QC: Pediatric Gynecology: When and How to Perform Safe Pelvic Exams for Young Patients

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Dr. Megan Wasson from Mayo Clinic explains how pediatric gynecological exams can be performed without causing trauma to young patients. She shares expertise on using external examinations and imaging techniques as alternatives to traditional speculum exams for diagnosing pelvic pain in adolescents.

• Speculum exams generally aren't appropriate for pediatric and adolescent patients, especially those who aren't yet sexually active
• External inspection of the vulva and introitus can identify conditions like imperforate hymen without invasive procedures
• Abdominal ultrasounds can effectively check uterine and ovary structure without internal examination
• Healthcare providers should avoid CT scans for young patients due to radiation exposure concerns
• MRIs should be used selectively as the lengthy, noisy procedure may cause trauma for children
• Physicians must balance diagnostic benefits against potential physical and emotional harm

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Episode Transcript

Speaker 1 (00:00):
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(00:21):
expert opinions shared here arefor general information and not
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I'm your host, alana, and it'stime to connect.
Today's guest is someone whobrings a deep expertise,

(00:44):
compassion and innovation to thefield of gynecology.
Dr Megan Wasson is the chair ofthe Department of Medical and
Surgical Gynecology at the MayoClinic in Arizona and a
professor of obstetrics andgynecology at the Mayo Clinic
College of Medicine and Science.
Whether it's in the operatingroom, at the podium or shaping
global surgical standards, drWasson is helping redefine what

(01:05):
care can look like for patientsaround the world.
Please help me in welcoming DrMegan Wasson.
How early can a pelvic exam besafely and ethically performed,
especially in these youngpatients and those experiencing
chronic symptoms?

Speaker 2 (01:22):
Yeah, oh my gosh.
I love this question so muchbecause we can do a lot of
trauma to individuals if thatfirst pelvic exam is not done
very thoughtfully and verydeliberately.
So pelvic exams and physicalexams in general can be
incredibly beneficial becausenot all pain is endometriosis

(01:43):
and we need to make sure thatwe're not missing alternative
sources of pain.
But there's a subspecialtywithin OBGYN and it's called
pediatric and adolescentgynecology and they've really
perfected how we can do theseexams and not do trauma.
Speculum exams really don't havemuch place at all in the

(02:03):
pediatric, adolescent population, especially in someone who has
not been yet sexually active.
There's a lot of trauma that wecan do with that.
But we can inspect the vulva,we can inspect the introitus and
make sure there isn't somethinglike an imperforate hymen that
someone may truly be cycling butthe blood just can't get out
and that's where their pain iscoming from.
So we can do physical exams,especially in those with pelvic

(02:28):
pain.
But that doesn't necessitatedoing what most individuals
would think of as a pelvic exam.
You don't need to do a speculumexam.
You don't need to do that bymanual exam where we're feeling
the uterus, feeling the ovaries.
A lot of just inspection isadequate to get the answers we
need.

Speaker 1 (02:46):
Is it necessary to do that to be able to potentially
diagnose or know next steps, oris imaging, mri or ultrasound
beneficial in those cases whereyou?

Speaker 2 (03:01):
don't really want to do an exam like that.
Yeah, so that externalinspection is incredibly helpful
, specifically to make surethere isn't that outlet
obstruction.
So the imperforate hymen, okay,but that isn't the point that
we stop.
So we absolutely can benefitfrom doing a ultrasound, but
again, it doesn't have to be aninternal ultrasound, doing a
screening ultrasound with justthe probe on the abdomen,

(03:23):
looking at the structure of onthe abdomen, looking at the
structure of the uterus, lookingat the structure of the ovaries
to make sure there's no mass,make sure there's no big cyst on
the ovary.
That's the source of thisdiscomfort.
If someone does have thatoutflow obstruction that even if
the cervix is blocked andthey're not able to bleed
through the cervix, you'll seethe uterus being filled with
blood and you'll be able to seethat on the ultrasound.

(03:46):
So very commonly in youngerindividuals who are struggling
with pain, we do lean veryheavily on just that extra
inspection of the vulva and theopening of the vagina, but then
also ultrasound.
We really don't like to do CATscans, especially because that's
radiation exposure for youngindividuals.
And then MRI absolutely we canuse it in very select patients,

(04:09):
but we don't want to do that oneveryone either, because that's
a 45 to an hour long exam verycommonly that you're asking a 10
year old to lay on a table andhear this clanging, banging like
.
How much trauma does thatinduce?
So we just need to be verydeliberate and very thoughtful
about what we're putting theseyoung individuals through and

(04:29):
making sure that there is trulythe benefit on the other side of
it and we're not doing moreharm than good.

Speaker 1 (04:34):
That's a wrap for this quick connect.
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(04:59):
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