Pediatric Gynecology: Assessment Strategies and Common Problems

Jane H. Kass-Wolff, RN, MS; Ellen E. Wilson, MD

Disclosures

Semin Reprod Med. 2003;21(4) 

In This Article

Collection of Specimens

Specimens of vaginal secretions for cultures, wet mounts, or cytology may be collected in several ways. Vaginal cultures are easily collected by a technique described by Pokorny[7] using a catheter within a catheter. A 4-inch segment of the tip of a no. 12 red rubber catheter is placed over the hub end of a butterfly catheter attached to a 1-mL tuberculin syringe (Fig. 7). Sterile normal saline (0.05 to 1 mL) is instilled slowly and aspirated back to acquire fluid. The aspirated fluid can be used for wet preps and potassium hydroxide (KOH) preps or for culture. Irrigating the vagina with larger amounts of saline after collection of the initial fluid for culture can often wash out small foreign bodies, such as toilet tissue. Collection of material to evaluate for gonorrhea may be collected by swabbing visible discharge on the perineum or in a similar manner as with chlamydia. Cultures for chlamydia must include material taken directly from the mucosal surface using a saline-moistened calcium alginate swab (male urethral swab). The swab is inserted into the vagina as the child coughs, which makes the hymen gape open and serves as a distraction.

Figure 7.

Example of catheter within a catheter for vaginal irrigation and specimen collection. (Reprinted with permission of The McGraw-Hill Companies.)

Radiological tests may be performed in those children who are unable to cooperate or have specific problems, such as suspicion of an abdominal mass, abdominal pain, or precocious puberty. Pelvic ultrasound, computed tomography, or a magnetic resonance imaging (MRI) scan can be scheduled if imaging is indicated.

The physical examination of the prepubertal female must be individualized to the specific problem and to the child. The techniques and helpful hints provided can easily be incorporated into the exam to provide a thorough evaluation of the following common pediatric gynecology problems.

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