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(Pediatrics in Review. 2007;28:332-342.)
© 2007 American Academy of Pediatrics

Screening Adolescent Gynecology in the Pediatrician's Office

Have a Listen, Take a Look

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Explain the importance of screening gynecology in adolescent girls.
   
2. Delineate the essential components of screening gynecology in adolescent girls.
   
3. Describe when and how to perform sexually transmitted disease testing on adolescent girls.
   
4. Discuss how to counsel adolescent girls on sexuality-related issues.
   

	Introduction

 
Pediatricians are in an ideal position to screen for common gynecologic problems in adolescents without ever performing a pelvic examination. Much information can be gathered by reviewing the menstrual history, addressing any sexuality concerns as they arise, and investigating specific gynecologic symptoms as they occur. A routine breast examination and simple external inspection of the genitalia should be considered essential components of the regular health supervision visit for adolescent girls. A more complete pelvic examination is not necessary unless a specific indication exists, as outlined in Table 1. The purpose of this article is to discuss important asymptomatic gynecologic conditions that can be detected readily in the pediatrician's office and for which a speculum or bimanual examination usually is not required.

Table 1. Indications for a Complete Pelvic Examination in Adolescents

Menstrual Disorders Delayed menarche Unexplained secondary amenorrhea Persistent oligomenorrhea Abnormal vaginal bleeding Severe dysmenorrhea Abnormal vaginal discharge Suspected pelvic inflammatory disease Unexplained abdominal pain Pregnancy-related care Suspected sexual abuse Unexplained frequency, urgency, or pain with urination Routine cervical cancer screening Within 3 years of first vaginal intercourse or 21 years of age, whichever comes first* Others as specifically indicated

^* Once screening is initiated, adolescents should be screened annually. Special considerations may apply, as noted in the Laboratory Investigation section of the text.

	Having a Listen

 
The gynecologic history-taking for adolescents should include questions regarding common menstrual problems, sexuality-related concerns, and specific genitourinary complaints. These and other sensitive issues should be addressed privately with the examiner, unless the patient specifically requests otherwise. Use of a self-administered questionnaire or checklist may expedite the process. Questions about current medications must be direct and very specific because many adolescents do not consider oral contraceptives, hormonal injections, or other contraceptives to be medication, and they may not want their parents to know that they are using these agents. Most parents respect their adolescents’ need for privacy and . . . [Full Text of this Article]