Signs of substance abuse, risk-taking behaviors, and trauma *If not, you will need a chaperone.
†For example, 70% of boys can have breast enlargement (gynecomastia), and girls often have one breast larger than the other.
the middle adolescent’s interactions with family, school, and peers. High-risk behaviors as a result of experimentation are common.
Individuality and planning for the future are the major characteristics of late adolescence. Greater emphasis is placed on the late adolescent’s responsibility for his or her health.
A full pelvic examination is rarely required in a virginal adolescent girl. A bimanual rectal-abdominal examination (all midline internal genitalia are immediately anterior to the rectal wall) is as efficient as a vaginal-abdominal examination. In some girls, anesthesia may be required for a full pelvic examination.
Before a pelvic examination, the patient should be informedabout the importance of the assessment and what maneuverswill take place; she should be encouraged to ask questionsbefore, during, or after the examination. A chaperone shouldbe offered when a family caregiver is not present. Assuringthe patient that she has complete control over the examination and allowing participating by using a mirror or guidingthe examiner is important. The examiner should maintain
Classic or juvenile fibroadenoma (70%) Fibrocystic disease Breast cyst Abscess/mastitis Intraductal papilloma Fat necrosis/lipoma Cystosarcoma phyllodes (low-grade malignancy) Adenomatous hyperplasia Hemangioma, lymphangioma, lymphoma (rare) Carcinoma (<1%) eye contact during the examination. Before all maneuvers,the patient must be informed of what to expect and the sensations.
A padded examination table with the patient in a frog-leg position maximizes comfort of a pelvic examination. Stirrups can be used but are less comfortable. The examination room, lubricants, and instruments should be warm. The examination should be unhurried but efficient.
Inspection of the genitalia includes evaluation of thepubic hair, labia majora and minora, clitoris, urethra, andhymenal ring. When a speculum examination is required,it must be performed before bimanual palpation of internalgenitalia because lubricants interfere with the evaluationof microscopic and microbiologic samples. The speculumallows visualization of the vaginal walls and cervical os forcollection of appropriate specimens, such as cultures orPapanicolaou (Pap) smears. A Pap smear is not needed untilthe adolescent is sexually active, unless there is a history ofsexual abuse or vulvar infection with human papillomavirus. In the rare circumstance that a vaginal examination isnecessary in a virginal girl, a Huffman (0.5 in. × 4.5 in.) orPederson (0.9 in. × 4.5 in.) speculum should be used. A non-virginal introitus frequently admits a small to medium-sizedadult speculum.
It is not unusual for one breast to begin growth before (or to grow more rapidly than) the other, with resulting asymmetry. Reassurance that after full maturation the asymmetry will be less obvious and that all women have some degree of asymmetry is needed by some. The breast bud is a pea-sized mass below the nipple that is often tender. Occasionally young women present with a breast mass; usually these are benign fibroadenomas or cysts (Table 68-2). Breast cancer is extremely rare in this age group. An ultrasound evaluation is better for the evaluation of young, dense breasts and avoids the radiation exposure of mammography.
Peripubertal girls (sexual maturity rating stage III) often complain of vaginal discharge. If the discharge is clear without
Drugs Antiandrogens Antibiotics (isoniazid, ketoconazole, metronidazole) Antacids (H2 blockers) Cancer chemotherapy (especially alkylating agents) Cardiovascular drugs