9.1 Paeds Adolescent Gyne Flashcards
is labial agglutination common?
Yes 3% of prepubertal girls
DDx of labial agglutination if no midline Raphe ?
- Imperforate hymen
- Disorder of sexual differentiation
Labial agglutination Rx?
Reassurance
Labial agglutination, manual separation?
Not recommended, 40% recurrence
Labial agglutination treatment?
Oestrogen cream plus moituriser
Vulvovaginal itch/soreness
What questions important?
How long Discharge Colour Odour Bleeding?
Vulvovaginal itch/soreness PMhistory ?
URTI
Eczema, dermatitis, atopy
Vulvovaginal itch/soreness irritants?
Soaps Bubble baths Irritants Underwear Leotards, tights Hygiene
DDx of vulvovaginitis?
Bacterial Threadworms Dermatoses Chrohn’s Ectopic ureter Sexual abuse
Vulvovaginal itch/soreness foreign body usually?
Toilet paper
Vulvovaginal itch/soreness, swab when?
Only if discharge present
Vulvovaginal itch/soreness examination, how to approach?
External genitalia
Swab if discharge
Check elbows, scalp
Vaginoscopy if bleeding occurred
Vulvovaginal itch/soreness most common reason?
Non specific inflammation
Management of Vulvovaginitis?
Perineal hygiene Cotton underpants Barrier creams Reassurance Vinegar baths dilute Abx after swab
Lichen sclerosis
Whitening of skin, ecchymoses and petechaie haemorrhage,
doesn’t involve vagina
Why important to carefully dx Lichen sclerosis?
Lifetime steroids
Risk of vulvocarcinoma
When girls get Lichen sclerosis?
Age 5-7
Lichen sclerosis what kind of condition?
Autoimmune
Lichen sclerosis after menarche?
75% improvement usually
Lichen sclerosis Rx??
0.05% betamethasone for 6-12/52 until resolution then low potency for 3/12
Dysmenorrhea, commonest cause?
Prostaglandin mediated from the shedding endometrium
When do you get lethargy in Dysmenorrhea?
Typically with onset of menses, not preceding it
Mx of Dysmenorrhea?
-NSAIDS
Maybe with paracetamol or codeine
-COCP
What to think of if Dysmenorrhea and refractory symptoms?
Endometriosis
Abdo/pelvic ultrasound
Adolescent menorrhagia, how to assess?
- How often changing tampon/pads
- flooding (nocturnal)
- missed school
- FHx
Adolescent menorrhagia most common cause?
Anovulation
Bleeding disorders
Pelvic pathology is uncommon
Adolescent menorrhagia investigations?
FBE Platelets Iron studies Coags -Preg Chlamydia PCR Pelvic US
Adolescent menorrhagia anovulation common causes?
Unopposed oestrogen due to immature hypothalamus pituitary ovarian axis
-takes up to 3 years to establish cycles
Adolescent menorrhagia other causes that affect HPO axis?
Chronic illness Eating disorders Sporting Drug abuse Thyroid
Most common cause of Adolescent menorrhagia bleeding disorders?
- Platelets
- Von Willebrand disease
- involve haematologist
Adolescent menorrhagia dose for tranexemic acid?
1g QID
NSAIDS for Adolescent menorrhagia?
Not in acute setting but can reduce later on by 30%
Adolescent menorrhagia hormone treatment?
COCP, prolonged extended cycles
key points for discussion of periods for daughter with developmental delay
individualise
open discussion
booklet
options for mentrual management in developmental delayed girls?
do nothing simple analgesia COCP Mirena - more and more surgery: last resort need court
implanon /depo provera for menstrual mangement of girls with developmental delay?
not ideal
overweight adolescent with irregular periods and hirsutism what ask in hx?
PCOS
DMII
overweight adolescent with irregular periods and hirsutism what ask in Ix?
pelvic U/S
Bloods: testosterone, 17 OH progesterone, androstenedione, DHEAS, LH, FSH, SHBF
-fasting insulin/glucose
-TSH
management of PCOS?
- lifestyle is mainstay
- weight loss
- menstrual regulation
- insulin sensitizers
- treat hyperandrogenism
PCOS pharmaco options?
- COCP with monthly withdrawal
- COCP with 3rd gen progesterone/cyproterone acetate
- Metformin
pelvic pain with amenorrhoea, may or may not be cyclical, think what dx?
imperforate hymen
imperforate hymen how diagnosis? treatment?
ultrasound
surgery
who to think of for imperforate/incomplete hymenal obstruction
14-16 year olds with well developed secondary sex characteristics, not having periods
adnexal masses presents how?
- increase abdo girth
- Urinary symptoms
- constipation,
- pelvic pain
- lower abdo fullness/heaviness/pressure - dysparunia
- irregular periods
adnexal masses broad categories?
- hormone secreting
non-hormone - solid/cystic
physiological ovarian cysts? 2 main
- functional fluid filled (follicles that fail to ovulate)
2. Corpus luteum: possible bleeding into it
ovarian cysts increase risk of
torsion
ovarian masses management
- monitoring
- laparoscopic over drainage
- cystectomy vs. oophrectomy
sudden onset severe abdominal pain ddx?
- appendicitis: more CRP, WBC?
2. ovarian torsion: bloods and urine NAD, guarding, no rebound
classic ovarian torsion symptom onset?
sudden onset pain, nausea, vomiting, low grade fever
