The Role of Examination under Anesthesia (EUA) and Vaginoscopy in Pediatric and Adolescent Gynecology: A Retrospective Review

• Published in: Journal of pediatric & adolescent gynecology Vol. 25; no. 1; pp. 64 - 66
• Main Authors: Nakhal, Rola S., MD, Wood, Dan, MBBS, PhD, FRCS, Creighton, Sarah M., MD, FRCOG
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2012
• Subjects: Adolescent; Anesthesia, General - methods; Child; Diagnosis, Differential; Disorders of sex development; Disorders of Sex Development - diagnosis; Endoscopy - methods; Examination under anesthesia; Female; Genital Diseases, Female - diagnosis; Gynecological Examination - methods; Humans; Obstetrics and Gynecology; Pediatrics; Pelvic pain; Retrospective Studies; Vaginal bleeding; Vaginal discharge; Vaginoscopy; Examination under anesthesia; Vaginal bleeding; Disorders of sex development; Vaginal discharge; Vaginoscopy; Pelvic pain
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/j.jpag.2011.08.005

Abstract Background Examination under anesthesia (EUA) with diagnostic vaginoscopy is an invaluable method in the lower genital tract assessment of pediatric and adolescent females. The literature on this topic remains scarce. Methods This is a retrospective medical notes review of all patients who underwent EUA with or without vaginoscopy over the past 5 years at a pediatric and adolescent gynecology unit specializing in disorders of sex development (DSD). Results From 2005 to 2010, 83 patients underwent 92 procedures. All procedures were performed under general anesthesia, and a 3-mm pediatric cystoscope was used for vaginoscopy. Of the 92 cases, 33 (36%) were EUA alone and 59 (64%) consisted of a combined EUA and vaginoscopy. The mean age was 13.3 ± 3.7 years. The most common indications included assessment for reconstructive surgery (33.7%), vaginal stenosis (21.7%), vaginal discharge (19.6%), vaginal bleeding (16.3%), and pelvic pain (8.7%). Most (61%) of those presenting for assessment for reconstructive surgery had a DSD and history of surgical correction in early childhood. In 88 cases (96%), the evaluation was satisfactory and a diagnosis was reached or normality confirmed. Four cases (4%) required further investigation. No significant intraoperative or postoperative complications were encountered. Of the 92 cases, 15 (16%) required a further minor procedure, which was performed at the time of the EUA/vaginoscopy. Another 33 (36%) required further major surgery, which was performed at a later date. Conclusion EUA/vaginoscopy is a safe and highly useful method in the assessment of the lower genital tract in pediatric and adolescent patients.