Pediatric Evaluation

• This section is under construction

Whereas most gynecologists will not deal with pediatric premenarcheal patients, it is useful to understand some of the basic issues that should be addressed should their parent present reporting bleeding. The hysteroscope can be an extremely useful device for evaluating the vagina for bleeding, discharge, or when foreign bodies are suspected, especially for pediatric patients, provided the proper clinical environment. The most common contributors to discharge or bleeding are vulvovaginal infections and inflammation which comprise about half of the cases, while foreign bodies, vaginal tumors, endogenous and exogenous estrogens and trauma, including that which results from sexual abuse, contributing the rest. In older girls, idiopathic precocious menstruation is commonly encountered. Visual inspection of the upper vagina and cervix can often be performed in the office setting, or, if determined necessary, in a procedure or operating room under anesthesia. While the vulva are examined directly for the vagina, vaginoscopy can be performed preferably using a rigid hysteroscope with a 5 Fr sheath which can be passed into most pediatric vaginas with relative comfort. Liquid distention media such as saline or dextrose in water can be used once appropriate specimens are obtained.