Genital skin exams in girls: expert advice

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Genital skin examinations in girls should be performed with special care and vigilance for signs of abuse, a dermatologist told colleagues at the Experience of virtual meetings of the American Academy of Dermatology.

“One in four adult women complains that they are victims of child sexual abuse in childhood, which is just a staggering figure. This is an opportunity for us to identify these patients early and give them the terminology. to be able to report on what is happening to them, ”he said. pediatric dermatologist Kalyani Marathe, MD, MPH, director of the dermatology division of Cincinnati Children’s Hospital. “We also have the opportunity to give them a sense of agency about their bodies.”

Marathe offered the following recommendations when performing a genital skin exam:

  • Make sure there is a “companion”. “Companions are essential when examining children and adolescents,” he said. “Ask who they prefer. For prepubertal children, usually use the father or mother who is there. If the father is their father, they may ask you to go behind the curtain, in which case you can bring your nurse or assistant. doctor “. Teenagers can ask any of the parents to leave the room, he said. In this case, a nurse, a medical assistant, a resident or an intern can fill it out. “If you have residents or interns with you and the patient really doesn’t want to be examined by a man, honor their request. Don’t force them.”

  • Explain why the exam is conducted. Make sure the patient understands why she is being seen, Marathe advised. For example, say something like “your pediatrician told us you have an itchy area” or “your mom told us there is some color loss in that area, that you have a problem.” He added that it is useful to explain the type of doctor you are, with a comment like the following: “We are examining you because we are specialist skin doctors … We want to help you feel better and make sure that the skin is healed and healthy “.

  • Ask permission from the child and parents to take the exam. While this may seem trivial, “it is very, very important to set the right tone for the meeting,” he said. “If the child says yes, we go to the mother and say, ‘Mother, is it okay for us to take this exam today?’ “You can see a visible relief from the parents, and as he relaxes, the child relaxes. Saying these few things makes the encounter much smoother.” However, “if they say no, you have to accept the answer. … You say, ‘Okay, we won’t do the exam today’ and you’ll see the patient in a few weeks. If it’s urgent, do an exam anesthesia may be an option, he added.

  • Talk to the child about the terms they use for private parts. It may be helpful to ask, “Do you have terms for your private area?” According to Marathe, “this is a good opportunity to educate them about the terms vulva and vagina, as they can use other terminology. Making sure they have the right terms will help patients identify and report abuse sooner.” Marathe recalled that a classmate had a patient who had been calling her private area a “pound cake” and had informed her teacher that someone had touched her “pound cake.” Her teacher did not know what she meant. with this, and this caused a great delay in the denunciation of his child abuse. “

  • Talk about what will happen during the exam. “I like to show them the instruments we will use,” Marathe said. “If we use a flashlight, for example, I like to show them a picture [of a flashlight] or show them that flashlight. If we use a camera to take digital photography, show them this. If we’re going to use a Q-tip or a swab to prove anything or to take a culture, I like to show them in advance to make sure they know what we’re doing. “As for photography.” make sure the father and son know where the photos will go, who will see them, what they will be used for. If they are used for educational purposes, make sure they have given explicit permission and know that they will be disidentified. “

  • Make it clear that the exam will not be painful. It is important to put both the patient and the parents at ease on this front, Marathe said. “Many parents are worried that we will do a speculum test on their prepubertal child. So make sure it is clarified before we do a speculum test.”

Commenting on this topic, Tor Shwayder, MD, a pediatric dermatologist at Henry Ford Health System, Detroit, urged colleagues to take action if they feel suspicious about a possible sign of child abuse, even if they are far from certain that nothing works. “Don’t ignore those feelings in the back of your brain,” he said in an interview.

Most states have child abuse hotlines for medical professionals and major hospitals will have child abuse equipment, Shwayder said. He urged dermatologists to take advantage of these resources when appropriate. “The professionals on the other side of the 800 number or the hospital will help you. You don’t have to decide right away if it’s child abuse. You just have to have a suspicion.”

Marathe and Shwayder do not report disclosures.

This article originally appeared on MDedge.com, which is part of the Medscape professional network.





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