Pocket Pediatrics: The Massachusetts General Hospital for Children Handbook of Pediatrics (Pocket Notebook Series), 2 Ed.

GYNECOLOGIC EXAM

(Pediatrics 2010;126(3):583)

Background

• External genital exam should be conducted at all annual exams. No speculum/bimanual exam required prior to rx of most hormonal contraception (can test urine hCG and STIs)

• STI testing now urine or vaginal swab based; does not require speculum exam

• Current guidelines for Pap test: At age 21, unless HIV+ or immune suppressed for which paps initiated at onset of sexual activity

• Despite high exposure to HPV, most sexually active adolescents clear infection without intervention; avoids potential pregnancy complications in future

• Low grade lesions and ASCUS followed by repeat Pap at 1 yr intervals; colpo only for persistent abnormality or high grade lesion over 2 yr period

Indications for Pelvic Exam

• Persistent vaginal discharge, dysuria in sexually active teen, dysmenorrheal unresponsive to NSAIDs, amenorrhea, abnml vaginal bleeding, lower abdominal pain, IUD or diaphragm placement, suspected rape/sexual abuse, pregnancy, pap test