Introduction and EXAMINATION
Pediatric (children) and adolescent (young adults) may also admit due to gynecologic problems. According to WHO, adolescent patients are the patient group which include patients between 10 and 21 years old. Within this period, secondary sexual characteristic develop, reproductive organs become mature and psychosocial maturation also occurs. Adolescence starts in the same period as puberty , person in sexual development process gains reproduction potential in puberty.
Parents are much worried about children’s diseases but if the case in point is a gynecologic problem, concerns are much greater. Children and young adults also hesitate from gynecologic examination. Gynecologic examination is a concern of hesitation even in the communities where sexual life is more free and mentioned in education programs . Different standards of judgement may be faced even in the same communities, gynecologists and medical staff should put aside their own values and prejudices while dealing with the patient. This is much more important in relations with the younger patients. While being sensitive to their problems, being judgmental should be avoided. Actually, 3 times of gynecologic examinations are recommended in the guidelines of American Obstetrics and Gynecology Society . These regular follow up examinations allow the detection of existing developmental disorders and diseases, but more importantly, enable the adolescent adapt the gynecologic examinations psychologically and perceive it as a normal process. When the child or adolescent comes for gynecologic examination, she should be welcomed same as her father or mother does and she should not be pushed into the background. The examination starts with communication, questions which children and adolescents can answer should be directed to them first, they need to feel their selves important and that you care about them. .
In some conditions, they should even be protected from their parents. It is important to well perceive the physiologic and pathologic changes which appear in this period. Gynecologic examination should also include breast examination and evaluation of the secondary sexual character. Vaginal examination is the important part of the clinic evaluation but it is difficult to perform this examination during pre-puberty (before adolescence), because vagina has not been exposure to estrogen hormone within prepubertal period, it is short and narrow. Even small size pediatric speculums may cause pain or small injuries, injuries concerning hymen (virginal membrane) may develop, too. Vaginal examination is not required always, sometimes rectal examination (examination from anus) may be performed. It is important to keep the mother of the child in the examination environment because taking small children into the lap of the mother and giving frog-leg position provides relief. Adolescences having sexual life may generally hide it from their families, in this condition, it is important to examine the adolescence without their parents, spare more time for examination and conversation in order to make them feel comfortable and win their trust. In some conditions, postponing or delaying gynecologic examination may cause life-threatening results and cause loss of organ. Another method for gynecologic examination of the children and adolescents is performing genital examination and vaginoscopy under anesthesia. Sometimes imaging techniques should be used for diagnosis. Most common technique is abdominal USG but the patient should have enough amount of urine stored in urinary bladder for this examination. If the patient doesn’t have enough amount of urine filling and compressing in urinary bladder or she is obese (fat), rectal (from anus) USG is also another alternative. Imaging techniques other than USG are very rarely used., but especially Magnetic Resonance (MR) is very helpful in diagnosing and accepted asa gold standard in congenital cervical and gender development problems.
Gynecologic Problems of the Pediatric and Adolescent Patients
-Puberty (adolescence) problems
-Vulvovaginal discharges and infections
-Adnexal masses – ovarian cysts
-Labial fusion (adhesion of the lips)
- Family planning (contraception)
-Anomalies of genital system
- Protecting the fertility in adolescents having cancer treatment