GYNAECOLOGICAL PROBLEMS IN CHILDREN AND ADOLESCENT Flashcards
What is the earliest point at which gynaecological care may begin for a girl child?
Gynaecological care may begin in the delivery room with detection of obvious pathology during routine newborn examination.
What handling considerations are crucial for the vulva in children and adolescents?
There should be minimal handling of the vulva except when absolutely indicated.
What are the four classifications of gynaecological disorders in children and adolescents?
Congenital anomalies, premenarcheal disorders, sexual maturation disorders, and disorders affecting sexuality.
List examples of congenital anomalies of the genital tract.
Labial anomalies, clitoral anomalies, imperforate hymen, vaginal anomalies, uterine anomalies, ovarian anomalies, and ambiguous genitalia.
What is an imperforate hymen?
A condition where the hymen completely covers the vaginal opening.
What are the common symptoms of urethral mucosal prolapse?
Increased urinary frequency, dysuria, urinary retention, bloody discharge, and painful vulva.
What is the management for urethral mucosal prolapse?
Management includes pain relief with warm sitz baths, applying oestrogen cream, and in severe cases, surgical intervention.
What is adhesive vulvitis, and what are its causes?
A condition where irritation of the labia(labia minor) induces scratching and ulcerations, leading to labial adhesion; associated with low oestrogen levels.
What are the clinical findings in adhesive vulvitis?
Dysuria, urinary retention, and recurrent vulval infections in symptomatic cases; asymptomatic cases often resolve spontaneously.
How is adhesive vulvitis treated?
Treatment involves applying oestrogen cream, digital separation, or surgical intervention if severe.
What are the major changes during puberty?
Major changes include development of secondary sexual characteristics, reproductive system maturation, and accelerated skeletal growth.
Define thelarche and its usual onset age range.
Thelarche is the development of breasts, typically starting between 8.5 and 13.5 years.
Describe Tanner staging for breast development.
Tanner staging ranges from Stage 1 (preadolescent) to Stage 5 (full adult breast size).
What is adrenarche, and which hormones are involved?
Adrenarche involves adrenal secretion of DHEA, DHEAS, and androstenedione, contributing to pubic and axillary hair growth.
Explain Tanner staging for hair development.
Tanner staging of hair development goes from no terminal hair (Stage 1) to adult distribution and quantity (Stage 5).
What is gonadarche, and how does it begin?
Gonadarche begins with pulsatile secretion of GnRH, leading to LH and FSH release and ovarian follicular development.
What changes occur during gonadarche?
Increases in oestradiol initiate breast development, vaginal and uterine growth, and skeletal growth, eventually leading to menarche.
Define menarche and its usual onset age range.
Menarche is the onset of menstruation, usually between ages 10 and 16.
Define precocious puberty.
Early appearance of secondary sexual characteristics, generally before age 8.
What are the classifications of precocious puberty?
Classified as gonadotrophin-dependent (true) or gonadotrophin-independent (pseudo), among others.
List possible causes of precocious puberty.
Causes include idiopathic factors, hypothalamic tumors, infections, and ovarian or adrenal lesions.
What investigations are carried out for precocious puberty?
Tests for hormones like FSH, LH, oestradiol, imaging studies, and thyroid function.
How is precocious puberty treated?
Treatment includes counseling and addressing the specific cause.
What is dysmenorrhoea, and what causes it?
Painful menstruation caused by elevated prostaglandin levels in the endometrium.
What is leukorrhoea, and how is it managed?
Vaginal discharge, physiological or pathological, managed with reassurance and counseling.
What are preventive measures against STDs?
Prevention involves counseling, barrier methods, and limiting sexual partners.
What are common causes of congenital genital anomalies?
Genetic mutations, developmental abnormalities, and maternal hormonal exposure.
What is clitoromegaly, and what causes it?
Enlargement of the clitoris, often due to excessive androgen exposure.
What are transverse vaginal septum and longitudinal vaginal septum?
Transverse vaginal septum: horizontal wall; Longitudinal vaginal septum: vertical partition.
What is ambiguous genitalia?
a rare birth defect that occurs when a baby’s external genitals are not clearly male or female
What is the usual treatment for imperforate hymen?
Surgical incision and drainage.
What are signs of vulvovaginitis in children?
Itching, redness, and foul-smelling discharge.
What are the common foreign bodies found in the genital tract of children?
Paper, toilet tissue, or small toys.
How does urethral prolapse differ from urethral caruncle?
