Review of the Prepubertal Gynecologic Examination: Techniques and Anatomic Variation

The prepubescent female genital examination can be challenging. In this article, we describe some techniques that can help to allow the examination to be performed effectively and efficiently. We will review the normal anatomy and anatomic variation present in prepubescent females, as well as how anatomic appearance changes with positioning. We will describe conditions that can distort the normal anatomy, dermatologic conditions that can alter skin color and surface characteristics, and systemic illness with genital findings. Although the differential diagnosis of genital complaints in prepubescent females is broad, skills in performing the genital examination and knowledge about normal anatomic variation are essential to informed diagnostic decisions for this population.