Genital Examination Findings Research Articles

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Where does postmenopausal dyspareunia hurt? A cross-sectional report.

A common symptom of genitourinary syndrome of menopause (GSM) is dyspareunia, attributed to vulvovaginal atrophy. Our objective was to systematically describe the pain characteristics and anatomic locations of tenderness in a cohort with moderate/severe dyspareunia likely due to GSM. This cross-sectional study reports the baseline data of postmenopausal women with dyspareunia screened for an intervention trial of topical estrogen. Postmenopausal women not using hormone therapy who had moderate or severe dyspareunia were eligible if estrogen was not contraindicated. Biopsychosocial assessments were performed using the Vulvar Pain Assessment Questionnaire, and participants underwent a systematic vulvovaginal examination that included a visual assessment and cotton swab testing for tenderness rated using the Numerical Rating Scale (0-10). Vaginal pH and mucosal sensitivity were assessed; pelvic floor muscles and pelvic viscera were palpated for tenderness. Fifty-five eligible women were examined between July 2017 and August 2019. Mean age was 59.5 ± 6.8 years, and duration of dyspareunia was 6.2 ± 4.3 years. The mean intercourse pain score was 7.3 ± 1.8, most often described as "burning" and "raw." Ninety-eight percent had physical findings of vulvovaginal atrophy. Median pain scores from swab touch at the vulvar vestibule (just outside the hymen) were 4 to 5/10, and topical lidocaine extinguished pain. Median vaginal mucosal pain was zero. Participants described their pain as "burning" and "dry." Tenderness was most severe and most consistently located at the vulvar vestibule. Correlating the symptom of dyspareunia with genital examination findings may further our understanding of treatment outcomes for GSM.

Circumcision requirement in children with phimosis: immediately or elective?

Objective: Phimosis is define as unretractable prepuce and has two different clinical presentation; pathological (PaP) and physiological. Physiological phimosis (PhP) is a common condition in children that does not require treatment. In our study, we aimed to determine the actual requirement for circumcision in patients with phimosis who were recommended circumcision.
 Material and Methods: Children who were offered circumcision due to phimosis between July 2019 and January 2020 and applied to the pediatric surgery and pediatric urology outpatient clinic were included in the study. They were evaluated in terms of referring physicians, genital examination findings and requirement for circumcision.
 Results: Between the study dates, 199 patients applied for circumcision due to phimosis. 126 patients are under one year old, 73 patients are over one year old. PhP was present in 194 of the patients and PaP in 5 of them. While PaP is not detected in patients under one year of age, there are 5 patients with PaP over one year of age (2%). There was no requirement for urgent circumcision in any of the patients. Genital examination revealed incidentally undescended testicle in 3 patients and hydrocele in 12 children.
 Conclusion: Male genital system examination and pathological findings are not well known by physicians. We think that there is a need for detailed training for physicians regarding PhP and childhood testicle pathologies.

A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa.

ObjectiveMedical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa.MethodsThis was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities.FindingsDuring the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8–13 year olds. Median age was 15 years (IQR: 12–23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8–13, 14–18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8–13 years (OR = 5.9; 95% CI = 4.8–7.1) and 14–18 years (OR = 1.9; 95% CI = 1.5–2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4–2.7).ConclusionThe high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries.

Multidisciplinary approach to the management of children with female genital mutilation (FGM) or suspected FGM: service description and case series

ObjectiveTo describe the first dedicated clinic in the UK for children with suspected or confirmed female genital mutilation (FGM) including referral patterns, clinical findings and subsequent management.Design and settingA prospective...

