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Pediatric & Adolescent Services

At the Pediatric and Adolescent Gynecology Center, our physicians evaluate patients with congenital malformations (problems that have been present since birth) as well as other problems that may occur in young girls, such as:

  • Abnormal vaginal discharge
  • Abnormal vaginal bleeding
  • Labial agglutination/fusion/adhesions
  • Ovarian cysts
  • Vulvar or vaginal skin conditions, including:
    • Common types of vaginitis such as yeast infections or bacterial vaginosis
    • Eczema
    • Lichen sclerosis,
    • Lichen simplex chronicus
    • Lichen planus

We also evaluate and treat older girls with problems, including: 

  • Delay in, or absence of development of secondary sex characteristics such as breast development
  • Delay of onset of menstrual periods

Congenital malformations we evaluate include:

  • Mullerian anomalies - including uterine and vaginal abnormalities that range from total absence of the uterus or vagina to abnormally shaped or divided organs.
  • Androgen insensitivity and other chromosome problems
  • Imperforate hymen (blocked vaginal opening)

Developmental disorders we evaluate include:

  • Precocious puberty (abnormally early development)
  • Primary amenorrhea (delayed onset or absence of menstrual periods)

Evaluating these problems is critical to rule out a serious disorder or disease.

Evaluation

Evaluation generally includes a brief visit in the office with the child and one or both parents. Any examination that occurs in the office is limited to a very brief visual inspection of the external genitalia. Speculum exams and internal exams are NOT required and are never performed on a young child in the office.

Procedures

The primary goal of this visit is to obtain a history of the problem and to determine if an exam under anesthesia is required. In an exam is indicated, this will be scheduled at the Johns Hopkins Bayview Medical Center for this outpatient procedure. 

What to expect at the procedure

  1. One parent may carry or walk with the child all the way into the operating room and remain there until the child is asleep.
  2. Anesthesia is usually given to a child through a scented mask until the child is asleep. No needle sticks or intravenous lines are placed until after the child is asleep.
  3. The parent is then escorted to the waiting area while the procedure is performed.

Types of procedures that may be recommended may include an exam under anesthesia:

  • Cystoscopy. This exam involves the use of a similar telescope-like device to look inside the bladder.
  • Vaginoscopy.  An exam under anesthesia involves looking very carefully at the genitals, including looking inside the vagina with a very small instrument called a vaginoscope. This instrument is like a small telescope, only 3mm in diameter, which allows us to look up inside the vagina without causing any stretching or tearing.
  • Vulvar biopsy.  This involves taking a very small piece of tissue from the skin of the vulva so that it can be evaluated microscopically. Children actually rarely have any pain from these biopsy sites, particularly when they are very young.

Other tests that may be ordered that may occur outside the operating area include ultrasounds or MRI or various blood tests. Depending on the age of the child, sedation may be required to obtain these tests as well.

Depending on the type of problem diagnosed, a variety of medicines might be prescribed for a child, or, rarely, surgery to correct a problem may be indicated. Sometimes the child must reach a certain age before corrective surgery can be performed.

The Department of Gynecology and Obstetrics
Gynecologic Specialties

Pediatric and Adolescent Gynecology Services
Children's Medical Practice at Johns Hopkins Bayview
5501 Hopkins Bayview Circle
Baltimore, MD  21224
Appointments:  410-550-4605 or 410-550-4606

 

 

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