual Characteristics?
- 16 years old
2. 14 years old
What investigations of Primary Ammenorrhoea will occur, prior to referral to a Gynaecology Clinic?
- Blood Hormone Levels - Follicular Stimulating Hormone / Luteinizing Hormone / Prolactin / Thyroid Stimulating Hormone / Testosterone / Oestrogen
- Pelvic Ultrasound
- Progesterone Withdrawal Bleed
How is a Diagnosis of Hypogonadotrophic Hypogonadism reached?
- History / Examination - No Secondary Sexual Characteristics
- Low FHS and LH - <5 IU per L
- Diagnosis Made
How is a Diagnosis of Premature Ovarian Failure reached?
- History / Examination - No Secondary Sexual Characteristics
- High FSH (>20 IU per L) and LH (>40 IU per L)
- Hypergonadotrophic Hypogonadism Diagnosis
- Karyotype Analysis - 46, XX
- Diagnosis Made
How is a Diagnosis of Turners Syndrome made?
- History / Examination - No Secondary Sexual Characteristics
- High FHS (>20 IU per L) and LH (>40 IU per L)
- Hypergonadotrophic Hypogonadism Diagnosis
- Karyotype Analysis - 45, XO
- Diagnosis Made
How is a Diagnosis of Androgen Insensitivity Syndrome made?
- History / Examination - Secondary Sexual Characteristics
- Ultrasound of Uterus - Uterus Absent / Abnormal
- Karyotype Analysis - 46, XY
- Diagnosis Made
How is a Diagnosis of Mullerian Agenesis made?
- History / Examination - Secondary Sexual Characteristics
- Ultrasound of Uterus - Uterus Absent / Abnormal
- Karyotype Analysis - 46, XX
- Diagnosis Made
When should Evaluation for Secondary Ammenorrhoea take place?
- History / Examination - Secondary Sexual Characteristics
- Ultrasound of Uterus - Uterus Present / Normal
- No Outflow Obstruction
- Tests for Secondary Ammenorrhoea performed
How is a Diagnosis of Imperforate Hymen (or Transverse Vaginal Septum) made?
- History / Examination - Secondary Sexual Characteristics
- Ultrasound of Uterus - Uterus Present / Normal
- Outflow Obstruction
- Diagnosis made
What happens in Puberty Induction?
- Gradual Build up of Oestrogen
- Effects on Breast Development
- Add Progesterone - once Max. Height, At least 20mg of Oestrogen Dose
How do / are Polycystic Ovaries:
- Present?
- Diagnosed?
- Treated?
- Switch between Hypothalamic and PCOS
- Diagnose with FSH:LH and Ultrasound
- Weight reduction / Lifestyle Changes / Oral Contraceptive Pill
What can cause Bleeding Disorders in Adolescent Gynaecology?
- Anovulation - Majority
- Pregnancy Complications
- Bleeding Disorders - Von Williebrands / Platelet Defects / Leukaemia
Note - Be aware of other Factors - Sexual Abuse / Bullying / Trauma
What is the treatment of Menorrhagia?
- Reassure / Talk to Girls Directly
- Medication:
- a) Progesterone Only Pill / Compined Oral Contraceptive Pill / Mirena
- b) Tranexamic / Mefenamic Acid
What is the Pathology of Cysts?
- Small Cysts are often Functional / Dermoids
- Gravity allows them to drop to the Lowest Pelvic Point
- Can then Tort / Turn Gangrenous / Rupture
Note - Often Subacute History - Tender on 1 side of the Pelvis and Mass may be felt
What is the most common age, in Adolescent Gynaecology, to present with Vulvovaginitis?
2-7 years old
What is the cause of Vulvovaginitis?
Labial Adhesions - C. Labial Aggulutination (Adhesion of the Labia Minora in the Midline)
What is the management of C. Labial Aggulutination?
- If asymptomatic - Improved Hygiene
2. Difficulty Urinating - Lubrication / Topical Oestrogen / Surgical Separation
What can cause Pathological Mucoid Discharge in Infants?
- Infections with Organisms
- Haemolytic Stroptococcal Vaginitis
- Monial Vaginitis
- Foreign Body
How is Pathological Mucoid Discharge in Infants managed?
- Culture to identify Causative Organism
- Urinalysis to rule out Cystitis
- Review Proper Hygiene
- Perianal Examination with Transparent Tape (Pinworms)
- Examination (under anaesthesia) for Foreign Body
