From Pierce AM, Hart CA. Philadelphia, PA, WB Saunders, 1981, 5. The genital examination of the infant through adolescence.Curr Opin Obstet Gynecol 1993;5:753, 11. The usual cause of genital trauma during childhood is an accidental fall. If you still cannot locate a hymenal opening, the child mayhave an imperforate hymen or vaginal agenesis. After you have established a rapport with the child and taken her history,you should explain the gynecologic examination to both the child and herparent. N gonorrhoeaerarely persists beyond the newborn period without symptoms. Although anovulatory cycles are common in the years after menarche, there are established norms and, alternatively, abnormal findings that require further investigation. Examination of the Female Genitourinary System. Gynecologic Examination with Pap Smear. These procedures are usually performed under anesthesia. Learn about our mission and more, or search for opportunities to join our team. Stanford 25 YouTube Channel Abdominal Examination Examination of the Spleen (Stanford Medicine 25) Percussion of the Spleen (Stanford Medicine 25) Diagnosis Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) with Carnett's Sign - Abdominal Pain Ankle Brachial Index Ankle Brachial Index (ABI) Test: How to Perform Venous Testing Bedside Ultrasound Most young children can be examined in the frog-leg position; that is,supine with knees apart and feet touching in the midline. Vulvovaginitis is the most common gynecologic problem in prepubertal girls. The history shouldassess the child's growth and development; signs of puberty such as breastdevelopment, axillary hair, pubic hair, growth spurt, and leukorrhea; genitaltrauma; vaginal discharge; and a history of foreign body insertion. Online Teaching Videos - Department of Urology Constipation or bladder problems can present as pelvic pain, so I also ask patients about bowel habits and urinary symptoms. It's also not true that the pelvic exam is a "test" to see if you are a virgin. Begin the procedure with relevant elements of the general pediatric exam,including height and weight and examination of the thyroid, neck, breasts,lungs, heart, and abdomen. Thefinding of genital herpes type 2 is a strong indication of sexual abuse.Coexisting primary oral and genital herpes type 1 may occur in young children,but a finding of type 1 in the genital area alone should prompt an evaluationbecause this is more likely to be acquired by abuse.14Trichomonaswill rarely cause symptoms in the newborn period and spontaneously resolveswith waning of estrogen levels. At the end of the examination, use your fingerto "milk" the vagina and assess for discharge or, very rarely,polypoid tumors. In perimenarchal girls, the vagina is 8 cm long, andthe vaginal mucosa and hymen are thicker. It is important to give the child a sense that she will be in control of the examination process. The child is told to have her abdomen sag into the table. Emphasize setting the stage to make the examinationa positive experience for your young patient. Promoting the Culture of Bedside Medicine, Promoting Inclusive Care at the Patient Bedside, The Significance of Small Gestures at the Patient Bedside, Through a Patients Eyes: Physicians Reflect on Personal Illness, Physical Exams and Clinical Observations Related to Cardiovascular Health, Combat Physician Burnout with the Joy of Bedside Medicine, Physical Exam Techniques to Support and Promote Womens Health, How Physicians Go Above and Beyond to Promote Patient Healing, How to Address Monumental Patient Conversations, The Importance of Cultural Competence in Bedside Medicine, How Physicians Can Help Promote Early Detection of Prostate Cancer, 7th Time's a Charm: The 2022 Stanford 25 Skills Symposium, Communication Strategies to Help Physicians Lead Meaningful Patient Conversations, Bringing Tidings of Comfort and Joy to the Patient Bedside, Registration is Now Open for the 2021 Stanford Medicine 25 Skills Symposium, Medscape Article Highlights Need for Physical Exam Training & Assessment, The Resurgence of Bedside Teaching During the Pandemic, The Presence 5 for Racial Justice: Promoting Anti-Racism in Clinical Interactions, Dr. Vergheses Rules for the Bedside Exam, Bringing Human Connection to the Forefront of Medicine in a Technological Era, Five Practices to Strengthen the Physician-Patient Relationship, Telehealth Tips to Preserve Key Aspects of Patient Care, How AI Can Improve the EHR and Bedside Medicine, Bedside Teaching is a Powerful Learning Tool in the ICU, Thoughtful Implementation of Machine Learning Can Help Physicians Improve Patient Care, Register Now for the 5th Annual Stanford 25 Skills Symposium, Cultivating The Golden Minute at the Bedside, Four Physicians Describe the Synergy Between Technology and Bedside Medicine, Artificial Intelligence and the Gift of Physician Time, Compassion: A Powerful Tool for Improving Patient Outcomes, The Physical Exam Remains an Effective Tool for Physicians, Learning from the Bedside at the 5th Annual Stanford 25 Bedside Teaching Symposium, Physicians Can Protect the Human Connection in Medicine, A Diagnosis of Nelson's Syndrome and Why You Won't See it Anymore.