Pelvic Examination of the Adolescent Patient
S. Jean Emans MD1
1 Associate Chief, Division of Adolescent/Young Adult Medicine, The Children's Hospital Medical Center, Boston; Assistant Professor of Pediatrics, Harvard Medical School
Providing health care to adolescent girls in the 1980s involves knowledge of many topics. A thorough understanding of the gynecologic problems that may occur during adolescence as well as comfort with the normal pelvic examination allows the pediatrician to provide this aspect of primary care. Not only does the physician need the technical skills which include speculum examination of the vagina and bimanual rectovaginal-abdominal palpation, but the practitioner seeing adolescents also needs the interpersonal skills, sensitivity, and time to establish a primary relationship with the adolescent herself. Principles of caring for adolescents and their families are not discussed here but are of obvious importance in dealing with a pelvic examination.
Pamphlets on a variety of gynecologic and nongynecologic subjects should be readily available in the office. Education for the young teenager should discuss leukorrhea, normal development, menses and menstrual cramps, and the use of tampons. The intermittent use of conventional tampons changed frequently allows the adolescent girl more freedom in activities and athletics, makes her more comfortable with her body, and makes the routine pelvic examination simpler and less anxiety provoking. The use of tampons is especially helpful in preparing the young adloescent exposed in utero to diethylstilbestrol for speculum examination. The adolescent should be encouraged to discuss boyfriends and peer relations.
