••• Chapter 40^ Pediatric and Adolescent Gynecology^395
❍ What is the role of laparoscopy in vaginal agenesis?
Laparoscopy is useful in evaluating patients with cyclic abdominal pain. It is useful in identifying the presence of
obstructed hemiuteri, and in the surgical removal of these structures.
❍ What congenital anomalies are associated with Müllerian agenesis?
(1) Inguinal hernia.
(2) Renal agenesis.
(3) Pelvic kidney.
(4) Scoliosis.
❍ What is the first-line approach to the creation of a neovagina?
The nonsurgical creation of a neovagina using dilators in a recumbent position is the primary approach. Many
patients report dilation using the bicycle seat stool to be awkward and uncomfortable. Adherence to the treatment
protocol is improved by providing the patient with a “buddy” who has successfully had vaginal dilation.
❍ Describe the steps in the creation of a neovagina using the Abbe-McIndoe operation.
(1) Dissection of the space between the bladder and the rectum.
(2) Placement into the space of a mold covered with split-thickness skin graft.
(3) Regular postoperative use of vaginal dilators, until regular coitus is assured.
❍ Name the important components of an annual examination of patients after the creation of a neovagina.
Examination for vaginal strictures or stenosis.
Screening for sexually transmitted disease (STD) when appropriate.
Inspection for malignancies for both bowel and skin neovaginas.
Inspecting bowel neovaginas for colitis or ulceration.
❍ When is it appropriate to initiate cervical screening in adolescents?
Cervical cancer screening should begin at 21 years of age, regardless of age at first sexual intercourse. The rate
of infection with human papillomavirus (HPV) in adolescent and young women is high; however, most HPV
infections resolve spontaneously within 1 to 2 years. Only 0.1% of cervical cancers occur in women under the
age of 21.
❍ What HPV genotypes cause 70% of all cases of cervical cancer?
Genotypes 16 and 18.
❍ What HPV genotypes cause 90% of all cases of genital warts?
Genotypes 6 and 11.