Adolescent Gynecology

· Promote parent-child interchange about sexuality

· Encourage parents to be good role models

· Encourage open discussion at age-appropriate levels

· Provide quality education through pamphlets, one on one counseling, being involved in community programs

· Life skills training, role playing and motivational interviewing

Normal Menstrual Cycle Parameters

· Median age on onset 12.7 years

· 90% of females have had menarche by sexual maturity rating 4

· Cycle length is 21-35 days

· 3-7 days of flow (>8 days considered abnormal)

· Normal blood loss is 30-40 mL (>80 abnormal)

· Regular ovulatory cycles may not be established for up to 2 years after menarche.

· Commonly precedes menarche 3-6 months

· Usually described as copious, whitish mucoid discharge with no odor or irritation

· Diagnosis made by wet mount with epithelial cells without evidence of inflammation, absence of infections

· Treatment consists of adolescent gynecology symptomatic care.

· Detailed sexual history including:

· menarche

· tampon and/or condom use

· gravidity/pregnancies caused and outcome - contraceptive methods - number of partners - prior infections

· description of discharge e.g. pruritic, odorous, quantity, onset, color, consistency

· Good external exam including inguinal region and pubic hair

· Abdominal exam

· Vaginal samples

- Blind vaginal swabs appropriate in young girls (12 to 13) if virginal and exam consistent

- Speculum exam preferred in older girls and those who are sexually active to examine and sample the cervix

· Vaginal pool for