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Gynecologic examination of the newborn and child

Authors
Marc R Laufer, MD
S Jean Emans, MD
Section Editors
Leonard E Weisman, MD
Teresa K Duryea, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Gynecologic evaluation of the prepubertal child is approached by directing attention to the specific complaint or question to be answered [1]. Educating the child and her family prior to this examination is important both for their reassurance and for gaining their trust. Inspection of the genital region should follow a focused general examination. Knowledge of normal prepubertal anatomy and use of accurate nomenclature are essential for describing and documenting anatomic findings (figure 1).

Gynecologic examination of newborns and children will be reviewed here. Evaluation of common vulvovaginal complaints in these patients is discussed separately. (See "Overview of vulvovaginal complaints in the prepubertal child".)

INDICATIONS

Examination of external genitalia is a normal part of the routine physical examination. This examination is discussed in detail elsewhere. (See "The pediatric physical examination: The perineum", section on 'Genitourinary system'.)

Assessment of the vulva, hymen, and vagina for signs of vaginal discharge is performed visually without the use of instruments. Visualization of the vagina, which is internal to the hymenal ring, in children typically requires instruments. It is performed under anesthesia for genitourinary complaints that cannot be addressed with external evaluation or in situations of suspected genitourinary pathology. These may include vaginal bleeding, persistent discharge, trauma, cystic or solid masses, suspected congenital anomalies, or acute sexual abuse with a penetrating injury.

HISTORY AND PHYSICAL EXAMINATION

General guidelines — The medical history is obtained from both the child, if possible, and her parent(s) or legal guardian. Prior to the examination, she should be told the reason for the office evaluation. A prior traumatic incident or examination can cause girls to become apprehensive and uncooperative. The provider should explain why examination of this area is needed and how the examination will be performed, including whether swabs or lights will be used. Allowing her to maintain some control of the environment is also important. As an example, she can be offered the opportunity to select the gown that she will wear and to view the light source (otoscope, magnifying glass, or direct light).

           
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Literature review current through: Oct 2017. | This topic last updated: Feb 24, 2017.
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References
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