Gynecologic Emergencies
Anh Do
Introduction
Gynecologic problems are commonly seen in both prepubertal and adolescent age groups
Speculum examination is contraindicated if no history of sexual intercourse
Developmental Changes by Age
Birth to 8 Weeks: Maternal Estrogen Effect
Thickened, enlarged labia minora
Large clitoris
Vaginal discharge/bleed
8 Weeks to 7 Years
Labia majora flat, minora thin
No breasts, no pubic hair
7-10 Years: Premenarchal
Labia majora filling out, labia minora thickening
Leukorrhea
Adolescent
Hormonal effects, adult genitalia
Vaginal Bleeding
History
Exam
Urethral Prolapse
Protrusion of distal urethral mucosa beyond urethral meatus
Cause: estrogen deficiency, intra-abdominal pressure, poor attachment of urethral mucosa to underlying smooth muscle
Typical age 3-5 years
African-American predominance
Clinical Presentation
90% present with painless vaginal bleeding/spotting
Acute urinary retention
Dysuria
Edema of prolapsed tissue
Vascular congestion: red/purple soft doughnut-shaped mass
If persistent, necrosis may occur: surgical removal
Treatment
Sitz baths several times daily
Topical estrogen cream +/− antibiotics
Medical treatment successful in up to 70% of cases
Straddle Injury
Caused by a blow to the perineum due to falling on surface/object with force of one’s own body
Mechanisms of injury: fall from bicycle/furniture/playground equipment, climbing, running into object, water injuries (water skiing, water jets, jet skiing)
Majority are minor lacerations/abrasions of genitalia, perineal body
Majority do not require suture repair
If repair required, consult gynecology
Emergency Assessment