TEXTBOOK PEDIATRIC GYNECOLOGY - 2013

Chapter 2. ORGANIZATION OF SPECIALIZED GYNECOLOGICAL CARE FOR ADOLESCENT GIRLS IN UKRAINE

PEDIATRIC AND ADOLESCENT GYNECOLOGY CLINIC

The pediatric and adolescent gynecology clinic is established within a regional (municipal, district) hospital, antenatal clinic, or children's outpatient clinic, serving as an organizational, methodological, and consultative center for the region (city, district) within the approved staffing schedule. The work of the clinic is organized and coordinated jointly with the regional (municipal, district) pediatric and adolescent gynecologist and the pediatric and adolescent gynecology department.

Patients are received at the pediatric and adolescent gynecology and sex education clinic without restrictions: both with and without a referral.

Pediatric and adolescent gynecologists working in these clinics provide comprehensive examinations for adolescent girls with gynecological conditions to clarify diagnoses, determine The Nature and tactics of Treatment, offer medical and counseling assistance on issues related to sex education and enhancing sexual culture among adolescents, and arrange consultations with the regional (municipal) pediatric and adolescent gynecologist when necessary.

The pediatric and adolescent gynecology clinic provides the following services:

— educational and methodological work on implementing adolescent sex education;

— counseling on Sexual Behavior;

— counseling on Contraception, Prevention, and treatment of Sexually Transmitted Infections;

— collection of vaginal discharge samples for bacteriological and bacterioscopic examination, as well as Determination of the degree of estrogen saturation;

— vaginoscopy;

— removal of foreign bodies from the Vagina;

— management of external genitalia injuries;

— removal of condylomas followed by pathohistological examination;

— lysis of synechiae;

— vaginal cleansing and sanitation;

— subcutaneous and intramuscular injections for patients who do not require hospitalization;

— subcutaneous sensitivity and response tests with estrogens and gestagens;

— trial testing of new diagnostic and treatment Methods.

Experienced physicians who have completed specialized training in pediatric and adolescent gynecology are recruited to work in specialized clinics. The physician works alongside a nurse skilled in examination and interviewing techniques for girls, as well as necessary therapeutic Procedures and manipulations (douching, administration of vaginal suppositories, instillation of medications, etc.).

The pediatric and adolescent gynecologist provides care for girls from the neonatal period up to 18 years of age and serves as a member of the medical board for routine preventive examinations.

Indications for referring adolescent girls for a consultation with a pediatric and adolescent gynecologist include the following:

— suspected gynecological pathology detected by a pediatrician or family doctor during routine preventive examinations in preschools, schools, or colleges;

— abnormal onset of menstrual function;

— Menstrual disorders;

— absence of secondary sexual characteristics at the age of 12–13;

— primary Amenorrhea (absence of menstruation after 16 years of age);

— precocious Puberty (breast development, pubic Hair growth before the age of 8);

— abnormal development of external genitalia;

— grade II–III obesity or body weight deficit exceeding 10% during puberty;

— hirsutism (pathological hair growth);

— impaired physical development;

— abnormal genital discharge;

— unexplained abdominal pain;

— extragenital pathology (cardiovascular diseases, Kidney and Urinary Tract disorders, endocrine disorders, etc.);

— frequent acute respiratory viral infections (ARVI) and tonsillitis;

— history of abdominal surgery;

— family history of genetic abnormalities.

Medical surveillance and dispensary care for girls and adolescents are carried out in the following cases:

1. Chronic diseases in the stage of compensation, subcompensation, or decompensation combined with impaired sexual development.

2. Combined endocrine and gynecological pathology.

3. Menstrual disorders (amenorrhea, algodismenorrhea, uterine bleeding).

4. History of surgery for genital malformations and tumors.

5. Recurrent vulvovaginitis, Labia minora adhesions (synechiae).

6. Precocious or delayed puberty.

7. Congenital DISORDERS OF SEXUAL differentiation.

8. Termination of Pregnancy at a young age.

In accordance with Order No. 391 of the Ministry of Health of Ukraine, day care units are established alongside pediatric and adolescent gynecology offices for the examination and treatment of adolescent girls suffering from puberty disorders and gynecological diseases. The operation of these day care units is determined on a case-by-case basis according to specific requirements.

The staff of the day care unit is formed in accordance with the staffing schedule provided for gynecological departments, and in outpatient clinic departments — depending on the volume of work in each specific case.