Paediatric and Adult Gynaecology Flashcards
Definition of the Gillick Competence
Child < 16 years can give/withhold consent if the doctor feels that they are fully understanding of what is involved in an intervention
Definition of Fraser Competence
A doctor can prescribe contraception/give contraceptive advise to a girl <16 y/o if
- mature enough to understand advise and the implications of treatment
- girl likely to begin or continue to have sex with or without treatment
- doctor try to get her to inform parents or allow him to inform them
- girls health would summer without treatment/advise
- in the girls best interests to give treatment/advise
When to investigate primary amenorrhoea
Normal secondary sexual characteristics - investigate at age 16
Absent secondary sexual characteristics - investigate at age 14
Investigations prior to referral for amenorrhoea
FSH, LF, PRL, TSH, testosterone, oestrogen
Pelvic USG
Progesterone withdrawal bleed (pregnancy, not enough oestrogen)
Cyclical abdominal pain
Puberty induction treatment
Gradual build up of oestrogen (until stopped growing so breast shape is not altered)
Then add progesterone once the max height potential is reached
Secondary amenorrhoea definition
Had periods before and now they have stopped
Causes of secondary amenorrhoea
Weight gain (obstructed uterus)
PCOS
Pregnancy
Fluctuating LH/oestrogens
Menorrhagia definition
Heavy periods
Possible treatments of menorrhagia
POP Tranexamic acid Medenamic acid COC Mirena (usually when cant take pills)
Length of treatment in a patient for menorrhagia
A year or so then come off it as it will have settled down
Presentation of accidents to cysts
Subacute history
Usually tender to one side of the pelvis or behind
Uterus may feel a mass
Vulvovaginitis causes
Foreign body (e.g. toys)
Playing with genitals
Sexual abuse
Urinary incontinence
Age that you would get vulvovaginitis
2-7 years old
Labial agglutination definition
Adhesion of labia minora in midline (usually)
Presentation of labial agglutination
Vulvovaginitis
Retention of urine
Retention of vaginal secretions
UTI
Treatment of labial agglutination
Improve hygiene may all be thats needed
treatment indicated if chronic vulvovaginitis or difficulty urinating
lubrication of labia with a bland ointment
topical oestrogen
surgical separation (rarely necessary)