How is a Gynecologic Examination Made in Young Girls
Gynecologic examination of a young girl is a source of serious stress not just for her but also for her parents. Doctor must be aware of the condition and must approach to patients knowing that this is a stressful process for both parents and young girls!
Spiritual and physical development of young girls is very fast in this period. Shortly, appearance of changes which she does not understand clearly, affects her relations with both her parents and environment. In another point of view, the problems she experiences in this period may even affect her family and the relations between her parents. Adolescence period is evaluated in 3 parts:
Early Period (12-14 ages): Pubertal growth and maturation period. She begins separating from the family and interpreting them in her own values.
Middle Period (15-17 ages): She begins forming her own moral values and making choices. She interprets right and wrong on her own. Commonly in this period, parents complain from her closing herself to her room and getting isolated from them. Therefore, they begin arguing with their parents. The most important change regarding us gynecologists is that they begin concerning their body looks and health. They begin taking risks while discovering their sexuality, interpreting right and wrong notions. Therefore, sociocultural environment, family, school becomes very important in this period.
Late Period (18-21 ages): Formal thought develops. She knows the conseuqences for her acts, she evaluates them. She accepts the values belonging to parents and maybe becomes a parent.
In the adolescence in which physical and spiritual changes occur quickly, gynecological examination of young girl is not a routine examination. The basic two purposes of this examination is to evaluate the patient clinically and do what is necessary in the phase of diagnosis and treatment. However, in order to make these two purposes real, you need to provide the environment in which you can help the young girl who is under serious emotional problems of sexuality and fertility and her problems and establish relations based on trust. On the other hand, it is very difficult to do this and it is a process which can only happen after some experiences.
Gynecologist must be ready to spend time, listen to her concerns, and gather personal and familial information. An important point is that adolescent commonly asks for help, wants to say that she needs this but fails to express her feelings.
In any case, principles of the examination stay the same: (a) full medical evaluation must be first; (b) patient must be informed about the examination and its purposes, taken her consent; (c) examinations must not be skipped just because of the age of patients. This must be told in detail. Doctor must care for sociocultural values of the family and patient and must not begin treatment without gynecological examination with just an anamnesis.
Commonly she is a young girl presenting with irregular menstruation who comes with her mother. Her age is between 13 and 18. Mother says “This is a young girl anyway doctor, what is there to examine, just prescript a drug to correct the menstruation” and expresses that an abdominal ultrasonographic evaluation will be sufficient. However, this ultrasonographic evaluation may easily skip problems such as pregnancy and even worse ectopic pregnancy. In ovarian problems, doctors may be mistaken in rates extending to %60 especially if girl is a bit overweight. Therefore, prescription of drugs without examination and evaluation is not just unethical but also legally wrong.
In the western literature, young girls above 13 should be examined alone, but in our practice we only do this above 16. Especially young girls in the ages 13-14 must be examined with her mother present. An important exception to this would be young girls who suffered from familial violence and she must be examined alone if she is scared of her mother and under stress about it which may be understood by evaluation of body language.
What should be Considered During Gynecological Examination of a Young Girl?
Whole body examination must be made; head, neck, abdomen and breast examination must be made. For a young girl who is not sexually active, gynecologic examination is the same as children. Vulva is estrogenized, vagina is 8-10 cm long and there are physiological secretions. According to rectal examination, uterus is usually deviated to left in lateral. Vaginal examination is only possible if girl is relaxed and her hymen is appropriate and it is not necessary in each case. When necessary, a small speculum may be used. Ovaries come to normal position in puberty and they go down to pelvis. Findings are discussed with patients after the examination and family is informed after patient is talked with.
In a sexually active patient, evaluation of cervix with speculum, taking smear and doing bimanual examination, taking samples for potential genital infections may be necessary. In gynecological examination, genital organs are the same with the woman in reproductive ages. Smear must be taken. Sexually active young girl must be informed about contraceptive methods.