The major factor in childhood vulvovaginitis is poor perineal hygiene. The most common gynecologic condition of children is vulvovaginitis . Adolescents often come for examinations with the preconceived idea that it will be very painful. Employee communication. Often reassurance and sometimes delay until another day are the best approaches. Palpate the abdomen for masses and the inguinal areasfor a hernia or gonad. Emphasize that the most important part of the examination is just looking and that there will be conversation during the entire process. Philadelphia, PA, WB Saunders, 1981, 5. Macleod's Physical Examination - Head, Eyes and Ears Examination - OSCE Guide 2017. After inspection of the vagina and cervix, vaginal secretions may be obtained for microscopic examination and culture (the technique is described later). There often are predisposing factors that lead to vulvar irritations, such as the use of perfumed soaps or the pressure from tight seams of jeans or tights, which create denudation, allowing the rectal flora to easily infect the irritated epithelium. Instructing patients to use nonmedicated, nonscented wipes rather than toilet paper may prevent the self-inoculation of the vagina with small pieces of toilet paper, which can initiate a chronic discharge. If you put your stethoscope over this, what will you hear? It is important to give the child a sense that she will be in control of the examination process. Physiologic leukorrheacan be confused with vulvovaginitis. These procedures are usually performed under anesthesia. Host virtual events and webinars to increase engagement and generate leads. What questions should PNPs consider related to womens health? Asking the child whether anyone hasever touched her in a way that made her feel uncomfortable often is helpfulin drawing out this information. Topics for the pediatric nurse practitioner to be aware of. Prepubescent Female Genital Examination Images: Evidence - PubMed It's also not true that the pelvic exam is a "test" to see if you are a virgin. Over the last decade, however, the management of ovarian masses has shifted toward a more conservative approach with the goal of ovarian preservation. Many gynecologic conditions in children can be diagnosed by inspection alone. Routine gynecologic examinationof infants and children can help prevent future health problems such asvulvovaginitis by giving the clinician the opportunity to educate parentsabout perineal hygiene.1 During the annual genital inspection,the pediatrician also may discover such significant abnormalities as clitoromegaly,signs of early puberty, vulvar dermatoses, or rarely hymenal or vaginaltrauma. Vaginoscopy is a diagnostic procedure that can be used to evaluate the inside of the vagina and is recommended for girls who are too young for a speculum exam or cannot tolerate one. It is recommended that the examination start with the nongenital areas , such as listening to the heart and lungs; an abdominal examination and inspection of the skin should be performed. If you identify and remove a foreign body, recommend that the child takesitz baths for two weeks. Genital Exam - Male (Pre- or Early Puberty) - Nationwide Children's A complete examination includes inspection of the external genitalia,visualization of the vagina and cervix, and rectoabdominal palpation. In this setting it may be helpful to use the extinction phenomenon, in which the examiner provides pressure on the perineum lateral to the introitus before insertion of the speculum.