Term
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Definition
| At 5-6weeks gestation, fetal gonads are capable of differentiating either into a testis or into an ovary. |
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Term
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Definition
| The gonads do not produce testosterone, and the gonads develop into ovaries. |
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Term
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Definition
| Woffian ducts deteriorate and the Mullerian ducts develop into the uterus, upper vaginal tract, and fallopian tubes. |
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Term
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Definition
| Creamy white or slightly blood tinged discharge is normal for up to 10 days after birth |
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Term
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Definition
| Should be used if the hymenal opening is small; virginal teens |
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Term
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Definition
| Used in a sexually active teen. |
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Term
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Definition
| Septate, cribriform, & transverse diameter |
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Term
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Definition
- In older but prepubertal girls, the hymen is thinner, redder, and more sinsitive to touch.
- With puberty, estrogen effect makes it pinker and more redundant
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Term
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Definition
| Rigid, nonelastic, and thin-walled, lined by columnar epithelium, which normally appears redder than the squamous epithelium lining the vagina of pubertal adolescents and adult women. |
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Term
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Definition
| The development of pubic and axillary hair, occurs at approximately the same time as breast development |
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Term
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Definition
| Development of the breast (occuring as early as 7-8 yoa) |
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Term
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Definition
Vag pH: 6.5-7.5
Mucosa: Columnar epithelium (red)
Discharge: Absent
Normal flora: Gram + Cocci & anaerobic Gram -; gonorrhea & chlamydia focally infect vagina
Vagina Length: 4-5 cm
External genitalia: Thin labia, rigid, nonelastic, wavy, or redundant hymen; more elastic vagina. |
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Term
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Definition
Vag pH: <4.5
Mucosa: Stratified squamous epithelium (pink); presence of columnar epithelium on ectocervix, surrounding the os
Discharge: Present, physiological leukorrhea begins at Tanner stage 2-3
Normal Flora: Lactobacilli; yeast part of normal flora; gonorrhea and chlamydia commonly infect cervix
Vag length: 11-12 cm
External genetalia: Thicker labia; thicker, more elastic, wavy or redundant hymen; more elastic vagina |
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Term
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Definition
1: No pubic hair; thicker more elastic labia; change from columnar to squamous epithelium in vagina, T1-2
2: Downy, scarcely pigmented straight hair, esp. along medial border of labia majora; physiological leukorrhea
3: Sparse, visibly pigmented curly pubic hair on labia; Onset of menses T3-4
4: Hair coarse, curly, abundant, but less than adult; no extension onto medial thighs
5: Lateral spreading, triangle distribution with some spread onto medial thighs |
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Term
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Definition
- Nabothian cysts=small, white/yellow, raised, round areas
- Ectropion=visible ring of reddened columnar epithelium surrounding the os
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Term
| Purpose of the Bimanual Exam |
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Definition
| To assess the cervix, the corpus of the uterus, and the adnexa |
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Term
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Definition
Consistency=Usually firm and shaped like the tip of the nose
Bumps=Nabothian cysts 3-8mm smooth, nontender firm lumps (result from blockage of endocervical gland ducts) |
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Term
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Definition
- Assess size, shape, consistency, mobility, tenderness of uterus, and palpable masses.
- Position varies: Anteverted, anteflexed, midposition, retroverted, retroflexed.
- Normal Uterus=Upsidedown pair; 7.5 cm long, 2.5 cm thick (size of lime)
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Term
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Definition
- Fingers in vagina (right then left lateral fornix, posteriorly, then high)
- Normal Ovaries=Smooth and almond shaped, slightly tender to deep palpation, 3cm X 1.5cm X 1cm.
- Abnormal=Tenderness/fullness, may indicate infection, ectopic pregnancy, or endometriosis
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Term
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Definition
- Omitted in Adolescents unless suspion of abnormality or an extremely retroflexed uterus.
- Index finger in vag, middle finger in rectum, opposite hand on abdomen.
- Rectovaginal septum=thin, pliable, free of masses
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Term
| Suspicion of Sexual Abuse & prompt referral |
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Definition
- Hymenal irregularities or absence
- Acute trauma to the hymen, posterior fourchette, or laceration of vaginal mucosa
- Confirmed sexually transmitted infection (HPV >2yoa)
- Increased erythema, irritation, and vaginal discharge.
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Term
| Differential: Sexual Abuse |
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Definition
| Kept in mind as part of differential whenever nonvenereal infection, chemical irritation, foreign bodies, and or poor hygiene are ruled out. |
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Term
| Vulvar and vaginal abnormalites |
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Definition
| Imperforate hymen, hematocolopos, vaginal agenesis or signs of a transverse vaginal septum, external condyloma, signs of trauma, erythema, discharge |
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Term
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Definition
| Reddened, friable (bleeds with insertion of cotton swab into os), visible condyloma, petechiae, erosions, double cervix, absence of cervix |
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Term
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Definition
**Masses resulting from intrauterine or ectopic pregnancy, from pelvic infection, adnexal torsion secondary to cysts, funcitional corpus luteal or dermoid or other complex ovarian cysts, endometriosis.
**Uterine tumors are rare in the adolescent, ovarian cancers comprise ~1% of all childhood cancers but are most common genital tract cancer in adolescence
**All Adnexal masses should be imaged with US then CT or MRI |
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Term
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Definition
- Adherence of labia minora or majora, seen in girls 3mos-6yoa; adhesion may persist until puberty or may separate spontaneously
- Treatment is controversial if opening is large enought for normal urinary flow and vaginal drainage.
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Term
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Definition
| Usually caused by Staphylococcus aureus and Streptococcus pyogenes |
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Term
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Definition
| May be initially mistaken for a hernia |
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Term
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Definition
- Edema of the clitoris, with hypoproteinemia, in conditions such as nephrotic syndrome
- Hypertrophy of clitoral hood and clitoris, caused by neurofibromatosis, rhabdomyosarcoma, increased androgens
- Hemorrages around clitoris coause by lichen sclerosis or trauma
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Term
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Definition
| Presents with bleeding and friable, red-blue doughnut like annular mass that may be visible in perineum "hemorrhagic cranberry" |
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Term
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Definition
| Uncommon; presents with atrophic hypopigmented parchment like friable skin around vulva and anus, often in an hour glass configuration with inflammation and subepithelial hemmorhages |
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Term
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Definition
| Often results from irritants such as bubble bath, poor hygiene, candidal overgrowth caused by antibiotics or diaper occlusion; rarely scratching can occur secondary to pruritus from a pinworm infestation |
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Term
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Definition
| Vaginal discharge may be caused by bacteria or overgrowth of normal flora; foreign body in vagina (toilet paper); poor hygiene; STI |
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Term
| Straddle injuries to Vulva |
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Definition
| Straddle injuries (playground falls) generally cause trauma to anterior vulvar structurees and rarely cause trauma to posterior portion of hymen or posterior fourchette; injury is usually somewhat asymmetrical and not penetrating in nature. |
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Term
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Definition
| Partially fused labia, enlarged clitoris, hypospadias, bilateral cryptorchdism in an apparent male are signs of a possible intersex condition |
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Term
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Definition
| Vaginal secretions collecting behind an inperforate hymen at birth may appear as a small cycstic mass between labia |
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Term
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Definition
Congenital absence of or hypoplasia of fallopian tubes, uterine corpus, uterine cervix, and proximal portion of vagina; occurring in ~ 1 in 5,000 births; in ~10% of these there is a rudimentary or functional uterus.
Commonly diagnosed at puberty when child presents with primary amenorrhea; however can be recognized at birth; should be diagnosed before onset of puberty.
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