Cleveland Clinic reexamines syphilis testing strategies after rise in cases. ObstetGynecol 1971;37:462, 13. Discuss the results of the examination and your diagnosis andmanagement plan with the child and her parents after she is dressed. Am J Obstet Gynecol1987;157:950, 6. The second phase of the examination involves evaluation of the vagina . When a child has vaginal discharge or bleeding andthe source (such as a foreign body) is not obvious, obtain samples for cultureand saline preparation. The majority of cases of persistent or recurrent nonspecific vulvovaginitis respond to improved hygiene and treatment of irritation resulting from trauma or irritating substances. The device is commercially availableas the Pediatric Vaginal Aspirator from Cook Ob/Gyn (Spencer, IN.). Asking the child whether anyone hasever touched her in a way that made her feel uncomfortable often is helpfulin drawing out this information. In preadolescent girls, both benign and malignant ovarian tumors are usually unilateral. You may need a pelvic exam sooner if you are experiencing problems with your period or have other symptoms, including: Pain in your lower abdomen or pelvic area. This is to help girls understand that there is a doctor dedicated to their reproductive health. A discharge that is both bloody and purulent is likely not from vulvovaginitis but from a foreign body (see Vaginoscopy for Prepubertal Bleeding without Signs of Puberty later in this chapter), although patients infected with some pathogens, particularly Shigella boydii, often present with a bloody or blood-tinged discharge . You can also ask the child to cough in order todistract her and cause her hymen to open. Bacterial vaginosis during pregnancy may lead to increased risks for preterm birth, preterm delivery, and spontaneous abortion, according to new research in the Archives of Gynecology and Obstetrics. Viscous lidocaine and warmsaline for irrigation through an IV set-up may be helpful when examininga child who has an acute straddle injury and bleeding. The first aspect of the pelvic examination is evaluation of the external genitalia ( Fig. Videos - Hopkins Medicine When this intervention fails, there should be greater suspicion of bacterial colonization; in this case a reasonable approach is the use of broad-spectrum oral antibiotics such as amoxicillin or trimethoprim/sulfamethoxazole given for 10 to 14 days. The work-up for vaginal bleeding includes a careful inspection of thevulva and vagina, wet preparation and bacterial cultures, and cultures forsexually transmitted infections if indicated. A complete vaginal evaluation should never be performed under duress or by force; to avoid this, sedation can be used when performing this examination on children. Without continuation of the hygiene measures, however, broad-spectrum antibiotics will only offer temporary relief and the problem is likely to recur ( ). 11 mins, 28 secs. The relative size ratio of cervix to uterus is 2:1 in a child. Labial adhesions, also common, usually are asymptomaticand are more likely to be noticed by a parent or found on routine pediatricexamination. Often reassurance and sometimes delay until another day are the best approaches.
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