Adolescent gynaecology Flashcards
How is adolescent gynaecology consultations different?
family consultation - up to 3 generations ethnic minorities just father? anxieties directed at parents separate consultations
Changes happening in adolescence
psychological, sexuality, peer acceptance, individuality, decisions over future
Changes for parents in adolescence
devolve decision making
encourage independence
age of this for child varies
Gillick competence
Child under 16 can give or withhold consent if doctor feels she fully understands what is involved
sometimes parents can override decision
Important gynaelogical history to take
age of menarche, cycle, pain
sexual intercourse and contraception
weight change, exercise, sexual abuse
Clinical examination
general, breast, gynae
Tanner staging
self stage
What age to investigate primary amenorrhoea
normal 2nd sexual characteristics - 16
absent - 14
Investigations for primary amenorrhoea
FSH,LH,PRL, testosterone, oestrogen
pelvic USG
progesterone withdrawl bleed
Puberty induction
build up oestrogen - breast development
start progesterone when full height
Causes of secondary amenorrhoea
PCOS
weight
fluctuations in LH/FSH
pregnancy
PCOS treatment
weight reduction, lifestyle, OCP
Bleeding disorders
anovulation - sexual abuse, foreign body - leukaemia - pregnancy complications
Menorrhagia management
reassure and download apps
POP, tranexamic acid, mefenamic acid, COCP, mirena
Cyst accident
small cysts drawn into pelvis by gravity rupture
pain on one side of pelvis or behind and may feel a mass
vulvovaginitis
2-7 years, rule out trauma, abuse and foreign body
When will labial ahesions sort themselves out?
when oestrogen starts to be produced
Labial agglutination complications
urine and vaginal secretions retention can lead to UTI and vulvovaginitis
Managing labial agglutination
hygiene - treat if chronic vulvovaginitis or difficult urinating - lubricate labia - topical oestrogen - ?surgical separation
Why is mucoid discharge common for 2 weeks after birth?
maternal oestrogen
Managing vaginal discharge
culture - urinalysis - hygiene - perianal pinworms test - examine under anaesthesia
Adolescent transgender
gender identity confirmation
support locally
fertility preservation
support for family and school
