(Pediatrics 2010;126(3):583)
Background
• External genital exam should be conducted at all annual exams. No speculum/bimanual exam required prior to rx of most hormonal contraception (can test urine hCG and STIs)
• STI testing now urine or vaginal swab based; does not require speculum exam
• Current guidelines for Pap test: At age 21, unless HIV+ or immune suppressed for which paps initiated at onset of sexual activity
• Despite high exposure to HPV, most sexually active adolescents clear infection without intervention; avoids potential pregnancy complications in future
• Low grade lesions and ASCUS followed by repeat Pap at 1 yr intervals; colpo only for persistent abnormality or high grade lesion over 2 yr period
Indications for Pelvic Exam
• Persistent vaginal discharge, dysuria in sexually active teen, dysmenorrheal unresponsive to NSAIDs, amenorrhea, abnml vaginal bleeding, lower abdominal pain, IUD or diaphragm placement, suspected rape/sexual abuse, pregnancy, pap test