Paediatric and Adult Gynaecology

Question 1

how is adolescent gynaecology different to adult?

Answer 1

fam consultation
child may speak english but not parients
anxiety about confidentiality

Question 2

what are the changes during puberty for the child?

Answer 2

psychological changes
developing sexuality
independence from parents
peer acceptance
decisions over future

Question 3

what are the changes during puberty for the parent?

Answer 3

devolve decision making
encourage independence
age of the child varies
may not be consistent

Question 4

what is Gillick competence?

Answer 4

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

Question 5

what is Fraser competence in regards to?

Answer 5

contraceptive advice to under 16 year old girls

Question 6

what is Fraser competence

Answer 6

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

Question 7

gynaecological Hx: gynaecological

Answer 7

age of menarche
cycle
cycle
pain

Question 8

gynaecological Hx: sexual (in absence of parents)

Answer 8

sexual activity

contraception

Question 9

gynaecological Hx: general

Answer 9

weight gain/loss
exercise
remember sexual abuse
develop rapport with patient first

Question 10

examination of adolescent gynae

Answer 10

General
Breast
Gynaecological
Do not examine in the first visit

Question 11

what is primary amenorrhoea?

Answer 11

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.

Question 12

investigations to perform prior to referral about primary amenorrhoea

Answer 12

• FSH, LH, PRL, TSH, testosterone and
oestrogen
• Pelvic USS
• Progesterone withdrawal bleed
o Pregnancy
o Not enough oestrogen

Question 13

how could you induce puberty in a girl?

Answer 13

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

Question 14

causes of secondary amenorrhoea

Answer 14

weight
PCOS
pregnancy
fluctuating LH/oestrogens

Question 15

what is PCOS?

Answer 15

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.

Question 16

name a criteria for PCOS

Answer 16

rotterdam consensus workshop

Question 17

bleeding disorders in asolescent gynae

Answer 17

• 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

Question 18

treatment of menorrhagia in adolescent gynae

Answer 18

• 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

Question 19

cysts in adolescent gynae

Answer 19

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.

Question 20

age for vulvovaginitis (paeds)

Answer 20

2-7 yrs

Question 21

causes of vulvovaginitis in children

Answer 21

trauma
sexual abuse
foreign body
urinary incontinence

Question 22

treatent of vulvovaginitis in children

Answer 22

potty training

removal

Question 23

long term implications of vulvovaginitis in children

Answer 23

none

Question 24

labial adhesions: what needs to be done

Answer 24

none if girl can pee

will sort during puberty

Question 25

labial adhesions: clinical picture

Answer 25

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.

Question 26

labial adhesions, management

Answer 26

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.

Question 27

vaginal discharge in adolescents: clinical picture

Answer 27

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.

Question 28

pathological causes of vaginal discharge in adolescents

Answer 28

infections with e.colim proteus, pseudomonas
haemolytic streptococcal vaginitis
monial vaginitis (fungal)
foreign body

Question 29

mangement of vaginal discharge in adolescents

Answer 29

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