TEXTBOOK OF PEDIATRIC GYNECOLOGY - 2013

Chapter 4. METHODS OF EXAMINATION IN PEDIATRIC GYNECOLOGY

The examination of girls with gynecological disorders should begin with determining the patient's basic age-specific parameters and physical development.

General examination of girls is carried out using standard pediatric methodology, which includes gathering Complaints, personal history, and medical history. Attention is paid to the age and health of the parents, the course of the mother's Pregnancy and labor, and a thorough inquiry is made into diseases the girl suffered during the neonatal period, early childhood, and prepubertal age. The General condition of the child is evaluated (body Temperature, Sleep, appetite, behavior, etc.), along with past illnesses that can provide a comprehensive understanding of the body's reactivity. Living conditions, Nutrition, daily routine, behavior in social groups, and relationships with peers should also be clarified.

Special attention should be focused on the Puberty period. The timing and progression of the girl's menstrual function must be thoroughly evaluated, and The Nature of any non-menstrual vaginal discharge should be determined.

Objective Examination of a girl suffering from a gynecological condition begins with assessing the core indicators of her physical development relative to her age (height, weight, chest circumference, pelvic dimensions), followed by a general systemic physical examination.

The physical development of girls is assessed using morphograms, which are constructed based on anthropometric data: height (H), chest circumference above and below the Mammary Glands (C), pelvic dimensions (P), including the "transverse pelvic width" (intertrochanteric diameter), and the sum of its four measurements. A chronological age scale (A) is introduced to account for age-related changes in body proportions.

There are Three types of morphograms: normal (physiological), morphogram with constitutional deviations, and morphogram associated with hormonal disorders:

1. When body dimensions and proportions correspond to the age-adjusted average norm, the morphogram appears as a horizontal straight line, the level of which is determined by the age.

2. The morphogram of girls who develop proportionally but exhibit constitutional deviations from average body sizes appears as an almost straight line, the slope of which relative to the horizontal axis is determined by the constitutional deviation from the average age norms and dimensions.

3. If there are changes in body proportions characteristic of hormonal disorders, the morphogram at any age takes the form of a broken line and retains a configuration typical of each specific type of hormonal imbalance.

SPECIFICS OF TAKING AN ANAMNESIS IN FEMALE INFANTS AND GIRLS

Taking a medical history from girls must be approached individually. Depending on the specific condition, the Anamnesis-taking protocol may vary.

Before taking the history, it is recommended to gather data concerning the child's living conditions, daily routine, physical activity, and other positive or negative factors that could have influenced the girl's development. It is necessary to clarify the child's place of residence and the level of environmental well-being.

A genealogical history is essential for evaluating a girl's development. Information regarding the health status of the girl's parents is required: the presence of somatic developmental anomalies in parents and close relatives, sexual development disorders in relatives of the examined girl, the age of menarche in the mother, and The rate of puberty in the father. It is important to establish whether the girl's parents resided in endemic disease areas.

Attention should be paid to the course of the antenatal period (duration of exposure to harmful factors and gestational age), the course of labor, birth weight, psychomotor development milestones, and the type of feeding in infancy. Data on past infectious diseases, helminthic infestations, and the child's contact with infectious patients (tuberculosis, Gonorrhea) must be obtained, as the latter can lead to The Development of corresponding gynecological diseases in the child.

The cornerstone of ethics in obtaining a history from a young girl is the delicate phrasing of questions by the pediatric gynecologist. The Nature of the relationship between the parents and the girl, as well as the mother's level of competence, must be taken into account. Up to the age of 15, the physician provides full information to the mother regarding the girl's gynecological issues, whereas after 15 years of age, the patient's opinion is taken into account.

When interviewing the girl, it is necessary to clarify how the disease began, the sequence in which symptoms appeared, the nature of the pain (acute, dull, prolonged, or short-term), its localization and radiation, the presence of genital discharge and its characteristics (purulent, mucous, serous), color, odor, and quantity. In the case of bloody discharge, its pattern—whether continuous or intermittent—should be specified.

The general condition (temperature, sleep, appetite, mood) and the function of Organs adjacent to the pelvic reproductive organs—the Urinary Bladder and intestines—are evaluated.

If the girl is menstruating, the date of menarche, the time frame for the establishment of a regular Menstrual cycle and its pattern, menstrual pain, and the timing and course of her last menstrual period should be clarified.

The synthesis and Analysis of the anamnesic data obtained, even prior to the objective examination, make it possible in some cases to establish a provisional Diagnosis.

Typical protocol for the examination of a girl

1. History taking (separately from the mother and the girl).

2. Visual inspection, Assessment of the degree of secondary sexual characteristics development.

3. Inspection, Palpation, Percussion, and (in some cases) Auscultation of the abdomen.

4. Examination of the external genitalia, hymen, external urethral meatus, and perianal region.

5. Rectoabdominal examination.

6. Vaginoscopy.

7. Instrumental Diagnostic Methods (vaginal probing, smear collection, biopsy).

8. Use of imaging modalities: ultrasound, MRI, etc.