Micro-hydrovaginoscopy in examining children.

BACKGROUND

The gynecologic evaluation of children is challenging and requires mastery of special examination techniques.

TECHNIQUE: small-diameter endoscopic trocar sleeves and endoscopes (2 or 3 mm) were used in conjunction with hydrodistention with normal saline, to view atraumatically the entire vagina and cervix.

EXPERIENCE: During the past 3 years we have used micro-hydrovaginoscopy (2-mm trocar sleeve and endoscope, with hydrodistention) for vaginal examination of young girls and in selected cases of young adolescents and virginal adults in whom traditional speculum examination proved difficult or impossible. This technique was effective for (1) confirming diagnosis of cribriform hymen and facilitated hymenotomy; (2) diagnosis of vaginal discharge unresponsive to medical treatment caused by an intravaginal foreign body (color crayon), which was removed under direct endoscopic view; (3) suspected müllerian agenesis and persistent vaginal discharge confirming absence of the cervix and ruling out foreign body in the urogenital portion of the vagina; and (4) a vulvar straddle injury and urinary retention in which vaginal laceration and hematoma were excluded.

CONCLUSION

Micro-hydrovaginoscopy is simple, minimally invasive, and effective for vaginal examination in prepubertal girls. It permits precise and complete diagnosis, directs and assists treatment, and has potential for well- tolerated office use in cooperative patients.