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 to under 16s:
- Mature enough to understand advice & implications of treatment
- Likely to continue/begin sex regardless of treatment
- GP has tried 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; 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
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!
What physical changes are seen during puberty?
- Growth accelerates
- Secondary sexual characteristics appear
- Initial increase in secretion of LH from pituitary gland- due to increase in estradiol
Tanner stages
DO NOT EXAMINE- show cards
How to take a history for teen?
1- Rapport!!!
o Ask about school
o Hobbies
o Tell them you aren’t necessarily going to have to examine them
2- Gynaecological
o Age of menarche
o Cycle
o Pain
3- Sexual
- In absence of parents
- sexual activity
- contraceptive
4- weight gain/loss
5- exercise
Examination
General o bone abnormality o Weight o Acne Breast o Show them chart
Gynaecological
o Rarely done
o If done has to be done under anaestetic
what are precocious and delayed puberty?
Precocius puberty
Precocious puberty is defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys
Delayed puberty
• boys have no signs of testicular development by 14 years of age
• girls have not started to develop breasts by 13 years of age, or they have developed breasts but their periods have not started by 15
Common pathologies seen in clinic?
- Vulvovaginitis
- Foreign body
- Labial adhesions
- Amennorhea
- Bleeding disorders
- Vaginal discharge
What is vulvovaginitis?
Presentation:
•yellow-green offensive discharge
•vaginal soreness and itching.
•On inspection the vulva has a typical appearance with a red ‘flush’ around the vulva and anus
Aetiology:
- Lack of oestrogen
- chemical irritation
- Poor hygiene
Foreign body presentation and treatment?
Presentation:
- Vaginal bleeding
- Persistant foul smelling discharge
Treatment:
- Examination UNDER anaestetic
- removal
Presentation and treatment of labial adhesions?
- Thin membranous line in mid-line where tissue fuse
- Urethra is size of a pinhole
What is mennorragia?
HEAVY BLEEDING
- Anovulatory periods
- Irregular periods- Normal for first 2 years whilst hypothalamic-pituitary-ovarian axis establishes regular cycles
Treatment for mennoragia?
- Reassure
- Talk to the girls directly
- progesterone only pill- first line of treatment
- Tranexamic Acid 1g qds
- Mefenamic Acid
- Combined Oral Contraceptive
- Mirena
- Length of treatment???
- Usually for months or years? Stop and see!
- App
What is dysmenorrhea?
PAINFUL PERIODS
What is the main cause of dysmennhea?
How to treat?
- Higher levels of prostaglandins
- OCP and anti-prostaglandins
