Clinical Problems in Pediatric and Adolescent Gynecology

by Goldfarb, Alvin F.

• ISBN13: 9780412072017
• ISBN10: 0412072017
• Format: Hardcover
• Copyright: 1996-06-01
• Publisher: Hodder Education Publishers

Summary

This book emphasizes the proper procedures when examining the patient, the growth and development stages, and problems occurring during adolescent sexuality. Clearly defined and organized, the text presents a variety of clinical problems including diagnoses and management for each. The book begins by focusing on the treatment of the patient during the examination and clinical problems related to vulvo-vaginal disease and sexual abuse. The next section discusses the physiology of puberty and the management of abnormal uterine bleeding. The third segment of the text explores problems concerning adolescent sexuality, the role of contraception and managing human papilloma virus (HPV). Finally, an excellent review of the differential diagnoses and management of pelvic pain is addressed. In order to understand the adolescent and pediatric patient one must realize that there are distinct physical and behavioral differences from those of an adult patient. This idea along with making the right decisions when dealing with specific adolescent and pediatric clinical problems is the focus of this book.

Table of Contents

Preface	xiii	(4)
Contributors	xvii
PART I	1	(46)
1 Tips, Tricks, and Tests for the Gynecologic Exam of Young Females	3	(16)
Elaine E. Yordan, M.D.
Introduction	3	(1)
The General Setting	3	(1)
The Preschool/Elementary School Age Patient	4	(9)
Initial Contact with the Parent	4	(1)
Interviewing the Mother	4	(1)
Establishing Rapport with the Patient	5	(3)
Preparing for the Examination	8	(2)
Examining the Patient	10	(3)
Evaluation of vaginal discharges	11	(1)
Removal of foreign objects from the vagina	11	(1)
Collection of vaginal secretions	12	(1)
Sedation and anesthesia	12	(1)
The Middle School Age Patient	13	(2)
Establishing Rapport with the Patient	13	(1)
Interviewing the Patient	14	(1)
Preparing for the Examination	14	(1)
Examining the Patient	14	(1)
The Adolescent Patient	15	(3)
Interviewing the Patient	16	(1)
Examining the Patient	17	(1)
Laboratory Testing	17	(1)
Post-Exam Counseling	18	(1)
Summary	18	(1)
Literature Cited	18	(1)
2 Pediatric Vulvovaginitis	19	(14)
Janice Bacon, M.D.
Introduction	19	(1)
Development of the Genital Tract from Birth to Menarche	19	(2)
Anatomic Changes	19	(1)
Physiologic Changes	20	(1)
Signs and Symptoms	21	(1)
History and Physical Examination	21	(2)
Differential Diagnosis	23	(8)
Poor Perineal Hygiene	24	(1)
Foreign Body	25	(1)
Contact Dermatitis and Allergic Reactions	25	(1)
Trauma	26	(1)
Systemic Illness	26	(1)
Nonsexually Transmitted Diseases	27	(2)
Sexually Transmitted Diseases	29	(2)
Labial Agglutination	31	(1)
Summary	32	(1)
Literature Cited	32	(1)
3 Pediatric Sexual Abuse	33	(8)
Susan F. Pokorny, M.D.
Introduction	33	(1)
The Role of Primary Care Physicians	34	(1)
Physical Evidence of Abuse Denied by the Child	35	(1)
Balancing History and Physical Findings	36	(1)
Conducting an Evidentiary Medical Examination	37	(1)
Evaluation of the Findings	38	(1)
Summary	39	(1)
