Adolescent gynaecology

Question 1

How is adolescent gynaecology consultations different?

Answer 1

family consultation - up to 3 generations 
ethnic minorities 
just father?
anxieties 
directed at parents 
separate consultations

Question 2

Changes happening in adolescence

Answer 2

psychological, sexuality, peer acceptance, individuality, decisions over future

Question 3

Changes for parents in adolescence

Answer 3

devolve decision making
encourage independence
age of this for child varies

Question 4

Gillick competence

Answer 4

Child under 16 can give or withhold consent if doctor feels she fully understands what is involved
sometimes parents can override decision

Question 5

Important gynaelogical history to take

Answer 5

age of menarche, cycle, pain
sexual intercourse and contraception
weight change, exercise, sexual abuse

Question 6

Clinical examination

Answer 6

general, breast, gynae

Question 7

Tanner staging

Answer 7

self stage

Question 8

What age to investigate primary amenorrhoea

Answer 8

normal 2nd sexual characteristics - 16

absent - 14

Question 9

Investigations for primary amenorrhoea

Answer 9

FSH,LH,PRL, testosterone, oestrogen
pelvic USG
progesterone withdrawl bleed

Question 10

Puberty induction

Answer 10

build up oestrogen - breast development

start progesterone when full height

Question 11

Causes of secondary amenorrhoea

Answer 11

PCOS
weight
fluctuations in LH/FSH
pregnancy

Question 12

PCOS treatment

Answer 12

weight reduction, lifestyle, OCP

Question 13

Bleeding disorders

Answer 13

anovulation - sexual abuse, foreign body - leukaemia - pregnancy complications

Question 14

Menorrhagia management

Answer 14

reassure and download apps

POP, tranexamic acid, mefenamic acid, COCP, mirena

Question 15

Cyst accident

Answer 15

small cysts drawn into pelvis by gravity rupture

pain on one side of pelvis or behind and may feel a mass

Question 16

vulvovaginitis

Answer 16

2-7 years, rule out trauma, abuse and foreign body

Question 17

When will labial ahesions sort themselves out?

Answer 17

when oestrogen starts to be produced

Question 18

Labial agglutination complications

Answer 18

urine and vaginal secretions retention can lead to UTI and vulvovaginitis

Question 19

Managing labial agglutination

Answer 19

hygiene - treat if chronic vulvovaginitis or difficult urinating - lubricate labia - topical oestrogen - ?surgical separation

Question 20

Why is mucoid discharge common for 2 weeks after birth?

Answer 20

maternal oestrogen

Question 21

Managing vaginal discharge

Answer 21

culture - urinalysis - hygiene - perianal pinworms test - examine under anaesthesia

Question 22

Adolescent transgender

Answer 22

gender identity confirmation
support locally
fertility preservation
support for family and school