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Hi. In this lecture we'll be reviewing pediatric GYN topics.
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You may sometimes see these questions on the USMLE, so let's begin.
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First, I wanna start with a question.
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What is the most common foreign body in prepubertal girls?
Not sure? That's okay.
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Continue to listen to the lecture and I'll give you the answer.
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So let's now talk about the reproductive anatomy
in girls specifically types of hymen.
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So here you can see a normal hymen with the normal external genitalia.
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However, sometimes the hymen can have an incomplete perforation.
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Typically, a patient can menstruate when she undergoes puberty and menarche with this type of hymen, but she may have also a septate hymen.
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Again, there is enough of an opening to allow menstrual blood to come out.
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You can sometimes have a cribriform hymen or a microperforate hymen.
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This restricts blood flow more
and sometimes we have a hymen that is imperforate.
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These patients have hematocolpos.
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When you do a physical exam on a young girl make sure to look.
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Let's now review reproductive anatomy in girls.
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In general we look at breast development and pubic hair.
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We have different tanner staging
and this is reviewed in another lecture called normal puberty.
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Remember, that tanner stage does not include 0
and prepubertal girls should be stage 1
and as they develop go through stages 2, 3, 4
and eventually 5, which is an adult contoured breast.
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Girls can also have prepubertal pubic hair.
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They may have fine vellus hair but at stage 1
you really can't see it unless you have closed inspection.
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Then as they start to develop and undergo puberche and adrenarche,
you can see that the pubic hair starts to extend
until finally in stage 5, it surrounds the thighs.
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Here, you can see the reproductive physiology of a prepubertal girl.
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When she's in utero in her mother's uterus hCG is what she's exposed to.
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You see here at the mid-gestation that she actually has
oogenesis and oogonia who make all the oocytes
or follicles that she'll have for life.
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These numbers decrease as she ages after birth.
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Also, in the mid-gestation which parallels the rise in hCG
can have a rise in FSH and LH.
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At birth this return to quiescent values.
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However, with the onset of puberty this increases
as puberty requires FSH and LH to be secreted from the anterior pituitary.
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As a young girl undergoes puberche and adrenarche,
you will see a rise in DHEA, androstenedione and estradiol.