Diagnostic methods in pediatric and adolescent gynecology

The evolving role of imaging techniques and endoscopic tools used in gynecologic practice has become essential over the last several years. Pelvic organs of the young girl are deeply hidden in the abdomen and the vagina is narrow and atrophic. The presence of an intact hymen provides an additional obstacle to vaginal examination. Therefore, bimanual pelvic (vaginal/rectal) examination has a limited advantage in this population. It could cause unnecessary discomfort and hamper further 'patient-doctor' dialog. Imaging techniques are constantly improving in sensitivity, thus providing more accurate diagnoses. Ultrasonography which is a safe and available modality provides real-time images of multiple planes and therefore is ideal for pelvic evaluation. It should be an integral part of child and young adolescent examination. Additional modalities such as CT and MRI should be reserved for cases which are ultrasonography doubtful and be applied as a subsequent evaluation. Vaginoscopy and laparoscopy, although invasive, are used for final diagnosis and provision of treatment as 'see and treat' procedures. These main modalities used in the diagnosis of gynecologic disorders in the young are described in this chapter.