Screening Adolescent Gynecology in the Pediatrician's Office: Have a Listen, Take a Look

Abstract

1. Robert M. Cavanaugh Jr, MD* 1. *Professor of Pediatrics; Director of Adolescent Medicine, SUNY Upstate Medical University, Syracuse, NY After completing this article, readers should be able to: 1. Explain the importance of screening gynecology in adolescent girls. 2. Delineate the essential components of screening gynecology in adolescent girls. 3. Describe when and how to perform sexually transmitted disease testing on adolescent girls. 4. Discuss how to counsel adolescent girls on sexuality-related issues. Pediatricians are in an ideal position to screen for common gynecologic problems in adolescents without ever performing a pelvic examination. Much information can be gathered by reviewing the menstrual history, addressing any sexuality concerns as they arise, and investigating specific gynecologic symptoms as they occur. A routine breast examination and simple external inspection of the genitalia should be considered essential components of the regular health supervision visit for adolescent girls. A more complete pelvic examination is not necessary unless a specific indication exists, as outlined in Table 1. The purpose of this article is to discuss important asymptomatic gynecologic conditions that can be detected readily in the pediatrician's office and for which a speculum or bimanual examination usually is not required. | Menstrual Disorders | || | Abnormal vaginal discharge | | Suspected pelvic inflammatory disease | | Unexplained abdominal pain | | Pregnancy-related care | | Suspected sexual abuse | | Unexplained frequency, urgency, or pain with urination | | Routine cervical cancer screening | | Others as specifically indicated | * ↵* Once screening is initiated, adolescents should be screened annually. Special considerations may apply, as noted in the Laboratory Investigation section of the text. Table 1. Indications for a Complete Pelvic Examination in Adolescents The gynecologic history-taking for adolescents should include questions regarding common menstrual problems, sexuality-related concerns, and specific genitourinary complaints. These and other sensitive issues should be addressed privately with the examiner, unless the patient specifically requests otherwise. Use of a self-administered questionnaire or checklist may expedite the process. Questions about current medications must be direct and very specific because many adolescents do not consider oral contraceptives, hormonal injections, …