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MRCOG PART 2 SBAs and EMQs

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EMQ1480
SBA2068
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essay 146 adolescent gynecology

essay 146 adolescent gynecology Posted by Abdul Aziz S.
Vaginal discharge is a distressing condition, both for the girl and her parents. Great care must be taken in handling such a sensitive problem. Adequate time must be given to establish rapport and build up confidence.
First step is to obtain a careful history. Amount, duration, color of discharge, any associated itching and blood stained discharge should be enquired. White curdy discharge
may be due to candidal infection ,greenish discharge due to trichomonal infection. Itching could be due to threadworm infestation. Blood stained discharge, though rare could be due to malignancy. If the girl is menarchal, history of use of tampons should be taken, as retained tampon could be a cause of infection and discharge.
History of drug or sexual abuse should be obtained, bearing in mind that the information given may be inconsistent. But may point to possibility of STI like gonorrhea, herpes, HIV.Pt may be seen alone to get information about her sexual activity and number of sexual partners.
A recent change in bathing soap, underwear or other agents, which may cause allergic reaction, must be excluded. Although sensitive, it must be ensured that the pt is well aware and takes good care of personal hygiene.Hist of medical illnesses such as diabetes, which may predispose tocandidal infections, should be taken.
General examination should make note of signs of drug abuse or child abuse. Abdominal examination done for any tenderness in the lower abdomen, or palpable abdominopelvic masses.local exam would include examination of vulva-for marks of itching, excoriation due to sexual abuse.
If discharge seen at introitus, swabs taken. Hymen should be checked for any tears. Vaginal examination done using nasal speculum, or paediatric laryngoscope or vaginoscope. If foreign body is found it should be removed under anesthesia. PR examination done to assess any masses bimanually. Consultant should be informed if signs of sexual abuse noted. All findings should be documented.
Investigations would include culture and sensitivity of swabs taken .USG if any mass found. X-ray abdomen to identify presence of any radio opaque object in vagina.
Treatment would depend upon identification of positive findings on culture; accordingly antibiotic or antifungal treatment may be given. If STI are detected on cultures, pt should be referred to support groups, contacts traced and treated with the pt. Nonspecific vulvovaginitis may be treated by barrier creams and observing proper personal hygiene.
If the pt is sexually active she should be advised to use barrier contraception. If PID is diagnosed, it should be actively treated and pt should be informed of its long-term consequences. This would ensure compliance to treatment.