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Pediatric & Adolescent Services

doctor and young patient bump elbows

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.

Evaluating these problems can be critical to ruling out a serious disorder or disease.


Conditions We Treat

Conditions more common in younger girls:

Conditions more common in adolescent girls:

  • Delay in, or absence of development of secondary sex characteristics such as breast development
  • Delay of onset of menstrual periods
  • Congenital malformation, including:
    • 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, including:
    • Precocious puberty (abnormally early development)
    • Primary amenorrhea (delayed onset or absence of menstrual periods)




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.

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


What to expect for an outpatient procedure where anesthesia is required:

  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 for an exam under anesthesia include:

  • 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 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.

Bayview Hospital

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

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