Child Girl Pussy Pics

The first famous picaninny was Topsy -- a poorly dressed, disreputable, neglected slave girl. Topsy appeared in Harriet Beecher Stowe's anti-slavery novel Uncle Tom's Cabin. Topsy was created to show the evils of slavery. Here was an untamable "wild child" who had been indelibly corrupted by slavery.

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Picaninnies as portrayed in material culture have skin coloring ranging from medium brown to dark black -- light skinned picaninnies are rare. They include infants and teenagers; however, most appear to be 8-10 years old. Prissy, the inept and hysterical servant girl in Gone With the Wind (Selznick & Fleming, 1939) was an exception. She was older than the typical picaninny, but her character was functionally a picaninny. Picaninny girls (and sometimes boys) have hair tied or matted in short stalks that point in all directions; often the boys are bald, their heads shining like metal. The children have big, wide eyes, and oversized mouths -- ostensibly to accommodate huge pieces of watermelon.

Picaninnies were often depicted side by side with animals. For example, a 1907 postcard, showed a Black child on his knees looking at a pig. The caption read, "Whose Baby is OO?" A 1930s bisque match holder showed a black baby emerging from an egg while a rooster looked on. On postcards black children were often referred to as coons, monkeys, crows, and opossums. A 1930s pinback2 showed a bird with the head of a black girl. Picaninnies were "shown crawling on the ground, climbing trees, straddled over logs, or in other ways assuming animal-like postures" (Turner, p. 15). The message was this: black children are more animal than human.

A gentle, patient approach is important when examining a prepubertal girl. Pay special attention to anatomic and pathophysiologic differences in the child. Emphasize setting the stage to make the examination a positive experience for your young patient.

A gentle, patient approach is important when examininga prepubertal girl. Pay special attention to anatomic and pathophysiologicdifferences in the child. Emphasize setting the stage to make the examinationa positive experience for your young patient.

Gynecologic assessment of the prepubertal girl is an essential componentof preventive and diagnostic pediatric care. Routine gynecologic examinationof infants and children can help prevent future health problems such asvulvovaginitis by giving the clinician the opportunity to educate parentsabout perineal hygiene.1 During the annual genital inspection,the pediatrician also may discover such significant abnormalities as clitoromegaly,signs of early puberty, vulvar dermatoses, or rarely hymenal or vaginaltrauma. A more thorough gynecologic examination is warranted for the evaluationof vaginal bleeding, vaginal discharge, trauma, or pelvic pain. It is importantto be aware that the gynecologic examination can influence her future attitudetoward gynecologic care. Making the examination a positive experience, ifpossible, therefore is critical.2

One of the most important principles to keep in mind when examining ayoung girl is to maintain her sense of control over the process. This canbe accomplished by establishing rapport with the child, keeping the paceunhurried, proceeding from less to more intrusive examinations and askingfor consent before proceeding, and allowing the child to be an active participantin the process as much as possible.2

Explain to the child that the most important part of the examinationis "looking," and that it is important for her to communicatewith you during the examination. Tell the child that the examination willnot hurt, and if you are going to use instruments, that these tools areall specially designed for little girls.1Let the child look atand touch the instruments to be used, such as an otoscope or a hand lens.When talking with parents, it is important to carefully explain that thechild's hymen will not be altered in any way by the examination, becausemany parents do not fully understand the anatomy of the vagina and hymen.Basic diagrams of the anatomy may be helpful.

If you need to visualize the vagina and cervix and the child is olderthan 2 years, the knee-chest position may be useful. Have the child resther head to one side on her folded arms and support her weight on bent knees,which are six to eight inches apart. The child's buttocks will now be heldup in the air and her back and abdomen will fall downward (Figure 4). Usingthis position and an otoscope head for magnification and light, you willbe able to visualize the lower vagina, and usually the upper vagina andcervix, in 80% to 90% of prepubertal girls.3

With the child supine, begin your external examination by inspectingher external genitalia (Figure 5). The child can assist you by holding herlabia apart. Inspect her for pubic hair and note the condition of the urethra,size of the clitoris, any signs of estrogenization, configuration of thehymen, and perineal hygiene. Newborns will exhibit maternal estrogen effects:the labia majora, labia minora, and clitoris will be relatively large, theepithelium a dull pink color, and the hymen often thick and redundant. Afterthe newborn period, the average size of a normal clitoral glans in a premenarchalchild is 3 mm in length and 3 mm in transverse diameter.4 Inprepubertal girls, the vaginal mucosa and perihymenal tissue will be moreatrophic and appear thin and red.

