When adolescent females present at EDs with abdominal pain, they are inconsistently diagnosed through a gynecological history and pelvic exam. Sometimes, this can lead to the wrong treatment, which suggests a need for comprehensive sexual and gynecological health intake, according to researchers.1
“We originally did this study because we had a couple of girls who presented to Nationwide Children’s Hospital with lower abdominal pain and went into the operating room for laparoscopy,” says Geri Hewitt, MD, chief of pediatric and adolescent gynecology at Nationwide Children’s Hospital in Columbus, OH. The laparoscopy revealed pelvic inflammatory disease (PID). “We were wondering if girls get treated differently if they present to a pediatric hospital with lower abdominal pain than at a general hospital for the pain,” she says.
Hewitt and colleagues found both settings lacked comprehensive sexual and reproductive health history when adolescent females presented with abdominal pain.
“But those who presented at a pediatric hospital were more likely to have a radiological study imaging. In the adult hospital, they were more likely to have lower abdominal pain,” Hewitt explains. “The way we diagnose PID is a clinical diagnosis: If someone has lower abdominal pain, you would note cervical motion tenderness. Both of these girls had significant enough PID that I would surmise that if they had had a pelvic exam, that would have been noted.”
Adolescent girls who present to the ED with abdominal pain are more likely to undergo a pelvic exam in the adult hospital setting. “You would want to do a pelvic exam to diagnose things like PID or vaginitis,” Hewitt says.
But the first step should be a comprehensive reproductive and sexual history. “It indicates a willingness to perform an exam based on what they find out when they do the history,” she says.
In Ohio, hospital EDs cannot perform exams of minors without parental consent. The consent for care would cover a pelvic exam, which could be conducted confidentially with the patient.
“Particularly with younger adolescents, to do a confidential conversation with them when the parents are out of the room is to do a good history,” Hewitt explains. “Then, you can tailor the evaluation and testing from what you learned from the patient’s history.”
Physicians and reproductive care providers need heightened awareness when treating a young patient with lower abdominal pain. They should ask questions and document the patient’s answers.
“Do not hesitate to do a comprehensive evaluation, which under certain circumstances may include testing for sexually transmitted infections,” Hewitt adds. “They should do a pelvic exam for girls who are sexually active and present with a common symptom like abdominal pain.”
From the perspective of a physician and researcher, the findings also suggest a difference in how adolescent females are treated in adult vs. children’s hospitals.
“I practice at adult and pediatric hospitals, and I do see a difference in terms of the comfort and willingness to address sexual and reproductive health, sometimes, in the pediatric setting,” Hewitt explains. “Providers need confidence in their skill set so they can do things like a pelvic exam.”
REFERENCE
- Onwuka AJ, Knaus ME, Lawrence AE, et al. Comparing the evaluation of abdominal pain in adolescent females at a pediatric vs. general emergency department. J Pediatr Adolesc Gynecol 2022;S1083-3188(22)00187-5.
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