How is Gynecological Examination of Female Children Made?


Gynecological examination of female children is different.
Although examination of a patient in this age group is simple, doctor must be aware of anatomy and physiology of genital organs in newborn, childhood, pre-pubertal and pubertal periods and differences of this period.
Weight and height must be noted during the examination. It must begin with inspection of head-neck-torso-abdomen and continue with examination of breast and abdomen. Doctor must define the stage of breasts according to Tanner during breast examination, check the color of areolas. Excessively dark areolas in early stage breast development is a typical symptom of exogenous hormone intake. Palpation of abdomen must be done.
What you should know is that children and adolescents do not forget any negative thing whatever their age is and reception and response level changes with age. You should talk first, communicate. Try to listen the complaint from the child first. If she is above 4 and the doctor can use children language and is experienced with children, they can tell their complaints.
If you ignore her and talk to her mother, she will ignore you after a while. Communication is more important than the examination (it actually works in every medical branch). Examination is made on her mother’s lap until the ages 7-8 and sometimes further. Her mother sits on the gynecological table, child is put on her lap and her legs and genitals are covered with sheets in order to emphasize that this is a private thing. Skin contact with her mother during the examination makes them feel safe.
Pediatric gynecologist should let the children examine the tools used for examination.
Gynecological examination indications in pediatric cases are: 1- gynecological complaints: vaginal discharge, itching, genital or abdominal pain, infection, tumor or malformation related bleeding 2. Endocrinologic causes: estrogenisation and/or androgenisation findings, ambiguous genitalia. 3. Suspicious or proven sexual harassment. Doctor is especially asked to find the objective proof of harassment and define it.