Study of prevalence of sexually transmitted infection in patients with symptoms of urinary tract infection

Introduction: Urinary tract infections are commonly encountered in day to day practice of a general practitioner.The purpose of this study is to determine if there is an association between urinary tract infections (UTI) and sexually transmitted infections (STI), as both may present with similar symptoms.
 Methods: This was a hospital based, prospective observational study in 104 women of 18 to 49 years age group, done during a period of six months at Patan hospital. Urinalysis results and genital examination findings were recorded.STI was defined as a vaginal swab positive for Trichomonas vaginalis(TV)/Neisseria gonorrhoeae (NG)/Chlamydia trachomatis(CT).UTI was defined as urinary WBC >=6per high power film. A urine c/s >105 colonies of a single pathogen was considered urine culture positive.
 Results: Mean age of patients was 28.38 years. The most prevalent organism was TV (6/104, 5.8%), followed by NG(4/104,3.8%) and CT(2/104, 1.2%). 11.5% of women had STI , while 57.7% were urine culture positive. Out of those with urine culture positive, 83.3% had urinary WBC<30/hpf , and 16.7% had urinary WBC> 30/hpf. The relation between pyuria and urine c/s positivity was significant ( p value 0.005). The prevalence of STI in urine c/s positive group was 13.3%, and in urine c/s negative group was 9.1% ( p value 0.553).
 Conclusion: There was no statistically significant difference in the prevalence of STI between urine culture positive and negative groups.

An important topic in medical education: Multidisciplinary approach to a sexual assault case in the emergency clinic

Alcohol related sexual violence is an important public health problem. However, there is a few research conducted on this problem in Turkey. The purpose of this case report is to compose a scientific approach in the view of literature. We report an alcohol related sexual assault case for presenting adequate approach to these cases according to current guidelines. The victim was 17 years old female adolescent diagnosed and treated in the emergency service. The patient was hospitalized in the Child and Adolescent Psychiatry Service after emergency treatment in the Pediatric Emergency Medicine and Intensive Care Unit. A review and discussion of alcohol related sexual assault case is presented, and also multidisciplinary diagnosis and treatment approach is offered for this entity. The blood alcohol level of the patient was 410 mg/dL, Glasgow coma scale (GCS) was seven and body temperature was 35°C in the emergency service. Whole body examination findings revealed physical assault and also genital examination findings confirmed sexual assault. It should be remembered that delay in diagnosis and treatment of cases may lead to significant health problems in the victims of sexual assault. Also assessing sexual assault cases, especially in emergency services needs to integrate assessments of different social and medical disciplines. Thus, latest guidelines for the evaluation of sexual abuse of children in emergency services must be learned by medical students and physicians. J. Exp. Clin. Med., 2014; 31:63-65

Practice changes in childhood surgery for ambiguous genitalia?

ObjectiveIn 2001, this team published an observational study of the clinical outcomes of a cohort of adolescent girls born with ambiguous genitalia. The poor outcomes observed represented a major scientific challenge to the standard practice of childhood feminising genital surgery. That publication was one of several contributing to a call for change in surgical practice, which culminated in the publication of the Chicago Consensus Document in 2006. The aim of this current study was to repeat the same evaluation of clinical outcomes on a recent cohort of adolescent girls and compare the two cohorts to identify differences in adolescent outcomes which may indicate a change in paediatric surgical practice. MethodsThis was an observational study of a current cohort of adolescent girls treated in childhood for ambiguous genitalia and referred to a specialist adolescent disorders of sex development (DSD) service for assessment. Data were collected on surgical history, genital examination findings and treatment recommendations for 30 consecutive adolescents over a 5-year period. Findings were compared with those of a similar cohort of adolescent girls published over a decade previously. ResultsClitoral surgery remained common (93% vs 100%, current cohort vs historical cohort). However, concomitant vaginoplasty was performed less frequently (80 vs 100% current vs historical). Vaginoplasty revision surgery was also less commonly required (65 vs 81%), although 24% of the recent cohort still required major revision surgery prior to intercourse. There was some improvement to the cosmetic outcomes as deemed by the surgical team using the same criteria as the previous report. ConclusionsThis study provides some slight evidence of recent practice change. There was a small reduction in the number of vaginoplasties performed in childhood and an improvement in vaginoplasty outcomes and cosmesis. However, there was no identifiable change in management of clitoromegaly and the numbers of clitoral reduction operations remained high. This is surprising given the clear evidence of a detrimental impact of surgery on clitoral sensation and sexual function.

