SURVEY OF GYNECOLOGICAL PROBLEMS DURING CHILDHOOD AND EARLY ADOLESCENCE IN A ACADEMICCENTER ppt

Συρϖεψ οφ Γψνεχολογιχαλ Προβλεµσ ∆υρινγ Χηιλδηοοδ ανδ Εαρλψ Αδολεσχενχε ιν αν Αχαδεµιχ Χεντερ A c t a U n i v e r s i t a t i s T a m p e r e n s i s 1024 ΑΧΑ∆ΕΜΙΧ ∆ΙΣΣΕΡΤΑΤΙΟΝ Το βε πρεσεντεδ, ωιτη τηε περµισσιον οφ τηε Φαχυλτψ οφ Μεδιχινε οφ τηε Υνιϖερσιτψ οφ Ταµπερε, φορ πυβλιχ δισχυσσιον ιν τηε αυδιτοριυµ οφ Φινν−Μεδι 1, Βιοκατυ 6, Ταµπερε, ον Αυγυστ 20τη, 2004, ατ 12 οχλοχκ. ΣΑΙΛΑ ΠΙΙΠΠΟ ∆ιστριβυτιον Υνιϖερσιτψ οφ Ταµπερε Βοοκσηοπ ΤΑϑΥ Π.Ο. Βοξ 617 33014 Υνιϖερσιτψ οφ Ταµπερε Φινλανδ Χοϖερ δεσιγν βψ ϑυηα Σιρο Πριντεδ δισσερτατιον Αχτα Υνιϖερσιτατισ Ταµπερενσισ 1024 ΙΣΒΝ 951−44−6045−6 ΙΣΣΝ 1455−1616 Ταµπερεεν Ψλιοπιστοπαινο Οψ  ϑυϖενεσ Πριντ Ταµπερε 2004 Τελ. +358 3 215 6055 Φαξ +358 3 215 7685 ταϕυ≅υτα.φι ηττπ://γρανυµ.υτα.φι Ελεχτρονιχ δισσερτατιον Αχτα Ελεχτρονιχα Υνιϖερσιτατισ Ταµπερενσισ 369 ΙΣΒΝ 951−44−6046−4 ΙΣΣΝ 1456−954Ξ ηττπ://αχτα.υτα.φι ΑΧΑ∆ΕΜΙΧ ∆ΙΣΣΕΡΤΑΤΙΟΝ Υνιϖερσιτψ οφ Ταµπερε, Μεδιχαλ Σχηοολ Ταµπερε Υνιϖερσιτψ Ηοσπιταλ, ∆επαρτµεντσ οφ Οβστετριχσ & Γψνεχολογψ, Πεδιατριχσ, ανδ Χηιλδ Πσψχηιατρψ Ηελσινκι Υνιϖερσιτψ Ηοσπιταλ, ∆επαρτµεντ οφ Πεδιατριχσ Φινλανδ Συπερϖισεδ βψ ∆οχεντ Ηαννα Λιισα Λενκο Υνιϖερσιτψ οφ Ταµπερε ∆οχεντ Ριστο Τυιµαλα Υνιϖερσιτψ οφ Ταµπερε Ρεϖιεωεδ βψ ∆οχεντ Λεο ∆υνκελ Υνιϖερσιτψ οφ Ηελσινκι Προφεσσορ ϑυηα Ταπαναινεν Υνιϖερσιτψ οφ Ουλυ To all my girls [...]... visual examination Owing to the lack of estrogen the vaginal mucosa is thin and less resistant to infectious organisms and irritants After puberty normal vaginal flora and the etiology of infections are the same as during adulthood 4.1 Vulvovaginitis Vulvovaginitis is inflammation of the vulvar and vaginal tissues In children, the vulva is usually inflamed first with the vagina uninvolved, or secondarily... can be used transrectally (Estroff 1997) Transrectal scanning can be used in children and adolescents instead of transvaginal scanning The images obtained are superior to transabdominal images and comparable to those obtained by transvaginal sonography (Timor-Tritsch et al 2003) 2.5.1 Sonographic findings in the normal ovary At birth the ovary is located within the superior margin of the broad ligament... infections are vaginal discharge (53%), erythema (15%) and pruritus (27%) (Koumantakis et al 1997) Vaginal discomfort, urinary symptoms and an abnormal odor can also be present The majority of cases of pediatric vulvovaginitis does not have a specific etiology (Paradise et al 1982, Jaquiery et al 1999) An alteration in the flora of the vagina is thought to cause the vulvar and distal vaginal inflammation Asymptomatic... examination and insufficient knowledge of the examination In a German study 169 girls up to 16 years of age, who had been examined at a pediatric and adolescent gynecological clinic, answered a questionnaire about anxiety and pain during the visit Anxiety was reported by 52% of the girls and pain by 28% and there was positive correlation between anxiety and pain The sex of the examiner had no influence on... and growth, normal anatomy and special features of gynecological conditions appearing during childhood The purpose of this study was to analyze the gynecological problems, gynecological examinations and findings in young female patients up to 17 years of age as seen at hospital level, especially at a consultation clinic for pediatric and adolescent gynecology 15 REVIEW OF THE LITERATURE This literature... protection against infections The vagina becomes more elastic By Tanner stage III the hymen is obviously thicker and by stage V, folded and the vascular pattern disappears At Tanner stage IV the labia minora become larger and more pigmented, offering better protection to the vestibulum and vaginal opening (Yordan et al 1992) 2.2 Settings for examination Patience during the examination, knowledge and clinical... The cervix-corpus ratio is 3:1 In a newborn up to eight weeks of age the vulva and vagina are under the influence of placental estrogens The labia majora are large and bulbous at birth and start to flatten a few days after birth The mons pubis is a fatty pad and the vestibule is more anteriorly placed than it is in an adult woman The labia minora are larger than in older children and close the vestibule... for an answer 18 2 Gynecological examination of children Gynecological examination of children is still a taboo subject and can be a frightening experience for the patient, her guardian and even for the physician Examination of the female genitalia is not routinely included in the health examination of girls In the USA trained student observers rated 123 physical examinations of children under 10 years... sonography At the age of six ovarian volume started to increase and more rapid growth was seen after the age of 9 years A microcystic ovarian structure appeared at the age of 6–8 years in 20% of the girls and at 9–12 years in 30–50% of them Macrocystic ovaries appeared at the age of 12 The uterus undergoes a regular increase in size and the cervix-corpus ratio changes progressively with advancing puberty... gonadostat hypothesis A new theory was based on the findings that agonadal patients showed identical changes in gonadotropin secretion throughout infancy as gonadal patients (Conte et al 1980) This indicates that a central inhibitory system restrains GnRH release and induces the quiescent phase in gonadotropin secretion Between 7–10 years is the awakening phase, with adrenal, pituitary and ovarian activity . cm long with a thin, red epithelium, alkaline pH and mixed bacterial flora. The labia majora are flat and the labia minora small and thin, offering little. weeks of age the vulva and vagina are under the influence of placental estrogens. The labia majora are large and bulbous at birth and start to flatten a few