Section 45
Chapter 44,642

The first pelvic examination and common gynecological problems in adolescent girls

Hein, K.

Women and Health 9(2-3): 47-63


ISSN/ISBN: 0363-0242
PMID: 6464481
DOI: 10.1300/j013v09n02_04
Accession: 044641737

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Indicators and special considerations of performing a 1st pelvic examination for a teenaged female -- a rite of passage into American womanhood -- are reviewed and factors in the history, physical examination, and laboratory evaluation are presented. The completeness of the pelvic examination depends upon the indication. A simple inspection examination of the external genitalia should begin on the 1st day of life and be continued routinely at each health maintenance examination throughout childhood. A table lists specific reasons for internal examination. The examiner cannot reassure the patient that she is developing normally unless the secondary sexual characteristiss are seen first. The excuse that the patient would be too embarrassed to have a genital examination usually denotes reluctance on the part of the examiner rather than the patient. The general the 2 main reasons to perform an internal examination are to answer specific questions that are raised by the physician or the patient herself. A verbal contract between the health care provider and patient must be established before the exam is performed. The examiner should discuss and assure the patient of confidentiality regarding sexual matters. The general categories in the history and physical examination of the teenager to be covered in the remaining portion of the visit should be outlined in the beginning. The adolescent sees herself as a teenager first rather than as a gynecologic patient. Asking additional information about other spheres of activities such as friends, family, and interests gives the feeling that the health care provider sees her as a person. At the initial interview visual aids in the form of plastic models, pictures, or illustrations should be introduced. There is no need to accomplish the entire interview, educational process, and complete pelvic examination in 1 session. Having taken the time to explain the reasons for the internal examination and familiarizing the teenager with the equipment should make the speculum exam no more uncomfortable or unpleasant than the speculum exam of the ears of the child. Baimanual examination is performed to feel the size, shape, and mobility of internal structures that cannot be visualized. Rectovaginal palpation also is necessary. At each step of the examination explanations are given to the patient about what structures are being palpated and reassurances offered as the exam progresses. The sequence of events in puberty is usually predictable but the chronological age at which they occur varies greatly. In adolescence the most common gynecologic complaints have to do with the onset, frequency, or duration of periods. No menses (amenorrhea), infrequent menses (oligomenorrhea), too much bleeding at the time of menses (menorrhagia), too frequent episodes of bleeding (metrorrhagia), or painful periods (dysmenorrhea) constitute the most frequent complaints. Because menstrual irregularities are so frequent during adolescence, all health professionals caring for teenagers should be familiar with the usual spectrum and problems associated with menarche and subsequent menses.

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