Literature Cited	40	(1)
Suggested Readings	40	(1)
4 Genital Trauma in Children and Adolescents	41	(6)
Janice L Goerzen, M.D.
Introduction	41	(1)
History	41	(1)
Physical Examination	42	(1)
Management	43	(3)
Surgical Management	43	(3)
Medical Management	46	(1)
Summary	46	(1)
PART II	47	(22)
5 Normal Pubertal Development	49	(12)
Peter A. Lee, M.D., Ph.D.
Introduction	49	(1)
Hypothalamic-Pituitary-Gonadal (HPG) Axis	50	(2)
Gonadarche	50	(2)
Adrenarche	52	(1)
Physical Changes of Puberty in Girls	52	(3)
Breast Development	52	(1)
Public Hair Development	53	(1)
Pubertal Genital Development	53	(1)
Menarche	54	(1)
Changes in Body Compositioon and Proportions	54	(1)
Pubertal Growth Spurt	54	(1)
Hormonal Changes during Puberty	55	(3)
Gonadotropins	55	(1)
Estrogens	56	(1)
Progesterone	56	(1)
Androgens	56	(1)
Inhibin	56	(2)
Sex Hormone-binding Globulin (SHBG)	58	(1)
Prolactin	58	(1)
Growth Hormone (GH)	58	(1)
Intratuterine Growth Factor (IGF-1)	58	(1)
Summary	58	(1)
Suggested Readings	59	(2)
6 Dysfunctional Uterine Bleeding	61	(8)
Alvin F. Goldfarb, M.D.
Introduction	61	(1)
Menstruation: Ovulatory and Anovulatory	62	(1)
Etiology of Abnormal Uterine Bleeding during Adolescence	63	(1)
Extra Pelvic Causes	63	(1)
Pelvic Causes	64	(1)
Evalution of Abnormal Uterine Bleeding	64	(2)
History	64	(1)
Physical Examination	65	(1)
Immediate Laboratory Evaluation	65	(1)
Treatment of Abnormal Uterine Bleeding in Adolescents	66	(1)
Summary	67	(1)
Literature Cited	67	(1)
Suggested Readings	68	(1)
PART III	69	(40)
7 Adolescent Sexuality	71	(6)
Robert T. Brown, M.D.
Introduction	71	(1)
Factors Shaping Human Sexuality	71	(3)
Biology	72	(1)
Family	72	(1)
Culture	72	(1)
Society	73	(1)
Development of Adolescent Sexuality	74	(1)
Early Adolescence	74	(1)
Middle Adolescence	74	(1)
Late Adolescence	75	(1)
Summary	75	(1)
Suggested Readings	75	(2)
8 New Hormonal Contraceptive Options for Adolescents	77	(12)
Susan M. Coupey, M.D.
Introduction	77	(1)
Factors Influencing Adolescent Contraceptive Compliance	78	(1)
Oral Contraceptive Pills Containing New Progestins	78	(3)
Progestin-Only Injectable Contraceptive	81	(4)
Progestin-Only Subdermal Implant	85	(2)
Summary	87	(1)
Literature Cited	88	(1)
9 Genital Human Papillomavirus Infection in Adolescents	89	(10)
Walter D. Rosenfeld, M.D.
Introduction	89	(1)
Significance of HPV Infection	90	(1)
Epidemiology	90	(1)
Diagnosis	91	(1)
Management of HPV Patients	92	(5)
Treatment of Condylomata	92	(1)
Role of Cytologic and Histologic Findings	92	(3)
Atypical Squamous Cells of Undetermined Significance (ASCUS)	93	(1)
Low-Grade Squamous Intraepithelial Lesion (LSIL)	94	(1)
High-Grade Squamous Intraepithelial Lesion (HSIL)	95	(1)
Counseling Issues	95	(1)
The Male Partner of HPV-Infected Females	96	(1)
Summary	97	(1)
Suggested Readings	98	(1)
10 Acute and Chronic Pelvic Pain	99	(10)
Karen J. Kozlowski, M.D.
Introduction	99	(1)
History	99	(2)
Physical Examination	101	(1)
Other Diagnostic Approaches	101	(1)
Etiology and Treatment of Pelvic Pain	102	(4)
Pregnancy	102	(1)
Ovarian Cysts	102	(2)
Pelvic Inflammatory Disease	104	(1)
Pelvic Adhesions	104	(1)
Adnexal Torsion	105	(1)
Dysmenorrhea	105	(1)
Summary	106	(1)
Suggested Readings	107	(2)
INDEX	109