PEDIATRIC GYNECOLOGY TEXTBOOK - 2013

Chapter 4. EXAMINATION METHODS IN PEDIATRIC GYNECOLOGY

OBJECTIVE EXAMINATION OF GIRLS AND ADOLESCENTS

A general examination of girls should be performed according to standard pediatric guidelines, as A number of somatic disorders are direct causes of various Reproductive System pathologies.

When performing a system-by-system examination, special attention should be paid to The Cardiovascular system. At 11–15 years of age, a mismatch between Heart size and configuration relative to the girl's overall body size is frequently observed. It is essential to keep in mind three variants of such changes: a small heart, a mitral heart configuration, and cardiac hypertrophy.

When measuring Blood pressure, it must be noted that certain thyroid, pituitary, and adrenal disorders in adolescents are accompanied by elevated blood pressure. Mild arterial Hypertension (BP 135/85 mmHg) may occur at this age, requiring Differential Diagnosis from neurocirculatory dystonia.

The primary prerequisite for assessing the physical and SEXUAL DEVELOPMENT OF children is the accurate Determination of the patient's age. The child's age is calculated to the exact day at the time of the examination (Table 9).

Table 9. Determination of girls' age

Class="center">Month of Birth	Month of Examination
Class="center">Month of Birth	I	II	III	IV	V	VI	VII	VIII	IX	X	XI	XII
January	0	+1	+2	+3	+4	+5	+6	+7	+8	+9	+10	+11
February	-1	0	+1	+2	+3	+4	+5	+6	+7	+8	+9	+10
March	-2	-1	0	+1	+2	+3	+4	+5	+6	+7	+8	+9
April	-3	-2	-1	0	+1	+2	+3	+4	+5	+6	+7	+8
May	-4	-3	-2	-1	0	+1	+2	+3	+4	+5	+6	+7
June	-5	-4	-3	-2	-1	0	+1	+2	+3	+4	+5	+6
July	-6	-5	-4	-3	-2	-1	0	+1	+2	+3	+4	+5
August	-7	-6	-5	-4	-3	-2	-1	0	+1	+2	+3	+4
September	-8	-7	-6	-5	-4	-3	-2	-1	0	+1	+2	+3
October	-9	-8	-7	-6	-5	-4	-3	-2	-1	0	+1	+2
November	-10	-9	-8	-7	-6	-5	-4	-3	-2	-1	0	+1
December	-11	-10	-9	-8	-7	-6	-5	-4	-3	-2	-1

By cross-referencing the birth month (horizontally) with the examination month (vertically), we obtain the number of months to be added (+) to or subtracted (-) from the total number of years.

To evaluate key anthropometric parameters, it is advisable to use percentile charts for height, body weight, chest circumference, and pelvic dimensions across various age groups of girls.

Attention is drawn to body build characteristics, adipose tissue development and distribution patterns, and the condition of the Skin (increased oiliness, dryness, moisture, striae, acne, folliculitis, etc.).

Special focus is given to the pattern of Hair growth, the timing of its onset (before or after menarche), and its intensity. Excessive hair growth is evaluated using the D. Ferriman and J. Galwey scoring system.

Morphotypes are determined to assess sexual development. A morphogram is constructed based on height, chest circumference, the sum of external pelvic dimensions, and age. In normal development, the girl's morphogram appears as a straight line with allowable deviations within 1.5 standard deviations (sigmas). In cases of delayed sexual development, an infantile or intersexual morphogram is formed; in precocious Puberty, a sexual or uniformly advanced morphogram is observed.

Last update: 08/08/2026

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