Paediatric and Adult Gynaecology Flashcards
What is Gillick Competence?
Method used the medical law to determine whether a child is able to consent to his/her medical treatment , without the need for parental permission or knowledge.
What is the Fraser guideline?
Fraser guidelines specifically relate to contraception and sexual health.
A doctor can give contraceptive advice and treatment to a girl under 16 if they are satisfied on the following matters:
The girl will understand his advice
He cannot persuade her to inform her parents or allow him to inform the parents.
She is very likely to continue having sexual intercourse with or without contraceptive treatment.
Unless she receives contraceptive advice or treatment her physical or mental health are likely to suffer.
Her best interests require him to give her contraceptive advice, treatment or both without the parental consent.
What changes occur during normal puberty?
Growth accelerates and secondary sexual characteristics appear.
Endocrine onset begins several years before physical changes are visible.
Increase in pulsatile secretion of LH from pituitary gland in response to increase in pulsatile GnRH from hypothalamus at night.
Stimulates a rise in estradiol levels.
Physical changes are progressive and described as tanner stages.
What are the Tanner stages for Boys?
Stage 1 - prepubertal
Stage 2 - Enlargement of scrotum and testes, scrotum skin reddens and changes in texture.
Stage 3 - enlargement of penis and further growth of testes.
Stage 4 - Increased size of penis and development of glans, testes and scrotum larger and scrotum skin darker.
Stage 5 - Adult genitalia
What are the Tanner stages for Girls?
Stage 1 - Prepubertal
Stage 2 - Breast bud stage with elevation of the breast and papilla, enlargement of the areola.
Stage 3 - further enlargement of the breast and areola, no separation of their contour.
Stage 4 - Areola and papilla form secondary mound above the level of breast.
Stage 5 - Mature stage - projection of the papilla only, in relation to recession of the areola.
What is precocious puberty?
The appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys.
What is delayed puberty?
Boys have no signs of testicular development by 14 yrs.
Girls have not started to develop breasts by 13 yrs or they have developed breast but their periods have not started by 15yrs.
What is Vulvovaginitis?
Infection or inflammation of the vulva and vagina.
Presents with yellow-green offensive discharge and vaginal soreness and itching.
Typical red flush around vulva and anus.
What are some causes of Vulvovaginitis?
Poor perineal hygiene
Lack of oestrogen
Chemical irritation - bubble baths, detergents.
What symptoms may raise suspicions of a foreign body?
Vaginal bleeding
Persistent foul smelling discharge refractory to treatment.
What are labial adhesions?
Clearly visible thin membranous line in the mid-line where the tissues fuse. The urethra may just be a pinhole opening.
Most children are asymptomatic.
When should vaginal examinations be carried out when there is suspected adolescent menstrual dysfunction?
Only performed on consenting adolescents who are sexually active and only when it is likely to add value to the assessment.
What is menorrhagia?
Troublesome periods that may be too frequent, irregular and heavy.
Von Willebrand disease and immune thrombocytopenic purpura need to be excluded if present with menorrhagia that is refractory to simple treatments.
Combined oral contraceptive pill is main treatment.
POP, tranexamic acid, mefenamic acid, mirena are also other options.
What is dysmenorrhea?
Pain during menstruation.
attributed to higher levels of prostaglandins so anti-prostaglandin drugs e.g mefenamic acid can be helpful.
Combined oral contraceptive pill is also effective.
What is primary amenorrhoea?
Failure of menstruation by the age of 16yrs in the presence of normal secondary sexual characteristics, or 14yrs in absence of other evidence of puberty.