In a microperforate hymen, it may be difficult to identify an opening.To establish its presence, try squirting a small amount of warm water orsaline with a syringe or angiocath, placing the girl in the knee-chest position,or probing with a small urethral catheter, feeding tube, or nasopharyngealCalgiswab moistened with saline or vaginal lubricant (Figure 8). If vaginalcultures are not needed, lidocaine jelly can be used to decrease the child'sdiscomfort. If you still cannot locate a hymenal opening, the child mayhave an imperforate hymen or vaginal agenesis. An imperforate hymen appearsas a thin membrane, and will bulge if hydromucocolpos is present. Vaginalagenesis is characterized by thick vestibular tissue, and often there isa dimple surrounded by a vulvar depression where the hymen should be.6

The vulva and anus. Next, examine the child's vulva and anus, observingfor hygiene, erythema, excoriation, labial adhesions, signs of trauma, andanatomic abnormalities. If extensive labial adhesions are present, you maynot be able to adequately examine the hymen and vagina and will need toreexamine the child after she has successfully completed treatment withlocal hygiene measures and topical estrogen (see Sidebar, "Common gynecologicfindings in the prepubertal girl").

After you have examined the external genitalia, you should visualizethe vagina if the child complains of discharge or bleeding that may be vaginalin origin, or if you suspect a tumor, ectopic ureter, or vaginal foreignbody.6 In premenarchal girls, the vagina is 4 to 5 cm long withthin, red epithelium. In perimenarchal girls, the vagina is 8 cm long, andthe vaginal mucosa and hymen are thicker. Leukorrhea may be present.

The hymen and vagina usually can be seen adequately when a child is inthe supine position, with her legs flexed on her abdomen. For girls olderthan 2 years, the knee-chest position also permits excellent visualizationof the vagina and cervix without instrumentation.3 If necessary,an experienced examiner or pediatric gynecologist may use a small vaginoscope,cystoscope, hysteroscope, or flexible fiberoptic scope with water insufflationof the vagina to improve visualization.

Rectoabdominal exam. After obtaining samples, perform a gentle rectoabdominalexamination with the patient either in stirrups or supine. This is especiallyimportant in girls who have persistent vaginal discharge, bleeding, or pelvicpain because it often is possible for an examiner to express vaginal discharge,palpate a foreign body, and detect masses. The child should be told thatthe examination will be similar to having her temperature taken or havinga bowel movement, and that a finger has a smaller diameter than a bowelmovement. After the newborn period, when the uterus is enlarged becauseof maternal estrogen effect, your examination should reveal a small, button-likecervix and uterus. Abdominal or upper pelvic masses that are palpable mayrepresent ovarian tumors. At the end of the examination, use your fingerto "milk" the vagina and assess for discharge or, very rarely,polypoid tumors.

Managing vulvovaginitis. A girl who has nonspecific vaginitis shouldbe counseled to do the following: (1) practice good perineal hygiene; (2)urinate with her knees spread apart; (3) wear white cotton underpants andloose clothing; (4) take sitz baths once or twice a day; (5) avoid irritantssuch as bubble bath and use hypoallergenic soaps; and (6) apply a barrierointment such as A and D, Vaseline, or Desitin to the perineum. If the child'ssymptoms of vulvovaginitis persist, you should review your diagnosis. Forunusually persistent cases, it is appropriate to prescribe a 10-day trialof antibiotics (amoxicillin, amoxicillin-clavulanate, or a cephalosporin)or occasionally a two- to three-week course of an estrogen cream. If youidentify a specific pathogen, appropriate antibiotic therapy is indicated,in addition to the measures previously described. 2ff7e9595c