Johns Hopkins Gynecologic Specialties - Pediatric and Adolescent Gynecology

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The Department of Gynecology and Obstetrics
Gynecologic Specialties

Pediatric and Adolescent Gynecology Services
Children's Medical Practice at Johns Hopkins Bayview
5501 Hopkins Bayview Circle
Baltimore, MD 21224
Appointments: 410-550-4605 or 410-550-4606

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Meredith Loveless, MD
Pediatric and Adolescent Healthcare Provider

Many different types of problems are treated at the pediatric and adolescent gynecology center. We evaluate patients with congenital malformations (problems that have been present since birth) as well as other problems that may occur in young girls such as abnormal vaginal discharge or bleeding or skin conditions that cause problems like vulvar itching.

We also evaluate and treat older girls with problems like delay in, or absence of development of secondary sex characteristics such as breast development or onset of menstrual periods.

Please see the list below for a more complete list of the types of problems commonly evaluated and treated at the center.

Congenital Malformations:

Bladder exstrophy - a rare condition where a child is born with the bladder outside of the body; associated with other problems including abnormal pelvic bones and can predispose to problems such as prolapse, or tissue bulging or falling out of the vagina
Mullerian anomalies - including uterine and vaginal abnormalities that range from total absence of the uterus or vagina to abnormally shaped or divided organs.

Androgen insensitivity and other chromosome problems

Imperforate hymen (blocked vaginal opening)

Developmental Disorders:

Precocious puberty (abnormally early development)

Primary amenorrhea (delayed onset or absence of menstrual periods)

Other Gynecologic Problems:

Abnormal vaginal discharge

Abnormal vaginal bleeding

Labial agglutination/fusion/adhesions

Vulvar or vaginal skin conditions (including common types of vaginitis such as yeast infections or bacterial vaginosis and also other skin problems such as excema, lichen sclerosis, lichen simplex chronicus and lichen planus)

Ovarian cysts

These types of problems should always be evaluated, because although most of these problems are not serious and are treatable, infrequently, a more serious problem may be diagnosed.

Evaluation generally includes a brief visit in the office with the child and one or both parents. Any examination that occurs in the office is limited to a very brief visual inspection of the external genitalia. Speculum exams and internal exams are NOT required and are never performed on a young child in the office.

The primary goal of this visit is to obtain a history of the problem and to determine if an exam under anesthesia is required. In an exam is indicated, this will be scheduled at the Johns Hopkins Outpatient Center in the outpatient surgery center. The outpatient surgery center is quite accommodating to young patients and has a dedicated play area for children and specialized teams of doctors and nurses for pediatric patients. Pediatric anesthesiologists generally "pre-medicate" children by giving them something to drink which makes them sleepy. One parent may carry or walk with the child all the way into the operating room and remain there until the child is asleep. Anesthesia is usually given to a child through a scented mask until the child is asleep. No needle sticks or intravenous lines are placed until after the child is asleep. The parent is then escorted to the waiting area while the procedure is performed.

Types of procedures that may be recommended may include an exam under anesthesia, cystoscopy, vaginoscopy or vulvar biopsy.

An exam under anesthesia involves looking very carefully at the genitals, including looking inside the vagina with a very small instrument called a vaginoscope. This instrument is like a small telescope, only 3mm in diameter, which allows us to look up inside the vagina without causing any stretching or tearing.

Cystoscopy involves the use of a similar telescope-like device to look inside the bladder.

Occasionally a vulvar biopsy is indicated. This involves taking a very small piece of tissue from the skin of the vulva so that it can be evaluated microscopically. Children actually rarely have any pain from these biopsy sites, particularly when they are very young.

Other tests that may be ordered that may occur outside the operating area include ultrasounds or MRI or various blood tests. Depending on the age of the child, sedation may be required to obtain these tests as well.

Depending on the type of problem diagnosed, a variety of medicines might be prescribed for a child, or, rarely, surgery to correct a problem may be indicated. Sometimes the child must reach a certain age before surgery can be performed.