Genital examination in the supine position

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Genital examination in the supine position

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Examination in the supine position. Examination for sexual abuse concerns should include a general physical examination, documentation of Tanner staging of breasts and pubic hair, and an external genital examination. Internal (speculum) examination is required only for adolescents in whom testing for previously acquired sexually transmitted infection or Pap testing is indicated. The use of stirrups may improve visualization in larger children or adolescents. Young children who are reluctant to be examined may be positioned in the lap of a seated parent.A, External genital examination is performed with the child in the supine “frog-leg” position. B, The labia are retracted laterally and posteriorly to expose the hymen. If the hymen is not adequately visualized, the labia are each grasped between the examiner’s index finger and thumb and retracted outwards and posteriorly (C). Care should be taken to avoid excessive stretch of the posterior fourchette during retraction