An Unusual Cause of Anuria and Hydronephrosis in a 12-Year-Old Girl

A 12-year-old girl was admitted for abdominal pain and signs of acute kidney injury. Physical examination showed abdominal distension and a tumefaction in the lower abdomen. Laboratory and clinical findings were consistent with acute kidney injury. Abdominal ultrasonography showed an oval mass, which corresponded with hematometrocolpos, and right-sided hydronephrosis. Catheterization followed by cruciate hymenectomy was performed. The patient recovered completely. Imperforate hymen is an obstructive anomaly of the female reproductive tract of unknown etiology that can cause a variety of symptoms. It is a rare, but possible cause of acute kidney injury. Patient history data and genital examination findings are sufficient to establish the diagnosis. Abdominal ultrasonography is the most useful diagnostic modality.

Male tolerance of ACIDFORM gel

Background ACIDFORM gel is being studied as a vaginal contraceptive and microbicide. This study was conducted to make certain that males will not be subjected to an unacceptable risk of penile irritation as a result of exposure to the product in future studies. Methods This was a randomized, double-masked, single-center Phase I study in circumcised and uncircumcised men to assess penile irritation, safety and acceptability of seven consecutive doses of ACIDFORM gel compared with K-Y ® Jelly Personal Lubricant. Each participant was instructed to apply 2 mL of the study product to his penis at bedtime, to wash it off 6–10 h later and to record any symptoms on a diary card. At the follow-up visit, a genital examination was performed and participants were asked about adverse events (AEs) and completed an acceptability questionnaire. Results Of the 36 men enrolled, 2 out of 24 (8.3%) ACIDFORM gel users and 5 out of 12 (41.7%) K-Y Jelly users reported genital symptoms. Genital examination findings were observed in 2 out of 24 (8.3%) ACIDFORM gel users and in 1 out of 12 (8.3%) K-Y Jelly users. All product-related AEs were considered mild except for two in the K-Y Jelly group. Both products were acceptable. Conclusion ACIDFORM gel applied to the penis for seven consecutive days appears to be at least as safe and well-tolerated as the marketed lubricant K-Y Jelly among healthy low-risk men.

Genital examinations for alleged sexual abuse of prepubertal girls: findings by pediatric emergency medicine physicians compared with child abuse trained physicians

Objective: This study compares abnormal genital examination findings made by pediatric emergency medicine (PEM) physicians to examinations by physicians with training in child sexual abuse in the evaluation of prepubertal girls for suspected sexual abuse. Method: A prospective study was performed following the genital examination by a PEM physician of prepubertal girls suspected of being sexually abused. A physician with training in child sexual abuse re-examined those girls whose examinations were interpreted as abnormal by the PEM physicians. The findings and interpretations of the PEM physician were then compared to those by the physicians with training in child abuse. Results: Between October 1994 and October 1998, 46 patients diagnosed by PEM physicians with nonacute genital findings indicative of sexual abuse were re-examined by a physician with training in child abuse. The follow-up examinations were done 2 days–16 weeks (mean 2.1 weeks) after the emergency department visit. The physicians with training in child abuse concluded that only eight of these children (17%) showed clear evidence of abuse. Normal findings were noted in 32 children (70%), nonspecific changes were noted in 4 children (9%), and 2 children (4%) had findings that are more commonly seen in abused children than nonabused children but are not diagnostic for abuse (concerning for abuse). Conclusions: There was poor agreement between the pediatric emergency medicine physicians and the physicians with training in child sexual abuse. This study suggests that emergency medicine physicians should consider additional training in this area. In addition, all children with abnormal ED examinations should have follow-up examinations by a child abuse trained physician.

Genital injury: is it significant? A review of the literature.

