hardening or thickening in the breast tissue. Pediatric and adolescent gynecologists have specialized training that helps them diagnose and treat conditions involving the female reproductive system in this group. Advances in the treatment of childhood, adolescent and young adult (CAYA) cancer over the last decades have greatly improved long-term survival, which now exceeds 80% for some cancer types. That way, if anything changes, you will be more likely to notice the difference. First, small lumps form behind the nipples. These postures allow your healthcare provider to look for differences in size or shape between your Request an Appointment. Introduction. The healthcare professional uses firm pressure with their fingers to feel for: lumps, including their size, shape and whether or not they move within the tissue. To keep your breasts healthy, get a breast exam every 1 to 3 years from ages 25 to 39. But sometimes a doctor or nurse might think a breast exam is a good idea. Wearing gloves may reduce your ability to fully appreciate all the features of a Feb 12, 2023 · 2 /11. A bimanual exam is a thorough check of a patient's cervix, uterus, and ovaries. The common causes of breast masses in children and adolescents and the approach to the evaluation of an adolescent with a breast mass will be Dec 7, 2022 · A testicular self-exam is an inspection of the appearance and feel of your testicles. Nov 3, 2013 · Breast development is the first sign of puberty in the majority of adolescent females. The U. Lots of girls and women have something called fibrocystic breast changes. This is because studies show they do not help find breast cancer or help people live longer. Two possible problems that can affect teen guys are hernias and — rarely — testicular cancer. Raisa Kanareva/Shutterstock. 4,5 Of particular concern is the 2 Get used to the way your breasts look normally. Mar 1, 1999 · Inspect the child's breasts and palpate themfor signs of puberty. Your health care provider will look at your breasts for changes in size, shape, or symmetry. tenderness or pain. The purpose of a breast self-exam is to become familiar with the way your breasts normally look and feel. An estimated 26,393 women under 45 are expected to be diagnosed with breast cancer this year. A more complete pelvic examination is not necessary unless a specific indication exists, as outlined in Table 1. Teens ages 15 to 17 years need to go to the doctor or nurse for a “well-child visit” once a year. With the pads of the three middle fingers, use a firm, smooth touch to make small, dime-sized circular motions up and down the breast tissue. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Raise your right hand over your head. For teen girls, the most common type of breast lump is usually just part of normal breast growth. Figure 1. In this video, Chief of Pediatric and Adolescent Gynecology, Tricia Huguelet, MD, discusses the epidemiology, clinical features and management of ovarian cysts that may occur during the fetal and neonatal periods, and on through adolescence. Download the SaintLukesKC App. 2 percent. women over 40 should have a clinical breast exam yearly. Three in four, if not more, will actually have some breast growth, the result of a biochemical reaction that converts some of their testosterone to the female sex hormone, estrogen. Stand up and repeat the same steps in #4 on both breasts. Breast growth is usually the first sign of puberty girls will notice. This can occur as early as age 8 years. In locations with few experienced practitioners, the iBreastExam might provide a high sensitivity breast evaluation tool. Sometimes doctors do pelvic exams if they think there's a problem. Feb 9, 2018 · ANSWER: You are correct that the role of breast self-exams have changed. During a breast exam, a doctor or nurse practitioner will feel a woman's breasts to check any lumps and bumps and see if there are changes since the last exam. Your healthcare provider will do a physical exam and may order an ultrasound of the breasts in order to make a diagnosis. A self-breast exam should be performed on a regular basis. The majority of breast cancers are diagnosed in women over the age of 50. You may still choose to do a BSE as a way to be familiar with your breasts Some pediatric breast conditions can affect physical health and mental well-being, and may benefit from evaluation and in some cases treatment. Stanford 25 YouTube Channel. 1 in 100,000. It's also common for breast buds to be somewhat tender or sore. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips. Redness of the skin on the breast or nipple. Jan 30, 2024 · Natural Cycle-Related Breast Changes . m. Your doctor or nurse may recommend you do May 1, 2023 · Some of the breast conditions you may have include cyclical breast pain, cysts, fibroadenomas, and fibrocystic breast changes. Step 1: How to visually examine your breasts. If a lump is tender, try an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Komen for the Cure summarizes early breast cancer detection techniques. It’s important that parents bring their daughters in for an office visit before they are sexually active. Find a mammography facility near you. Call 646-497-9064. Around 1 in 10 women who attend The Royal Marsden diagnosis and assessment clinics, held daily at Sutton and three times a week