Paediatric and Adolescent Gynaecology Flashcards
How is adolescent gynaecology different?
- Usually a family consultation
- Can be 3 generations present
- Sometimes just with father
- Ethnic minorities- child may speak English but parents do not
- Often anxieties about confidentiality
- Consultation often directed at Parents
- Sometimes separate consultations
What types of changes do adolescents do through?
- Psychological changes
- Developing sexuality and individuality
- Independence from parents
- Peer acceptance
- Making decisions about their futures
What changes do parents go through as their children grow up?
- Devolve decision making
- Encourage independence
- Age of child at which this happens varies with families
- May not be consistent
What is Gillick competence?
- Child <16 years can give/withhold consent if doctor feels they fully understands what is involved in an intervention
- Can sometimes be overridden by parents
What does Fraser competence refer to?
Contraceptive advice to under 16 year old girls
What are the components of Fraser competence?
- Mature enough to understand advice and implications of treatment
- Girl likely to begin or continue to have sex with or without treatment
- Doctor tried to persuade girl to inform her parents or to allow her/him to inform them
- Girl’s health would suffer without treatment/advice
- In girl’s best interests to give treatment or advice
What is important to gather in a gynaecological history?
DEVELOP RAPPORT FIRST
- Age of menarche
- Cycle
- Pain
- Sexual activity
- Contraception
- Weight gain/loss
- Exercise
Beware of sexual abuse
What is included in examination?
NEVER ON FIRST VISIT
- General
- Gynaecological
- Breast
How can girls stage themselves (puberty)?
Using a Tanner staing system
What is amenorrhoea?
Absence of menstrual period
What are the 2 forms of primary amenorrhoea?
Primary amenorrhoea and normal secondary sexual characteristics
-Investigate at age 16
Primary amenorrhoea and absent secondary sexual characteristics
-Investigate at age 14
What investigations should be carried out for amenorrhoea prior to referral?
- FSH, LH, PRL, TSH, testosterone, oestrogen
- Pelvic USG
What are the causes of a progesterone withdrawal bleed?
- Pregnancy
- Not enough oestrogen
How can puberty be induced?
- Gradual build up of oestrogen (high dose will cause misshapen breasts)
- Breast will start to develop
- Add progesterone once maximum height is reached and at at least 20mg of oestrogen dose
What are some causes for secondary amenorrhoea?
- Weight
- PCOS
- Pregnancy
- Fluctuating LH/ oestrogens
What is PCOS?
A syndrome of ovarian dysfunction along with the cardinal features: hyperandrogenism and polycystic ovary morphology
What can the diagnosis of PCOS be made of the basis of?
2 out of 3
- Oligo or anovulation
- Clinical or biochemical signs of hyperandrogenism
- Polycistic ovaries o US or direct inspection
How can PCO in adolescents be treated?
- Weight reduction and lifestyle changes
- OCP
How are polycystic ovaries diagnosed?
- FSH:LH
- TAS USS
For how long is anovulation normal?
Normal for 2-4 years after post-menarche
What bleeding disorders may impact menstruation?
Up to 10-20%
- Von willebrand
- Platelet defects
- Leukaemia
What is the treatment for menorrhagia?
- Reassure
- Talk to the girls directly
- Progesterone only pill
- Tranexamic Acid 1g qds
- Mefenamic Acid
- Combined Oral Contraceptive
- Mirena
- Treatment can be for months to years.Stop and see!
- App
What are small ovarian cysts usually?
Functional or dermoids
How can ovarian cysts get injured?
- Gravity allows them to drop to lowest point in the pelvis
- Can then tort, turn gangrenous or rupture
- Often subacute history
- Usually tender to one side of pelvis or behind uterus and may feel a mass
Who is vulvagintis common in?
Aged 2-7
What are the causes o vulvovagintis?
- Wetting pants
- Other irritants
- Sexual abuse
What does treatment of vulvovagnitis include?
Toilet training
How does labial agglutination present?
- Adhesion of the labia minora in the midline is the usual presentation.
- This vertical line of fusion distinguishes labial agglutination from imperforated hymen or vaginal atresia.
- The agglutination encourages retention of urine and vaginal secretions and can lead to vulvovaginitis or urinary tract infection.
How is labial agglutination managed?
- If a symptomatic, improved hygiene may be all that is necessary.
- Treatment is indicated if there is a chronic vulvovaginitis or difficulty urinating.
- Lubrication of the labia with a bland ointment.
- Topical estrogen.
- Surgical separation is rarely necessary.
What may unusual vaginal discharge be the result of?
Infection
When is a mucoid discharge common in infants/children?
- Common in infants for up 2 weeks after birth; it result from maternal oestrogen.
- Common finding in prepubertal girls, who experience increased oestrogen production by maturing ovaries.
What may pathological discharge be due to?
- Infections with organisms, such as E.coli, Proteus, Pseudomonas.
- Hemolytic streptococcal vaginitis.
- Monial vaginitis.
- A foreign body.
How is pathological discharge managed?
- Culture to identify causative organisms.
- Urinanalysis to rule out cystitis.
- Review proper hygiene.
- Perianal examination with transparent tape to test for pinworms.
- In cases of persistent discharge, examination under anesthesia is indicated to rule out foreign body
Who is labial reduction not performed in?
Under 18s
