TEXTBOOK PEDIATRIC GYNECOLOGY - 2013

Chapter 4. EXAMINATION METHODS IN PEDIATRIC GYNECOLOGY

LABORATORY INVESTIGATION METHODS IN PEDIATRIC GYNECOLOGY

Bacterioscopic examination of genital secretions is performed following the physical examination of the genitalia. Vaginal discharge analysis is conducted in all examined girls, whereas testing of secretions from adjacent Organs (Urethra, rectum) depends on the specific condition (e.g., Gonorrhea, Trichomoniasis). Material is collected using a grooved probe, a Volkmann spoon, or a rubber catheter. Prior to inserting the instrument, the vaginal introitus, external urethral meatus, and perianal region are wiped with a cotton swab moistened with warm saline solution. Instruments for sample collection are inserted 0.5 cm into the urethra, 2–3 cm into the rectum, and, whenever possible, up to the posterior fornix of the Vagina. Test results must be evaluated taking into consideration the girl's age.

To identify the causative pathogen, In addition to bacterioscopic examination of discharges from the vagina, urethra, and rectum, the material is cultured on media to isolate the pathogen and determine its antibiotic susceptibility.

Functional Diagnostics tests are utilized in girls presenting with juvenile bleeding, pubertal disorders, and suspected hormonally active ovarian tumors. Cytological diagnostic Methods include: Cytological examination of vaginal discharge with calculation of the maturation index and karyopyknotic index, the "pupil" sign, the "fern" pattern, basal (rectal) body Temperature measurement, and Blood hormone level determination.

Thermography retains its diagnostic value in identifying inflammatory processes of the internal genital organs, allowing for a sufficiently high degree of accuracy in confirming the presence of genital inflammation.

The examination of girls with gynecological disorders differs from that of adult patients due to specialized techniques for genital examination, a tailored approach to the pediatric patient, and the application of general clinical assessment methods.

Since most children—especially those visiting a gynecologist for the first time—experience anxiety, discomfort, and fear regarding the examination, the pediatric gynecologist must establish a favorable environment prior to the Procedure: build rapport, reassure the patient, and gain the girl's trust. The preliminary interview with the mother is best conducted in the child's absence. It is advisable to let the mother describe The history of her daughter's illness, after which any necessary clarifying questions can be asked.