Adolescent GYN

Question 1

What is adolescence?

Answer 1

• transition from childhood to adulthood marked by numerous physical, mental, and emotional milestones.

Question 2

When does ACOG recommend that girls see their first GYN visit?

Answer 2

age 13-15 for Hx, physical, and screening tests

Question 3

What history aspects are important?

Answer 3

• menarche and menstrual Hx
• ROS: complete and concentrating on vaginal, urinary, and GI symptoms.
• family Hx
• personal and family relationships
• fitness and nutrition Hx

Question 4

What screening tests should we do?

Answer 4

• STI (chlamydia/gonorrhea can be tested from a urine sample. HIV, PRP and hepatitis from blood draw).
• PAP starting at age 21.
• Labs (depending on clinical presentation): CBC, ferritin, thyroid, hormonal levels, thrombophilia testing, von willebrand’s levels…
• pelvic ultrasound

Question 5

Is herpes including in screening tests?

Answer 5

No, because most over 80% of population is exposed to HSV I

Question 6

What recommendations and counseling should we provide to adolescents?

Answer 6

• HPV vaccine
• breast self awareness
• injury prevention
• dietary and fitness guidance
• reproductive and sexual health
• peer pressure and high risk behaviors
• self esteem

Question 7

What are some common conditions in adolescent girls?

Answer 7

• heavy menstrual bleeding and dysmenorrhea (pain)
• irregular menses
• PCOS
• vaginal and vulvar infections
• contraception and LARC (long acting reversible contraception).
• STIs
• puberty concerns

Question 8

Can a confidential conversation with a teen patient (by law) happen without disclosure to the parent?

Answer 8

YES, however the gynecologist should still review with the parent or guardian that a confidential conversation was done, in order to facilitate communication between the two, and encourage the patient to involve the parent in their health care.

Question 9

What are Pennsylvania’s laws about minors?

Answer 9

minors may consent to:

• contraceptive services
• STI serves
• prenatal care
• adoption
• medical care for minor’s child
• abortion services

Question 10

What are some consequences of menstrual disorders?

Answer 10

• iron deficiency anemia
• missed days form school
• absence at activities and sports
• depression
• athletic energy deficiency

Question 11

Is it normal for girls undergoing puberty have a white, clear annoying discharge?

Answer 11

YES

Question 12

What are 2 common opportunistic vaginal infections in teens?

Answer 12

• yeast= thick pasty discharge that is itchy

- bacterial vaginosis= slimy yellow foul smelling (fishy) discharge and less itchy than yeast. This is NOT an STI.

Question 13

What is atopic dermatitis and what could cause this in a young girl?

Answer 13

burning of the vulva with itching, burning, tickling, ecchymosis (discoloration of the skin resulting from bleeding underneath) and fissures, due to reactions to soaps, detergents, bubble baths, excessive washing, lufas…

Question 14

What should you do after treating a girl for chlamydia with the appropriate antibiotic?

Answer 14

test of cure should be done in 3-4 months to insure that the drug of choice worked.

Question 15

Are long acting reversible contraceptives (LARCs) recommended as a first line agent for young girls?

Answer 15

YES bc the compliance rate is better with a lower failure rate.

Question 16

What is a common complaint with the arm implant (flexible plastic devices no large than a match stick) LARCs?

Answer 16

irregular bleeding that occurs for 2-3 weeks at a time.

*these work by suppressing ovulation and thicken cervical mucous. Lasts 3 years. No risk of bone demineralization.

Question 17

What are the 2 types of intrauterine devices (IUDs)?

Answer 17

1. hormonal with levonogestrel (Mirenea)
2. copper, non-hormonal (Paraguard)
   * both small T shaped devices that are inserted in the uterus with thin strings tied at the bottom of the stem that hang through the cervix for removal.

Question 18

What is a common complaint of IUDs?

Answer 18

can cause spotting and cramping for 3-6 months after insertion.

Question 19

Is it required for a woman to have undergone a pregnancy in order to receive an IUD?

Answer 19

not anymore :)

Question 20

How long can the copper IUD be effective?

Answer 20

up to 10 years!

*just make sure pt doesn’t have a sensitivity to copper.

Question 21

What is a benefit for some pts with the Mirena hormonal IUD?

Answer 21

no periods at all

Question 22

What should we try to encourage our young ladies to do in the office?

Answer 22

wait until 18 to have sex. Remind them that the more partners, the more life time risk of STI and unintended pregnancy.

Question 23

What are some signs of sexual abuse?

Answer 23

• anxiety and depression
• change in school performance
• becoming withdrawn or acting out
• bedwetting
• frequent visits to the school nurse

Question 24

What are the sexual abuse sequelae?

Answer 24

• drug use and abuse
• early onset sexual activity
• eating disorders, obesity
• cutting
• long term physical and emotional complications

Question 25

Can HPV transmission occur without intercourse?

Answer 25

YES via skin to skin contact. Educate pts of this and that clinically genital HPV has no signs or symptoms. Most people’s immune systems will clear the infection.

Question 26

What is gender identity?

Answer 26

• refers to an individual’s intrinsic sense of being female, male, or gender nonconforming (not fully male/female).

Question 27

What is sexual orientation?

Answer 27

refers to the sex of the person to whom an individual is attracted (gay, straight, lesbian, bisexual).
*this is NOT related to gender identity

Question 28

What is transgender?

Answer 28

• having a gender identity that is a different form of the sex you were assigned at birth (biological sex).

Question 29

What is cisgender?

Answer 29

term used to describe people whose gender identity is the same as the sex they were assigned at birth.