Adolescent Gynaecology Flashcards
Define Gillick Competence?
Child <16yrs is able to give/withhold consent if the doctor feels she fully understands an intervention and it’s risks
It can be overridden by parents in some circumstances
Define Fraser Competence?
Refers specficially to giving contraceptive advice/prescription:
- Mature enough to understand advice & implications of treatment
- Likely to continue/begin sex regardless of treatment
- Attempted to persuade to tell parents (or let you tell them)
- Health would suffer without treatment/advice
- In their best interest
At what age do you investigate Primary Amenorrhoea as abnormal?
16 if normal 2* sex characteristics
14 if not
What tests can you do for 1* amenorrhoea?
FSH, LH, PRL, TSH, Test & oestrogen
Pelvic US
Progesterone withdrawal bleed
How do you induce puberty?
Gradually build up Oestrogen
Add progesterone once max height potential reached (and on atleast 20mg of oestrogen)
Causes for 2* amenorrhoea in adolescents?
- Weight (Anorexia)
- PCOS
- Pregnancy
- Fluctuating LH/oestrogens
What bleeding disorders are common in adolescence?
Amenorrhoea (common periodically for 1st 2 years)
Pregnancy
Coagulation disorders e.g. vWs
Leukaemia
How do you manage menorrhagia in adolescants?
Reassure
PoP
Tranexamic Acid
Mefenamic Acid
cOCP
Mirena (LNG-IUS)
Who gets vulvovaginitis and why?
2-7yr olds
Often due to infection or labial agglutination (adhesion of labia minora in midline)
How do you manage labial agglutination?
- Hygiene
- Lubrication
- Topical Oestrogen
- Surgical separation (rarely)
How do you manage infection in vulvovaginitis?
- Culture (E. Coli, Proteus, Pseudomonas)
- Urinalysis (rules out cystitis)
- Hygiene
- Perianal exam with tape for pinworms
- Exam UA if persistant discharge to rule out foreign body
Also always remember to test teens for!
Chlamydia!
