Professional Documents
Culture Documents
M. Thamrin Tanjung,
Prof.Dr.dr.Sp.OG(K)
M. Rusda Harahap, dr.Sp.OG(K)
Gynecological care
begins in the delivery room
as part of the newborn
examination with palpation
of the breast buds and
examination of the
external genitalia
Gynecological care
Evaluation
Specially designed
equipment
The
The
The
Since
Give
Be
Never
Instruments
May
Topical
General
Huffman-Graves
Saline
Speculum
Methodes of examination
Placing
FIG. 1-4. Positioning the child in the frog-leg position with the aid of her
mother. (Courtesy of Dr. Trina Anglin, Office of Adolescent Health, Health
Resources and Services Administration (HRSA), Washington, DC.)
The Tanner stages for the development of female pubic hair. (Adapted
from Grumbach MM, Styne DM. Puberty: Ontogeny,
neuroendocrinology, physiology and disorders. In: Wilson JD, Foster
DW, eds. Williams textbook of endocrinology, 8th ed., Philadelphia:
WB Saunders, 1992; and from Marshall WA, Tanner JM. Variations in
pattern of pubertal changes in girls. Arch Dis Child 1969;44:291.)
Microperforate hymen.
Microperforate septate
hymen.
Microperforate septate
hymen.
Imperforate hymen.
Septate vagina.
Hymenal tags.
Gonadal disgenesis
Turner
syndrome (45,X)
Sweyer syndrome (46,XY)
Mixed gonadal dysgenesis (45,X /
46,XY)
Abnormalities of the X
chromosome
Pediatric Gynecologic
Disorders
Pediatric Gynecologic
Disorders
I.
VULVOVAGINAL LESIONS
1. Lichen sclerosis et
atrophicus
2. Trauma
3. Labial adhesion
4. Prolapsed urethra
5. Vaginal discharge
Vaginal Discharge
Normal
: mucoid discharge it
results from maternal estrogen
Pathologic discharge :
Infections
Hemolytic streptococcal vaginitis:
bloody or serosangguineous discharge
Monilial vaginitis
A foreign body: persistent vaginal
discharge
Nonspecivic vaginitis
Labial adhesion
Adhesion
II. NEOPLASMS
VAGINA
Sarcoma botryoides
OVARIAN
Sarcoma Botryoides
From
Ovarian tumors
Germ cell tumors
Benigne cystic teratoma
Benign cyst
Arrhenoblastoma (androgen
producing)
Dysgerminomas & gonadoblastomas
Endodermal sinus tumors
Embryonal carcinoma (hCG
secreting tumors)
Immature teratomas(malignant)
agenesis: Mayer-von
Rokitansky-Kuster-Hauser(MRKH)
syndrome
Ectopic ureter with vaginal
terminus
Vaginal ectopic anus
(CAH)
Adrenal tumors
Maternal ingestion of androgens
Childhood ingestion of androgens
Androgen insensitivity syndrome
(testicular feminization)
True hermaphroditism
Maternal virilising tumor during
pregnancy(luteoma of pregnancy)
A. Normal puberty
B. Normal physical changes
Growth spurt
Thelarge
Adrenarche and pubarche
Menarche
C.
Precocious puberty
D.
Delayed puberty
Central
Peripheral
Hypergonadotropic hypogonadism
Hypogonadotropic hypogonadism
Normal Puberty
3.
Examination of the
Newborn Infant
A. GENERAL EXAMINATION
B. CLITORIS
C. VAGINA
D. RECTOABDOMINAL
EXAMINATION
A. General Examination
may
LABIAL ADHESIONS
Agglutination
Vulvar
The
For
We
prescribe an estrogen-containing
cream (e.g., Premarin) twice daily for
3 weeks and then at bedtime for
another 2 to 3 weeks. Approximately
half of adhesions will resolve in 2 to 3
weeks (105), and therapy can then
be changed to ointment.
After
Forceful
separation is contraindicated
because it is traumatic for the child and
may cause the adhesions to form again.
Labial abscess.
B. Clitoris
The
Enlargement of
Clitories
C. Vagina
The
vaginal orifice
Labia are separated or retracted.
If it is not, it can be found by gently inserting a
small, well lubricated pediatric feeding tube
When an opening cannot be found, the infant most
likely has an imperforate hymen or vaginal
agenesis.
Infrequently, associated inguinal hernias suggest
the possibility that the child is a genetic male,
particularly when there is a mass in the hernial sac.
If the vaginal orifice cannot be located, further
investigation is warranted.
Imperforate hymen in a
baby.
Imperforate
Hymen
D. Rectoabdominal
Examination
To
Examination of the
premenarcheal child
Focus
Examination of the
premenarcheal child
A. PHYSICAL EXAMINATION
1. General inspection.
2. Breasts
3. Abdomen
4. Genitalia.
B. Vaginoscopy
CONGENITAL ANOMALIES
VAGINA
UTERUS
OVARIUM
URETHRA
ANUS
ANOMALIES OF THE
VAGINA
1. IMPERFORATE
2. TRANSVERSE VAGINAL
SEPTUM
2. LONGITUDINAL VAGINAL
SEPTUM
3. VAGINAL AGENESIS
4. PARTIAL VAGINAL AGENESIS
ANOMALIES OF THE
UTERUS
1. RUDIMENTARY UTERINE
HORN
2. UNICORNUATE UTERUS
WITH PARAMESONEPHRIC
CYST
ANOMALIS OF THE
OVARIUM
drawn by the round ligament into the inguinal canal
or the labium majus.
A firm inguinal mass should alert the examiner to
the possible presence of an aberrant gonad,
possibly containing testicular elements, even
though the external genitalia are female.
A karyotype should be obtained when a girl
presents with an inguinal gonad.
At the time of hernia repair, the gonad should be
biopsied. If it proves to be an ovary, it should be
returned to the peritoneal cavity and the hernia
repaired. If a testis is identified, the gonad should
be removed.
Sarcoma botryoides
=botryoid
rhabdomyosarcoma
One of rare mesenchymal tumors, grows in
the form of polypoid grapelike masses and
derives its name from this gross appearance
Clinical characteristics
The most common clinical finding is vaginal
bleeding. They may appear as a polypoid
mass, somewhat yellow in color and are
friable: thus, they (possibly) may break off,
leading to vaginal bleeding or infections.
Epidemiology