Urethral prolapse: circumferential eversion; caruncle: partial eversion of distal urethra.
What age group is most commonly affected by urethral prolapse?
Typically affects children aged 3–11 years.
What are the common benign tumours found in the genital area of children?
Hemangiomas, retention cysts, and condyloma acuminata.
What is lichen sclerosus, and how is it managed?
Lichen sclerosus is a chronic inflammatory skin condition affecting the vulva; it is managed with topical corticosteroids and monitoring for potential complications.
What are the stages of Tanner breast development?
Tanner stages for breast development range from Stage 1 (no breast development) to Stage 5 (full adult breast size and form).
What are the stages of Tanner pubic hair development?
Tanner stages for pubic hair development range from Stage 1 (no terminal hair) to Stage 5 (adult quantity and distribution).
What is the first measurable sign of puberty?
Pulsatile LH secretion during sleep is the first measurable sign of puberty.
What is the role of oestradiol during puberty?
Oestradiol triggers breast development, fat distribution, vaginal and uterine growth, and rapid skeletal growth.
What is the average age for menarche?
The average age for menarche is 13.5 years.
How does societal influence affect adolescent health?
Societal influences such as peer pressure and social media can affect adolescent risk-taking behaviors and health outcomes.
What is pseudo-precocious puberty, and how does it differ from true precocious puberty?
Pseudo-precocious puberty occurs without GnRH stimulation, often due to peripheral hormonal sources, unlike true precocious puberty.
What is the significance of juvenile hypothyroidism in precocious puberty?
Juvenile hypothyroidism can cause isosexual precocious puberty due to excessive TSH production acting on FSH receptors.
What imaging studies are used for investigating precocious puberty?
Imaging studies like pelvic ultrasound and MRI help investigate causes of precocious puberty.
What are common management strategies for psychological problems in adolescents?
Psychological problems in adolescents are managed through counseling, behavioral therapy, and support groups.
What is the pathogenesis of primary dysmenorrhoea?
Primary dysmenorrhoea results from elevated prostaglandin F2α levels, leading to uterine hypercontractility and cramping.
What differentiates physiological from pathological leukorrhoea?
Physiological leukorrhoea is a normal discharge before menarche, while pathological leukorrhoea is associated with infections.
What are the clinical signs of STDs in adolescents?
Clinical signs of STDs in adolescents include abnormal discharge, genital sores, and pelvic pain.
What is the management approach for vulval injuries in children?
Management of vulval injuries in children includes wound cleaning, pain relief, and addressing underlying causes like trauma.
What are the clinical features of labial adhesions?
Clinical features of labial adhesions include difficulty with urination, recurrent infections, and sometimes dysuria.
How is labial adhesion treated?
Labial adhesion treatment involves oestrogen cream application, manual separation, or surgical correction if necessary.
What is the role of GnRH in puberty?
GnRH initiates puberty by stimulating the pituitary to release LH and FSH, which promote gonadal activity.
What are the effects of elevated LH and FSH during puberty?
Elevated LH and FSH stimulate ovarian follicle development and oestradiol production during puberty.
What is the Tanner stage associated with menarche?
Menarche typically occurs during Tanner Stage 3 or 4 of breast development.
What factors influence the timing of puberty?
Timing of puberty is influenced by genetics, nutrition, and environmental factors.
What are the types of ovarian anomalies?
Types of ovarian anomalies include agenesis, hypoplasia, and cystic malformations.
What are the common causes of delayed sexual maturation?
Common causes of delayed sexual maturation include constitutional delay, chronic illnesses, and hormonal imbalances.
What is the typical treatment for delayed sexual maturation?
Delayed sexual maturation is treated with hormone therapy or addressing underlying medical conditions.
What are the psychological impacts of delayed puberty?
Psychological impacts of delayed puberty include low self-esteem, anxiety, and social withdrawal.
What are the social challenges faced by adolescents with gynaecological problems?
Adolescents with gynaecological problems face social challenges like stigma, lack of awareness, and limited access to care.
What is the role of hormonal therapy in managing adolescent gynaecological problems?
Hormonal therapy manages conditions like delayed puberty, precocious puberty, or menstrual irregularities.
What are the common causes of genital injuries in children?
Common causes of genital injuries in children include accidental trauma, sexual abuse, or foreign body insertion.
How can gynaecological care improve outcomes for adolescent girls?
Gynaecological care improves outcomes by addressing physical, emotional, and reproductive health needs early.