at Chelsea, are found to have cancer; 9 out of 10 women receive positive news of no cancer being found. Feel for any lumps, thick spots or other changes. Use light pressure, then medium, then firm. Pelvic exam is a important part of the exam for female patients and important towards making various diagnoses such as yeast vulvovaginitis, bacterial vaginosis, lichen sclerosis, cancers such as cervical cancer, anal/rectal cancer, sexually-transmitted infections (gonorrhea, chlamydia, trichomonas, syphilis, herpes and human papillomavirus) and many other diagnoses. Breast Cancer, Breast Self Exam (BSE) Grade D recommendation. Can teenagers get breast cancer? Developing breast cancer when you’re a teenager is very rare. The teen years Dec 16, 2020 · Usually, your daughter’s first gynecologist appointment is just to get acquainted with the doctor and talk about her development, and a traditional exam does not take place. Teens don't usually get pelvic exams. Breast self-examination, carried out once monthly, between the 7th and 10th day of the menstrual cycle, goes a long way in detecting breast cancer at the early Signs of breast infection. If there is a possibility that you might be pregnant, take a pregnancy test if you can. (Eastern time) Make an Appointment. A clinical breast examination may be part of your regular checkup. Your provider Nov 14, 2019 · Breast tenderness can also be an early sign of pregnancy. ASSOCIATED PRESS. Breast cancer in adolescents and young adults is often more aggressive and more difficult to treat than in older women, but treatment options are similar. But if the discharge is bloody, greenish, or clear; if it affects only one The three main components of this exam are visual inspection, palpation of the lymph nodes, and palpation of the breast tissue. It is not unusual for breast growth to start on one side before the other. There is no age limit to buy pregnancy tests. Pull your feet toward your butt and spread your legs. Injury to your breast. A clinical breast examination (CBE) is a physical examination of the breast done by a health professional. Breastfeeding (nursing) An infection in the breast. Athelia (absence of nipples) and amastia (absence of breast tissue) may occur on one side or in both breasts. Breast exams help doctors check that everything's normal. Between 2012 and 2016, the incidence rate for female breast cancer in 15- to 19-year-olds in the United States was 0. The breast exam. A Guide to Pregnancy from Ob-Gyns. Jun 26, 2023 · Any fluid that leaks from one or both nipples of a non-pregnant and non-breastfeeding breast is referred to as nipple discharge. AccessMedicine is a subscription-based resource from McGraw Hill that features trusted medical content from the best minds in medicine. Almost every woman can probably relate to a few of these pretty personal stories, we're guessing. 1-3 As a result, CAYA cancer survivors are a growing group of individuals, many of whom have a high risk of treatment-related morbidity and mortality. Breast exams are usually included in your regular gynecological check-ups. In those girls under 2 years, breast tissue is thought to be a 0808 800 6000. Self-exams can also alert you to potential testicular Sep 24, 2022 · A milky-white leakage from both breasts can also happen before menopause. of 100. But you can be diagnosed while you’re younger, too. Each human breast has 15 to 20 milk ducts. For trusted, in-depth advice from ob-gyns, turn to Your Pregnancy and Childbirth: Month to Month. Learn about the different types of breast exams that can help detect breast cancer at its earliest stages, before symptoms develop. That means your doctor should do more than just feel the lump in your breast. g. Experts recommend that young women first see a gynecologist between ages 13 and 15, or earlier if she started menstruating before age 12. Fisher says, adding that “99% percent of lumps in young women are related to hormonal cycles. S. Aug 17, 2023 · Breast cancer is the most prevalent malignancy among female populations and is responsible for the second-highest number of cancer-related deaths in American women. Nipple discharge can originate from one or more of these milk ducts. Preparing for the first appointment. Ages 50-75. Find out why, as well as what's involved in a breast exam. You may not need treatment for these conditions, but your provider may advise taking Video Gallery of the Stanford Medicine 25. Pediatric gynecology is a branch of medicine that focuses on the gynecologic care of infants, children and adolescents. In a study reporting the 10-year experience of adolescents with breast complaints, 634 adolescent girls (age 9–19) were evaluated. women in their 20's and 30's should have a clinical breast exam every 3 years. If you’re age 76 to 85, your doctor can help you decide if you should continue screening. In this video, we will first briefly review the anatomy of the breast tissue, and then we will demonstrate the essential steps required to carry out a comprehensive breast examination. Breast cancer can strike at any age, though most people are over 50 when they receive a diagnosis. Stand squarely in front of a large mirror and place your hands on your hips. For the exam, you undress from the waist up. At a well-child visit, the doctor or nurse can help catch Breast self-exams (BSE, for