The purpose of this review was to critically evaluate the available literature on genital injury in order to facilitate an understanding of its significance in relation to sexual offence trials. Wide variation exists in research objectives, study populations and methodology, hindering interpretation considerably. The most valuable research in this field identifies the range of normal genital findings and those associated with consensual sexual intercourse, to enable interpretation of genital findings in sexual assault victims. However, there are, unfortunately, few studies of this nature. Difficulties arise when examining doctors are not experienced in the genital examination of those other than sexual assault victims, limiting their ability to draw conclusions about genital injury if it is detected. If the methods of genital examination employed are not the same as those used to examine a wide range of non-sexual assault victims, comparison and thus valuable interpretation is further limited. This review of the literature finds that the most appropriate genital examinations and indeed the most legally valuable as far as interpretation is concerned, are done macroscopically by doctors with considerable experience in the examination of normal, diseased and traumatized genitalia, and a sound knowledge of the principles of injury interpretation. A deficiency exists in the literature in relation to macroscopic genital examination findings in consensually sexually active women who have been examined by forensically trained doctors. This deficiency must be addressed before the medicolegal significance of genital injury relating to sexual assault can be accurately interpreted, and before any decision is made to incorporate colposcopy or staining techniques into the routine assessment of sexual assault victims.

Assessments of girls genital findings and the likelihood of sexual abuse — agreement among physicians self-rated as skilled

Objectives: To measure agreement about genital examination findings among physicians who rate themselves as skilled in evaluating children for suspected sexual abuse, to compare these physicians' descriptions and interpretations with consensus standards developed by an expert panel, and to investigate the effects of physician and case characteristics on agreement. Study Design: Questionnaires including 7 simulated cases, each consisting of a brief history and 1 photograph of a girl's genitalia, were mailed to random samples of 2 groups: the members of 4 physician organizations concerned with child abuse or pediatric gynecology, and pediatricians at large. Among the surveyed physicians who rated their own skill in evaluating cases of suspected sexual abuse as higher than average, we measured agreement, both overall and between those with the most and with less clinical experience, and assessed their conformity with consensus standard descriptions and interpretations. Results: We received responses from 548 (50.9%) of 1076 physicians; 414 responses (75.5%) were analyzable. Two hundred six physicians (50%) rated themselves as skilled in assessing children for sexual abuse. On average, 45% of these physicians' descriptions and 72.6% of their interpretations conformed with the consensus standards. In 4 cases, between 5% and 20.7% of these physicians described genital findings that the expert panel had considered absent from the photographs. Conformity with standard interpretations tended to be higher in cases with photographs concordant with the accompanying, unambiguous histories ( P =.06). The most experienced physicians resembled the expert panel more closely than did the less experienced self-rated skilled physicians in interpreting 3 simulated cases ( P ≤.001). Conclusions: Assessments of girls' genital findings by physicians who rate themselves as skilled in examining children for suspected sexual abuse often differ. In some cases, among physicians who all rate themselves as skilled, assessments made by very experienced physicians may conform more closely to consensus standards than do assessments made by less experienced physicians. Arch Pediatr Adolesc Med. 1997;151:883-891

Assessments of girl's genital findings and the likelihood of sexual abuse: agreement among physicians self-rated as skilled.

To measure agreement about genital examination findings among physicians who rate themselves as skilled in evaluating children for suspected sexual abuse, to compare these physicians' descriptions and interpretations with consensus standards developed by an expert panel, and to investigate the effects of physician and case characteristics on agreement. Questionnaires including 7 simulated cases, each consisting of a brief history and 1 photograph of a girl's genitalia, were mailed to random samples of 2 groups: the members of 4 physician organizations concerned with child abuse or pediatric gynecology, and pediatricians at large. Among the surveyed physicians who rated their own skill in evaluating cases of suspected sexual abuse as higher than average, we measured agreement, both overall and between those with the most and with less clinical experience, and assessed their conformity with consensus standard descriptions and interpretations. We received responses from 548 (50.9%) of 1076 physicians; 414 responses (75.5%) were analyzable. Two hundred six physicians (50%) rated themselves as skilled in assessing children for sexual abuse. On average, 45% of these physicians' descriptions and 72.6% of their interpretations conformed with the consensus standards. In 4 cases, between 5% and 20.7% of these physicians described genital findings that the expert panel had considered absent from the photographs. Conformity with standard interpretations tended to be higher in cases with photographs concordant with the accompanying, unambiguous histories (P=.06). The most experienced physicians resembled the expert panel more closely than did the less experienced self-rated skilled physicians in interpreting 3 simulated cases (P< or =.001). Assessments of girls' genital findings by physicians who rate themselves as skilled in examining children for suspected sexual abuse often differ. In some cases, among physicians who all rate themselves as skilled, assessments made by very experienced physicians may conform more closely to consensus standards than do assessments made by less experienced physicians.

