1 / 29

Adolescent Gynecology

Adolescent Gynecology. Amy Gregory Weeks, M.D. Vanderbilt University School of Medicine February 20, 2007. Adolescent Gynecology Patient Encounter. Dramatis Personae Amanda Jones . . . . . . . .Defensive Teenager Mrs. Jones . . . . . . . .Protective Mother

dianne
Download Presentation

Adolescent Gynecology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Adolescent Gynecology Amy Gregory Weeks, M.D. Vanderbilt University School of Medicine February 20, 2007

  2. Adolescent Gynecology Patient Encounter Dramatis Personae Amanda Jones . . . . . . . .Defensive Teenager Mrs. Jones . . . . . . . .Protective Mother Dr. Weisenkeind . . . . . . Average Gynecologist

  3. Scene 1 Dr. Weisenkeind’s Office

  4. Intermission

  5. What else do we want to know about this patient’s menses?

  6. Age of menarche Flow – duration, amount Pads or tampons Intermenstrual bleeding Unusual discharge Pain at other times during the month Bladder/bowel complaints

  7. Do we ask the Question now?

  8. General medical history: points specific to the adolescent patient • Direct your questions to the patient • Adjust your language as necessary – use slang terms as appropriate • She may not know her own PMHx/PSurgHx – include parent when this is the case • Social history is an opportune time to lighten things up. • What grade, what school? • Outside interests • Home situation, brothers/sisters, Mom and Dad? • Grades?

  9. General Medical History, continued • Family history – again, teenagers may not know • Review of Systems: - sleep - homework -dietary habits/exercise

  10. Do we ask the Question now?

  11. Scene 2 Still in the exam room

  12. Intermission

  13. What do we want to ask the patient now?

  14. Number of partners, consensual or not? • STD screening/symptoms • Dyspareunia • Contraception!! • Is there anything else?

  15. JUDGE NOT.

  16. N.B. The patient is still dressed at this point.

  17. Discussion of care with parents: you CAN talk about hormonal contraception, without specifically talking about the patient’s sexual activity.

  18. Physical Examination • NOW the patient gets undressed. • Confidence: If you don’t have it, fake it. • Involve the patient: “verbal anesthesia” • Least invasive to most invasive • Choice of speculum – ask if patient wants to see it

  19. Scene 3 Patient exam room. Mandy is dressed again.

  20. Intermission

  21. Is it okay to play this game?

  22. . . . I have resolved to speak the rude truth in all ways. Ralph Waldo Emerson

  23. Is this the way everyone should approach this issue?

  24. Contraceptive choices • OCP’s • Patch • Ring • Depo Provera • IUD

  25. Gardasil • TABLE 1 Summary of American Cancer Society (ACS) Recommendations for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors • Routine HPV vaccination is recommended for females aged 11 to 12 years. • Females as young as age 9 years may receive HPV vaccination. • HPV vaccination is also recommended for females aged 13 to 18 years to catch up missed vaccine or complete the vaccination series. • There are currently insufficient data* to recommend for or against universal vaccination of females aged 19 to 26 years in the general population. A decision about whether a woman aged 19 to 26 years should receive the vaccine should be based on an informed discussion between the woman and her health care provider regarding her risk of previous HPV exposure and potential benefit from vaccination. Ideally the vaccine should be administered prior to potential exposure to genital HPV through sexual intercourse because the potential benefit is likely to diminish with increasing number of lifetime sexual partners. • HPV vaccination is not currently recommended for women over age 26 years or for males. • Screening for cervical intraepithelial neoplasia and cancer should continue in both vaccinated and unvaccinated women according to current ACS early detection guidelines. • * Insufficient evidence of benefit in women aged 19 to 26 years refers to (1) clinical trial data in women with an average of 2, and not more than 4, lifetime sexual partners, indicating a limited reduction in the overall incidence of cervical intraepithelial neoplasia (CIN)2/3; (2) the absence of efficacy data for the prevention of HPV16/18-related CIN2/3 in women who have had more than 4 lifetime sexual partners; and (3) the lack of cost-effectiveness analyses for vaccination in this age group. CA Cancer J Clin 2007;57:7-28

  26. Every great and commanding moment in the annals of the world is the triumph of some enthusiasm. Ralph Waldo Emerson

More Related