short) can be helpful for women. On campus access is available on CU Anschutz and UCHealth networks and on the library workstations. Jan 5, 2023 · Pediatric Gynecology. Nonetheless, the finding of a breast mass can be disconcerting to the patient and their family [ 1,2 ]. Dr. This is when small fluid-filled cysts in the breasts change size based on where a girl is in her menstrual cycle . And every year, more than 1,000 women under age 40 die from breast cancer. Jul 1, 2019 · The condition accounts for 30–50 percent and 44–94 percent of adolescent breast masses in medical and surgical series respectively and accounts 50 percent of all breast biopsies (6, 11). The Adolescent Breast Center at Boston Children's Hospital is the first program in the nation dedicated exclusively to evaluating and treating breast conditions in teens, children and young adults. . Tailor your gynecologic examination to the presentingissue. Ninety-eight percent were evaluated with ultrasound, of which 59% showed no abnormality. 1,2 Nevertheless, it is common for adolescents and young adults (AYAs) to present for specialist assessment and advice with breast symptoms that are benign or who have variations of normal development. BREAST HEALTH EDUCATION + NATIONAL STANDARDS FOR TEACHING AND LEARNING Breast Health Education for Young Women is designed so that it can be integrated into existing school units, lessons and activities. 5 Most current recommendations for those with a genetic mutation or Jan 17, 2024 · A breast self-exam is an early detection tool that uses a combination of physical and visual examinations of the breasts to check for signs and symptoms of breast cancer. 1 in 8 women will be diagnosed with breast cancer during their lifetime and 5% of those women will be under 40. Your doctor should also examine Step 4: Feel for Breast Lumps While Lying Down. Water retention, which may happen during your period. “Whether it’s needed, and which parts, depend on the presenting issue Oct 29, 2020 · Educating adolescent girls from a young age about a wide range of breast topics is likely to reduce breast-related concerns, improve attitudes to breasts and breast issues, and promote positive breast habits in adolescent girls (e. The doctor may examine her neck, heart, lungs, and belly. ” Sep 12, 2022 · Bloody or clear fluid discharge from the nipples. They can be sore, but the pain goes away as breasts grow and change shape Apr 29, 2019 · Then came the breast exam, Even if things like cervical cancer and breast cancer are rare in teens and young women, regular visits to the gyno are an important preventative measure that helps Apr 12, 2023 · For many people, puberty begins between the ages of 8 and 13 years old, but your breasts continue to develop well into adulthood. Keep track of your breast lumps with a self-exam for one or two menstrual cycles. To fully understand pediatric breast disease, it is important to have a firm comprehension of normal development and of the various tumors that can arise. 1. You can also borrow the DVDs from the library. Depending upon the activities chosen, Breast Health What is a breast self-examination (BSE)? BSE is when a woman physically and visually examines herself for any changes in her breasts and underarm areas. Basic checks. For example, if a girl complains of Aug 23, 2018 · Jenny Rusby, Consultant Oncoplastic Breast Surgeon at The Royal Marsden, demonstrates how to do a breast examination. Doctors usually just look at a girl's breasts during her yearly gyn checkup to see where she is in her development. With your left hand, use gentle pressure to feel the right breast from top to bottom. That's because it's rare for girls to have breast problems. By LORI JOHNSTON. Dec. Stethoscope Exam Girl stock photos are available in a variety of sizes and formats to fit your needs. Breast Self-Examination was initially proposed as an intuitive, inexpensive, non Bates Video series delivers head-to-toe and systems-based physical examination techniques in a series of streaming videos that features more than 8 hours of video content. A pelvic exam is where a doctor or nurse practitioner looks at a girl's reproductive organs (both outside and internally). Breast cancer (this rarely causes pain, but it can happen) Surgery from a Feb 12, 2013 · OBJECTIVE. Sep 6, 2012 · Macromastia (also called gigantomastia) is characterized by excessive growth of the breasts that occurs spontaneously during puberty, pregnancy or while taking certain medications. No breast development by age 15. Most teens don't need breast exams. Fibroadenomas are easily diagnosed by palpation (approximately 2–3 cm in size (ranging 1–10 cm), consistency, texture, location and tenderness as they Sep 20, 2022 · Dr. However, it's useful even in the absence of such findings, as it allows the practitioner to establish an understanding of Breast Development. They can help you schedule an appointment. We have all been there in some way, shape, or form. During a clinical breast exam, your healthcare provider checks your breasts’ appearance. Routine testicular self-exams can give you a greater awareness of the condition of your testicles and help you detect changes. Nipple discharge is a complex diagnostic challenge for the clinician as it can occur normally or be a manifestation of a wide variety of diseases. Most health insurance plans are required to cover screening mammograms every 1 to 2 years for women beginning at age 40 with no out-of-pocket cost (like a co-pay, deductible, or co-insurance). 