Paediatric and Adult Gynaecology Flashcards
how is adolescent gynaecology different to adult?
fam consultation
child may speak english but not parients
anxiety about confidentiality
what are the changes during puberty for the child?
psychological changes developing sexuality independence from parents peer acceptance decisions over future
what are the changes during puberty for the parent?
devolve decision making
encourage independence
age of the child varies
may not be consistent
what is Gillick competence?
Children under 16 years can give/withhold consent if the doctor feels she fully understands what is involved in an intervention. In certain situations, parents can override girls wishes. Do not make big decisions without seeking others advice
what is Fraser competence in regards to?
contraceptive advice to under 16 year old girls
what is Fraser competence
If the girl is mature enough to understand advice and implications of treatment. The girl is likely to begin or continue to have sex with or without treatment. The doctor has tried to persuade girl to inform her parents or to allow her/him to inform them. The girl’s health would suffer without treatment/advice. it is in the girl’s best interests to give treatment or advice
gynaecological Hx: gynaecological
age of menarche
cycle
cycle
pain
gynaecological Hx: sexual (in absence of parents)
sexual activity
contraception
gynaecological Hx: general
weight gain/loss
exercise
remember sexual abuse
develop rapport with patient first
examination of adolescent gynae
General
Breast
Gynaecological
Do not examine in the first visit
what is primary amenorrhoea?
With primary amenorrhoea and normal secondary sexual characteristics investigate at age 16. With primary amenorrhoea and absent secondary sexual characteristics then investigate at age 14.
investigations to perform prior to referral about primary amenorrhoea
• FSH, LH, PRL, TSH, testosterone and oestrogen • Pelvic USS • Progesterone withdrawal bleed o Pregnancy o Not enough oestrogen
how could you induce puberty in a girl?
There is a gradual build up with oestrogen which has an effect on breast development. Add
progesterone once maximum height potential is reached. If you give progesterone early, then breast
shape with be altered. At least 20mg of oestrogen dose
causes of secondary amenorrhoea
weight
PCOS
pregnancy
fluctuating LH/oestrogens
what is PCOS?
PCOS is syndrome of ovarian dysfunction along with the cardinal features hyperandrogenism and
polycystic ovary morphology. No single diagnostic criterion is sufficient. The diagnosis of PCOS can be
made on the basis of two out of three of the following:
• Oligo or anovulation
• Clinical or biochemical signs of hyperandrogenism
• Polycystic ovaries on USS or direct inspection
Other causes of hyperandrogenism should be excluded.
name a criteria for PCOS
rotterdam consensus workshop
bleeding disorders in asolescent gynae
- Anovulation – majority (normal for up to 2-4 years post-menarche
- Be aware of other factors e.g. sexual abuse
- Bullying, trauma etc
- Pregnancy complications
- Bleeding disorders ?up to 10-20%
- E.g. Von Willebrand’s, platelet defects
- Leukaemia
treatment of menorrhagia in adolescent gynae
- Reassure
- Talk to the girls directly
- Progesterone only pill
- Tranexamic acid 1g qds
- Mefenamic acid
- COC
- Mirena
- Length of treatment
- Usually for months or years – stop and see
- App
cysts in adolescent gynae
Small cysts are often functional or dermoids. Gravity allows them to drop to lowest point in the pelvis. They 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.
age for vulvovaginitis (paeds)
2-7 yrs
causes of vulvovaginitis in children
trauma
sexual abuse
foreign body
urinary incontinence
treatent of vulvovaginitis in children
potty training
removal
long term implications of vulvovaginitis in children
none
labial adhesions: what needs to be done
none if girl can pee
will sort during puberty
labial adhesions: clinical picture
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 UTI.
labial adhesions, management
If asymptomatic, 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 oestrogen. Surgical separation is rarely necessary.
vaginal discharge in adolescents: clinical picture
A mucoid discharge is common in infants for up to 2 weeks after birth as a result from maternal oestrogen. It is also a common finding in prepubertal girls, who experience increased oestrogen production by maturing ovaries.
pathological causes of vaginal discharge in adolescents
infections with e.colim proteus, pseudomonas
haemolytic streptococcal vaginitis
monial vaginitis (fungal)
foreign body
mangement of vaginal discharge in adolescents
Mostly conservative:
• Culture to identify causative organisms
• Urinalysis to rule out cystitis
• Review proper hygiene
• Perianal examination with transparent tape to test for pinworms
• In cases of persistent discharge examination under anaesthesia is indicated to rule out foreign body
