Paediatric and Adolescent Gynaecology

Question 1

Which guideline covers giving contraceptive advice to girls under 16yrs?

Answer 1

Fraser guideline

Question 2

Describe the changes that occur during normal puberty

Answer 2

• Growth accelerates and secondary sexual characteristics appear
• Endocrine onset appears several years before physical changes are visible
• Initial pulsatile increase in LH secretion from the pituitary gland
• These pulses stimulate a rise in estradiol levels
• The physical changes are described

Question 3

What changes occur during adolescence?

Answer 3

• Psychological/behavioural
• Hormonal change
• Independence
• Peer acceptance
• Decisions over future

Question 4

What should be asked about in the history?

Answer 4

-Age of menarche
-Cycle
-Pain
-Sexual activity
-Contraception
-Weight gain/loss
-Exercise
(remember sexual abuse)

Question 5

What is precocious puberty?

Answer 5

The appearance of secondary sexual characteristics before the age of 8 in girls and 9 in boys

Question 6

What is delayed puberty?

Answer 6

• Boys have no signs of testicular development by age 14

- Girls have not started to develop breasts by age 14 or have not started their period by age 15

Question 7

What are the features of vulvovaginitis?

Answer 7

• Persisten vulval irritation or vaginal discharge
• Peak age: 3-7
• Yellow green offensive discharge and vaginal soreness and itching

Question 8

What are the causes of vulvovaginitis?

Answer 8

• Poor perineal hygiene
• Lack of oestrogen
• Chemical irritation: bubble baths and detergents

Question 9

Which symptoms raise a suspicion of a foreign body?

Answer 9

• Vaginal bleeding

- Persistent foul smelling discharge refractory to treatment

Question 10

What are the features of labial adhesions?

Answer 10

• Peak incidence: first year of life
• Thin membranous line in the midline where the tissues fuse
• Diagnosis can be made on examination

Question 11

How can labial adhesions be treated?

Answer 11

• Oestrogen therapy

- Surgical separation: only if urinary symptoms and oestrogen therapy has failed

Question 12

Which treatment is the mainstay in menorrhagia in adolescents?

Answer 12

Combined oral contraceptive pill

Question 13

How can menorrhagia be treated?

Answer 13

• Progesterone only pill
• TXA
• Mefenamic acid
• COCP
• Mirena

Question 14

How can dysmenorrhoea be treated?

Answer 14

Anti prostaglandin - mefenamic acid or COCP

Question 15

Which investigations should be done for amenorrhoea before referral?

Answer 15

• FSH, LH, PRL and TSH
• Testosterone and oestrogen
• Pelvic USS

Question 16

How can puberty be induced?

Answer 16

• Gradual build up with oestrogen

- Add progesterone once max height potential is reached

Question 17

What are the causes of secondary amenorrhoea?

Answer 17

• Weight
• PCOS
• Pregnancy
• Fluctuating LH/oestrogens

Question 18

How can polycystic ovaries be diagnosed and treated?

Answer 18

• FSH and LH
• USS
• Weight reduction and lifestyle changes
• Oral contraceptive pill

Question 19

How can endometriosis be treated?

Answer 19

• NSAIDs
• Oral contraceptive
• Diagnostic laparoscopy

Question 20

Which conditions can cause vaginal discharge?

Answer 20

-Infection
-Haemolytic streptococcal vaginitis
-Foreign body
(Normal for two weeks after birth)

Question 21

How can vaginal discharge be managed?

Answer 21

• Culture
• Urinalysis to rule out cystitis
• Review proper hygiene
• Perianal exam with tape to test for pinworms
• Examination under anaesthesia if persistent to rule out foreign body