QC: Pediatric Gynecology: When and How to Perform Safe Pelvic Exams for Young Patients

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Speaker 1
0:41

Today's

guest

is

someone

who

brings

a

deep

expertise
,

compassion

and

innovation

to

the

field

of

gynecology
.

Dr

Megan

Wasson

is

the

chair

of

the

Department

of

Medical

and

Surgical

Gynecology

at

the

Mayo

Clinic

in

Arizona

and

a

professor

of

obstetrics

and

gynecology

at

the

Mayo

Clinic

College

of

Medicine

and

Science
.

Whether

it's

in

the

operating

room
,

at

the

podium

or

shaping

global

surgical

standards
,

dr

Wasson

is

helping

redefine

what

care

can

look

like

for

patients

around

the

world
.

Please

help

me

in

welcoming

Dr

Megan

Wasson
.

How

early

can

a

pelvic

exam

be

safely

and

ethically

performed
,

especially

in

these

young

patients

and

those

experiencing

chronic

symptoms
?

Speaker 2
1:22

Yeah
,

oh

my

gosh
.

I

love

this

question

so

much

because

we

can

do

a

lot

of

trauma

to

individuals

if

that

first

pelvic

exam

is

not

done

very

thoughtfully

and

very

deliberately
.

So

pelvic

exams

and

physical

exams

in

general

can

be

incredibly

beneficial

because

not

all

pain

is

endometriosis

and

we

need

to

make

sure

that

we're

not

missing

alternative

sources

of

pain
.

But

there's

a

subspecialty

within

OBGYN

and

it's

called

pediatric

and

adolescent

gynecology

and

they've

really

perfected

how

we

can

do

these

exams

and

not

do

trauma
.

Speaker 2
1:59

Speculum

exams

really

don't

have

much

place

at

all

in

the

pediatric
,

adolescent

population
,

especially

in

someone

who

has

not

been

yet

sexually

active
.

There's

a

lot

of

trauma

that

we

can

do

with

that
.

But

we

can

inspect

the

vulva
,

we

can

inspect

the

introitus

and

make

sure

there

isn't

something

like

an

imperforate

hymen

that

someone

may

truly

be

cycling

but

the

blood

just

can't

get

out

and

that's

where

their

pain

is

coming

from
.

So

we

can

do

physical

exams
,

especially

in

those

with

pelvic

pain
.

But

that

doesn't

necessitate

doing

what

most

individuals

would

think

of

as

a

pelvic

exam
.

You

don't

need

to

do

a

speculum

exam
.

You

don't

need

to

do

that

by

manual

exam

where

we're

feeling

the

uterus
,

feeling

the

ovaries
.

A

lot

of

just

inspection

is

adequate

to

get

the

answers

we

need
.

Speaker 1
2:46

Is

it

necessary

to

do

that

to

be

able

to

potentially

diagnose

or

know

next

steps
,

or

is

imaging
,

mri

or

ultrasound

beneficial

in

those

cases

where

you
?

Speaker 2
3:01

don't

really

want

to

do

an

exam

like

that
.

Yeah
,

so

that

external

inspection

is

incredibly

helpful
,

specifically

to

make

sure

there

isn't

that

outlet

obstruction
.

So

the

imperforate

hymen
,

okay
,

but

that

isn't

the

point

that

we

stop
.

So

we

absolutely

can

benefit

from

doing

a

ultrasound
,

but

again
,

it

doesn't

have

to

be

an

internal

ultrasound
,

doing

a

screening

ultrasound

with

just

the

probe

on

the

abdomen
,

looking

at

the

structure

of

on

the

abdomen
,

looking

at

the

structure

of

the

uterus
,

looking

at

the

structure

of

the

ovaries

to

make

sure

there's

no

mass
,

make

sure

there's

no

big

cyst

on

the

ovary
.

That's

the

source

of

this

discomfort
.

If

someone

does

have

that

outflow

obstruction

that

even

if

the

cervix

is

blocked

and

they're

not

able

to

bleed

through

the

cervix
,

you'll

see

the

uterus

being

filled

with

blood

and

you'll

be

able

to

see

that

on

the

ultrasound
.

Speaker 2
3:46

So

very

commonly

in

younger

individuals

who

are

struggling

with

pain
,

we

do

lean

very

heavily

on

just

that

extra

inspection

of

the

vulva

and

the

opening

of

the

vagina
,

but

then

also

ultrasound
.

We

really

don't

like

to

do

CAT

scans
,

especially

because

that's

radiation

exposure

for

young

individuals
.

And

then

MRI

absolutely

we

can

use

it

in

very

select

patients
,

but

we

don't

want

to

do

that

on

everyone

either
,

because

that's

a

45

to

an

hour

long

exam

very

commonly

that

you're

asking

a

10

year

old

to

lay

on

a

table

and

hear

this

clanging
,

banging

like
.

How

much

trauma

does

that

induce
?

So

we

just

need

to

be

very

deliberate

and

very

thoughtful

about

what

we're

putting

these

young

individuals

through

and

making

sure

that

there

is

truly

the

benefit

on

the

other

side

of

it

and

we're

not

doing

more

harm

than

good
.

Speaker 1
4:34

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wrap

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.

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