Paediatric and Adolescent Gynaecology Flashcards
What is the Gillick competence?
Child <16 years can give/withold consent if doctor feels she fully understands what is involved in an intervention
What information is it important to ask about in a gynaecological history?
Age of menarche Cycle Pain Sexual activity and contraception Weight loss/gain Exercise
At what age would you investigate primary amenorrhoea and normal secondary sexual characteristics?
16
At what age would you investigate primary amenorrhoea and absent secondary sexual characteristics?
14
What investigations should be done before referral?
FSH, LH, PRL, TSH, testosterone and oestrogen
Pelvic USS
Progesterone withdrawal bleed
How can puberty be induced?
Gradual build up with oestrogen
Add progesterone once maximum height potential is reached
At least 20mg oestrogen dose
How are polycystic ovaries diagnosed in adolescents?
Diagnose on FSH:LH
How can polycystic ovaries be managed in adolescents?
Weight reduction and lifestyle changes
Oral contraceptive pill
What cane the cause of some bleeding disorders within gynaecology?
Anovulation Sexual abuse, bullying, trauma Pregnancy complications Von Willebrands Platelet defects Leukaemia
What is the adolescent treatment for menorrhagia?
Progesterone only pill Tranexamic acid Mefenamic acid Combined oral contraceptive pill Mirena
What is the usual presentation of accidents to cysts?
Tender to one side of the pelvis or behind uterus
May feel mass
How do cysts become problematic?
Gravity allows them to drop to their lowest point in the pelvis
Can tort, turn gangrenous and rupture
What is the common age range for vulvovaginitis?
2-7 years
What are the causes of vulvovaginitis?
Yeast Poor hygiene STI Chemical allergens (soap etc) Parasites Bacteria
What are the symptoms of vulvovaginitis?
Vaginal discharge Dryness Soreness Itching Dysuria Bleeding
How is vulvovaginitis treated?
Vaginal creams, suppositories, ointments
Good hygiene
Antibiotics
What causes labial adhesions?
Low levels of oestrogen
Vulvar irritation from harsh soaps, wet nappies or trauma
What are the symptoms of labial adhesions?
Can be asymptomatic
Pain in the genital area
Difficulty urinating
Frequent UTIs
What is the treatment for labial adhesions?
Emollient
Gentle separation
Oestrogen cream
Surgery
What can cause mucoid discharge in children?
Infections with organisms (E coli, proteus, pseudomonas)
Haemolytic streptococcal vaginitis
Monial vaginitis
Foreign body
What is the management for mucoid discharge in children?
Culture to identify organism
Urinalysis to rule out cystitis
Perianal examination
