TEXTBOOK PEDIATRIC GYNECOLOGY - 2013

Chapter 4. EXAMINATION METHODS IN PEDIATRIC GYNECOLOGY

VAGINAL CLEANLINESS INDEX IN GIRLS

In healthy girls, vaginal microecology is a hormonally dependent system whose state is interconnected with the body's immune features and determined by the functional state of the Ovaries, the concentration of lactoflora, the pH of vaginal secretions, and the state of local Immunity.

Functional Diagnostics tests

To assess ovarian endocrine function in girls, especially during Puberty, measuring basal BODY Temperature AND performing colpocytological examination are most commonly used.

Basal body temperature measurement over several months provides insight into the establishment of menstrual function, the duration of individual cycle phases, and the presence or absence of ovulation. Measurements are taken under the same conditions as in adult women. The temperature curve becomes biphasic after 15–16 years of age. It must be kept in mind that in the presence of fever or subfebrile conditions, the diagnostic value of the method is lost.

Colpocytological examination. The ideal site for material collection is the lateral vaginal fornix. The smear is obtained gently using a pediatric probe, a Volkmann spoon, or a pipette. If obtaining a vaginal smear is not feasible (e.g., imperforate hymen, small hymenal opening), it can be prepared from centrifuged morning urine, or smears from the nasal mucosa or the inner cheek. The examination should preferably be performed several times during the Menstrual cycle, once the latter is established, but no more frequently than once every 3 days.

Age-related dynamics of the colpocytological pattern. During the first week of a girl's life, intermediate Cells predominate, while superficial cells account for 10%. Subsequently, from the 7th day up to 7–8 years of age, only basal and parabasal cells are observed, indicating low proliferative activity of the vaginal epithelium. This is due to low estrogen saturation. In the prepubertal age (from 8–9 years), intermediate cells appear, and the proportion of superficial cells reaches 50%.

During puberty, the proportion of highly differentiated Cells of the vaginal wall gradually increases; in accordance with the Phases of the menstrual cycle, signs of increasing estrogenic influence, followed by progestogenic influence, can be detected dynamically. During this period, the karyopycnotic index and its dynamics can be calculated.

In cases of Menstrual disorders and puberty abnormalities, the colpocytological method holds high diagnostic value.

Cytogenetic examination

In pediatric gynecology, the results of genetic testing are often crucial for Diagnosis, prognosis, and Treatment Selection.

Determination of Sex Chromatin. Typically, cells from the mucosa of the inner cheek (buccal epithelium) are examined. The identification of Barr bodies in at least 10–12% of the examined cells indicates chromatin positivity. Conversely, sex chromatin is considered negative in individuals with Barr bodies in less than 5% of cells. If sex chromatin is detected in 6–9% of cells, a repeat examination is recommended, and if a similar result is obtained, karyotyping is necessary.

In terms of accuracy, cytogenetic evaluation is inferior to karyotyping; however, the simplicity and speed of the method offer distinct advantages.

Sex chromatin testing is indicated in the diagnosis of external genitalia malformations and sexual development disorders, in primary Amenorrhea (especially when combined with short stature in girls), and in eunuchoid tall stature combined with hypogonadism (in boys). It is not recommended to determine sex chromatin during the first day of life, while taking hormonal medications, Antibiotics, and certain other potent drugs.

The karyotype determines the morphogenetic characteristics of Cell nuclei at the stage of division (metaphase) and provides An Overview of the Organism's chromosomal Complement. Venous Blood and a cultured lymphocyte suspension are used to determine the chromosomal set.

Indications for karyotype testing include: intersexual Structure OF THE genitalia; absence or a low percentage (less than 10%) of sex chromatin in females; positive chromatin in males; gynecomastia combined with hypogonadism and/or eunuchoid body proportions in males. It should be remembered that identical karyotypes can present with completely different phenotypic manifestations. For example: 46,XX in true Hermaphroditism (in 60%); 46,XX in female pseudohermaphroditism (congenital adrenal hyperplasia).