The physical exam in the pediatric and

adolescent patient
Dr. Eric Tjahyadi
Dr. H. A. Abadi, OBGYN(C)
Anatomy
Gynecology Examination
• A brief examination of the breasts and external genitalia.
• Congenital anomalies that are visible externally, such as imperorate hymen,
may be identified. Alternatively, parent or child has a specific complaint
regarding vulvovaginal pain, rash, bleeding, discharge, or lesions, a
gynecologic examination is directed toward the area of concern.
• A parent or guardian should be present at the examination.
• This allows the child to understand that the examination is sanctioned.
Moreover, clinicians can use this opportunity to inform a parent regarding
findings and potential treatment.
• They can also emphasize the concept o inappropriate genital touching by
others and parental noti cation i this occurs. In mid-to-late adolescence,
however, a patient may prefer, or privacy reasons, not to be examined with
a parent present
A number of positions have been described to allow adequate
visualization of the area, and the most useful will be the one that
facilitates the goal at hand.
• The frog-leg position is the most commonly used position in the younger patient
and allows the patient to have a direct view of the examiner and herself
A number of positions have been described to allow adequate
visualization of the area, and the most useful will be the one that
facilitates the goal at hand.
• Using stirrups and the lithotomy position may assist in better visualization of the
perineal area as a child grows older.
• Asking for mother ’ s assistance with the examination can prove useful and
placing her daughter between her legs may be of assistance
A number of positions have been described to allow adequate
visualization of the area, and the most useful will be the one that
facilitates the goal at hand.
• Combining the use of low-power magnification as with an otoscope or
ophthalmoscope with the knee-chest position, often allows visualization of the
lower and upper vagina.
• This position may be especially helpful in those patients where a vaginal
discharge or a foreign body may be a complaint
• The examination begins with a less-threatening approach to checking the ears,
throat, heart, and lungs.
• Breasts are inspected.
• The external genital examination is best performed with the child in a frog-leg or
knee-chest position to improve visualization.
• Occasionally, the patient may feel more com ortable sitting in a parent’s lap.
• Sitting on a chair or examination table, the parent allows the child’s legs to straddle
the parent’s thighs.
• Once the child is optimally positioned, each labium may be gently held with a
thumb and forefinger and pulled toward the examiner and laterally. In this manner,
the introitus, hymen, and lower portion o the vagina are inspected (Fig. 14-5).
Technique for examination of female genitalia
Proper equipment for this age group should be
available.
A Huffman (1/2 inch wide × 4 inches long) or
Pederson speculum (7/8 inch wide × 4 inches
long) may be of help in young patients and
those who are not sexually active
Breast Development
(Telarche)
Pubic Hair
(Pubarche)
Thank You