Concepts of Pediatric and Adolescent Gynecology Donald E. Greydanus MD, Dr HC (ATHENS) Professor Pediatrics & Human Development Michigan State University College of Human Medicine East Lansing & Kalamazoo, Michigan USA [email protected] A. Approach to the Prepubertal Child Genital Inspection B. Genital Complaints in the Prepubertal Child 1. Vaginitis - Normal Vaginal Flora 2. Management of Vulvovagnitis 3. Vaginal Bleeding 4. Lichen Sclerosis 5. Labial Adhesions External Female Genitalia: Prepubertal Frog-leg position for genital Exam of Child Knee-Chest Position Hymen: Frog Leg vs. Knee Chest— same patient Normal Hymen—Knee-Chest Position