An ultrasonographic exam allows for assessing the uterine proportions and the appearance of the ovaries. The cervix, uterus, and adnexa in the child can be evaluated through an examination, using a finger placed rectally and the other hand abdominally, with the patient lying supine. Vaginal cultures should be obtained before the vaginoscopy. A liquid distention medium can be used for vaginoscopy to visualize the whole vagina and cervix. When performing an anesthesia examination, a lighted Killian nasal speculum and a fiberoptic scope (cystoscope, flexible hysteroscope) are useful for examining the prepubertal vagina. Visualization of the mid and upper vagina may be accomplished while the baby is in the knee-chest position but often requires a sedated examination and instruments. As the maternal hormone levels decrease, the labia majora lose their fullness, and the labia minora and hymen become thinner and flatter. The vaginal mucosa is pink and moist, with an acidic pH. The hymenal folds appear thick and redundant. Normally, the labia majora are full, and the labia minora are thickened. This examination is mostly performed visually, without the use of instruments. It is also essential to evaluate the hymen and the presence of a discharge from the vagina (fluor neonatalis). The gynecologist assesses the appearance of the vulva, the size and color of labia minora and majora, the introitus of the vagina, the color of the mucous membrane, and the size of the clitoris. Knowledge of normal prepubertal anatomy and the use of an accurate terminology are essential for describing and documenting anatomic findings. However, if these abnormalities are disturbing or unusual, the baby should be referred to a pediatric gynecologist for a proper gynecological examination and to a pediatric endocrinologist or pediatric surgeon for further examination and treatment. In most cases, the related changes are physiological. The neonatologist or the pediatrician is usually the first specialist who detects genital abnormalities in a little girl. Adequate feeding is also important with regard to development. In the neonatal period, it is crucial to instruct mothers of the proper hygienic procedures for girls’ genitals and of how to prevent diaper dermatitis. As far as health promotion and prevention are concerned, it is essential to take care of a baby girl’s health in relation to her future maternity since birth. There are, however, some disorders that are typical of the neonatal period. There are not many gynecological problems leading to abnormalities in later development that can be diagnosed in newborns. That is why they should be included in specialistic gynecological care, particularly in its preventive aspect. Girls with gynecological disorders constitute 10% of all gynecological patients. It deals with patients from the neonatal period until maturity. Pediatric-adolescent gynecology or developmental gynecology is separated from general gynecology because of the unique issues that affect the development and anatomy of growing girls and young women. In a broader sense, this medical specialty covers the entire woman’s health, including preventive actions, and represents the specificity of anatomical and physiological distinctness of sex. Gynecology (from the Greek word ‘gyne’ = woman) is the area of medicine that specializes in the diagnosis and treatment of diseases affecting female reproductive organs (“woman’s diseases”).
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