Examination Findings in Legally Confirmed Child Sexual Abuse: It's Normal to be Normal

Studies of alleged victims of child sexual abuse vary greatly in the reported frequency of physical findings based on differences in definition of abuse and of "findings." This study was designed to determine the frequency of abnormal findings in a population of children with legal confirmation of sexual abuse, using a standardized classification system for colposcopic photographic findings. Case files and colposcopic photographs of 236 children with perpetrator conviction for sexual abuse, were reviewed. The photos were reviewed blindly by a team member other than the examiner, and specific anatomical findings were noted and classified as normal to abnormal on a scale of 1 to 5. Historical and behavioral information, as well as legal outcome was recorded, and all data entered into a dBase III program. Correlations were sought between abnormal findings and other variables. The mean age of the patients was 9.0 years (range 8 months to 17 years, 11 months), with 63% reporting penile-genital contact. Genital examination findings in girls were normal in 28%, nonspecific in 49%, suspicious in 9%, and abnormal in 14% of cases. Abnormal anal findings were found in only 1% of patients. Using discriminant analysis, the two factors which significantly correlated with the presence of abnormal genital findings in girls were the time since the last incident, and a history of blood being reported at the time of the molest. Abnormal genital findings are not common in sexually abused girls, based on a standardized classification system. More emphasis should be placed on documenting the child's description of the molestation, and educating prosecutors that, for children alleging abuse: "It's normal to be normal."

The relationship between vaginal douching and lower genital tract infection in young women

The purpose of the study was to investigate the relationship between a history of vaginal douching and gynecologic history, genital examination findings, and laboratory data in predominantly black adolescent and young adult females at an inner city family planning clinic. Of 175 females (mean age 17.7 ± 1.46 years), 69% reported douching. Of those reporting douching, 25% reported douching 48 hours prior to their clinic visit. Univariate analysis indicated significant associations between vaginal douching and a past history of gonorrhea and trichomonas infection, current Neisseria gonorrhoeae and current bacterial vaginosis (p < 0.05). Multiple logistic regression analysis indicated this was not an independent association. Recent vaginal douching did not appear to significantly influence microscopic detection of vaginal infections, vaginal white blood counts (WBCs), and endocervical polymorphonuclear cells (PMNs) indicating that recent douching had no effect on laboratory tests performed in the clinic.

Audit of clinical documentation of external genitalia examination findings in the newborn: The Benin-city experience

Background: Over the years, poor medical documentation is a well known phenomenon in medical practice but the magnitude of the problem in our setting has not been defined.Objective: To assess the overall frequency of missed detection of anomalies of external genitalia following the routine newborn physical examination and to describe the general pattern of its documentation.Methods: In this hospital-based descriptive cross-sectional study, 915 full-term newborn infants in an open population survey were systematically screened for anomalies of the external genitalia, using a checklist derived by modifying parameters in the Prader scoring system and the External masculinization score charts. The pattern of documentation was assessed in 915 case files. The findings of the researchers were then compared to those previously documented by the attending physician/midwife. The study was conducted in two Nigerian hospitals (University of Benin Teaching Hospital and St Philomena Catholic Hospital) in Benin City. All members of staff of the two hospitals were blinded to the fact that the previous examination findings documented in the case files were being assessed during this study.Results: Of the 915 infants, 19 (2.1%; 95% CI= 1.2-3.0) had anomaly of the external genitalia at birth. The overall frequency of missed diagnosis of external genital anomalies was 68.4% with undescended testes (UDT) being the most frequently missed. The level of documentation of the findings of the external genital examination was poor in both hospitals. Combining the two hospitals, the external genital examination findings were not documented in 76.1% of case files.Conclusions: The routine newborn examination as currently practiced in the two hospitals was weak in detecting external genital anomalies. Poor documentation of the external genital findings is a common occurrence in the setting where we practice, irrespective of whether the health institution is tertiary or secondary.Key words: Audit, clinical documentation, external genitalia anomalies, missed diagnosis, routine newborn examination.