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17 Cards in this Set
- Front
- Back
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physiology of puberty
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hypothalamic-pituitary-gonadal axis dormant until puberty; unknown trigger activates it
-hypothal releases GnRH at night which controls hormones in the anterior pituitary |
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sexual maturity rating
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should be recorded ona visit
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tanner staging
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1. Preadolescent: only a small elevated nipple
2. Breast bud stage: a small mound of breast and nipple develops. The areola widens 3. The breast and areola enlarge. The nipple is flush with the breast surface 4. The areola and nipple form a secondary mound over the breast 5. Mature breasts; only the nipple protrudes |
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female early adolescence
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age 8-13
breast buds begins with SMR 1-2 |
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menarche
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2-2.5 years after begining of puberty
-average age 12 |
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middle adolescence
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14-16
-SMR 3-5 -ht growth peaks -90% of women achieve menarche by SMR 4 -sex drive surges -quesitons of sexual orientation |
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late adoles
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17-20 and beyond
-SMR 5 -sex experimentaiton increases |
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menses
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-irreg for first yr
-anovulatory for 1st yr or so -preg can occur prior to menarche! - |
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precicious puberty
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-develop sex characteristics before normal age (<8)
-do an endocrine evaluation -centrial due to increases FSH or LH -peripheral due to increase of sex steroids |
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pediatric gyn
-indications for inititaing the pelvic exam |
-precoital adolescent
-delayed menarche -secondary amenorrhea -unusual vag discharge -abnormal bleeding -dysmen unresponsive to tx |
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indications for initiating the pelvic exam
postcoital adoles |
-same for precoital but lower your threshold
-STI screening -pap |
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teens and sex
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--nearly 1/2 of all 15-19 yo in the US have had sex at least once
-by the time they are 19 7/10 teens -start having sex by age 17 but dont marry until late 20s thus young sdults at high risk for unwanted preg and STDs for nearly a decade -20% of male and 10% of female teends have at oral sex and not vag sex |
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teens and preg
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-most teens think it cant happen to them
-although teen preg has decline still almost 750,000 women aged 15-19 become preg each year -rate has decline pro due to more consistent contraceptive use -nearly 1/3 of teens preg end in abortion |
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adoles gyn exam: what do teens want
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1. confidentitality
2. reassurance 3. education: teaching about the exam, birth control |
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adoles gyn exam hx
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-important!! may not tell the nurse everything
-look for hidden agendas in the CC -look for healht promotion opportunities -menstrual, preg hx -vag discharge -sexual hx -diet, substance abuse, vaccinations |
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adoles gyn exam: PE
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- should cover vitals, skin, neck breasts, genitalia
-STd screening -explain to them what the exam should feel like, normalize it for them -Labs: STI, bloodwork, urinalysis -offer HPV vaccine to ages 11-12+ -PAP |
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consent and legal aspects
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-consent parent before medical care for minors
-exceptions in nys: 1. emergenices 2. emancipated minors 3. preg related care 4. provision of birth control 5. sexual assault 6. HIV 7. abortion 8. reportable or contagious disease 9. drug or EtoH abuse tx. 10. mental health tx |