4 The majority (93%) was aged 15 to 19 years and had a primary complaint of lump or thickening in the breast (87%). She also discusses the preferred diagnostic modality and when to consider surgery. Aug 24, 2021 · Breast exam; Pelvic exam to check the vagina, cervix, uterus, and ovaries. There are a couple of reasons why: Breast problems like cancer are extremely rare in teen girls. Initially, breast development is noticed under the areola, or the nipple area as a hard mobile mass that may be tender. New lumps, or lumps that grow or are painful. It can be normal to feel lumps or pain when your breasts are developing. Some medicines, including hormone therapies. In performing the breast exam is important to keep in mind the following general points: - It is better not to wear gloves while palpating the breasts. Before age 21, a pelvic exam is typically only performed if she has very heavy periods or pelvic pain. Why? Because 80% of breast cancers detected in young women are found by the women themselves. breast health and breast cancer to the Breast Health Education for Young Women sessions. A well-child visit is when you take your teen to the doctor to make sure they’re healthy and developing normally. Breast cancer is rarely diagnosed in people aged <25 years, with an age-standardised incidence of 3–5 per million in developed countries. share. Girls usually begin puberty between the ages of 8 and 13 years old. Nov 1, 2023 · Breast cancer in young women and people assigned female at birth ( AFAB )— also known as early-onset breast cancer — is when you receive a breast cancer diagnosis between the ages of 18 and 45. If you have never visited an ob-gyn before, learn about what to expect, exams that may be done, and concerns that may be discussed. This PDF from Susan G. A mass felt by a teen is usually prominent breast tissue, Dr. Feel for any lumps, bumps or thickened skin. Colonoscopy every 10 years or virtual colonoscopy every five years to check for colorectal cancer. A complete examination includes inspection of the external genitalia,visualization of the vagina and cervix, and rectoabdominal palpation. Next, check for breast lumps or abnormalities by feeling your breasts while lying down, using your right hand to feel your left breast, and then your left hand to feel your right breast. Cron, who specializes in pediatric and adolescent gynecology, suggests talking about the idea before you make the appointment. The American College of Obstetricians and Gynecologists (ACOG) recommends scheduling the initial appointment between ages 13 and 15, whether or not a teen is sexually active. Pediatric and adolescent gynecologists have specialized training that helps them diagnose and treat conditions involving the female reproductive May 17, 2017 · Johns Hopkins Medical center states, “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important” . A breast self exam (BSE) should be performed every month. Apr 30, 2024 · Overall, about 11% of all breast cancers occur in women younger than 45, according to the Centers for Disease Control and Prevention (CDC). Saturday 9am to 1pm. Further research into improved specificity with device updates and cost feasibility in low-resource Feb 16, 2024 · Overview. Available Monday through Friday, 8 a. STI (sexually transmitted infection) screening: this can be done with a urine test or a vaginal test (swab). From there, the breast continues to grow and increase until adult size is reached. A testicular self-exam (TSE) is an easy way for guys to check their own testicles to make sure there aren't any unusual lumps or bumps, which can be the first sign of testicular cancer. Apr 23, 2024 · Sit on your bed or on a towel on the floor against a wall with your back propped up by pillows. Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan The onset of breast development in girls less than 8 years of age may be the first sign of precocious puberty or more likely a condition referred to as benign premature thelarche. But doctors don't usually suggest them for teen girls. ATLANTA —. MD Anderson does not recommend cervical cancer screening for women age 65 and older. If your doctor is worried about your breast health, they will do a breast exam and keep an eye on you through regular office visits. Jan 17, 2024 · A Visual Check Of Skin And Tissue. Browse Getty Images' premium collection of high-quality, authentic Stethoscope Exam Girl stock photos, royalty-free images, and pictures. In a packed high school auditorium, teenage girls feel for cancerous lumps in soft fake Apr 30, 2024 · If you want to be screened for breast cancer, call your doctor's office. Ages 30 - 39. Clinical breast examinations are used along with mammograms to check women for breast cancer. Feb 24, 2014 · Breast buds are small lumps the size of a blueberry or marble that "erupt" directly beneath a young girl's areola and nipple. Use the right hand to completely feel the entire left breast. You can do a testicular exam yourself, typically standing in front of a mirror. This is different from other visits for sickness or injury. , checking breasts, wearing a sports bra). Below is a collection of all our Stanford 25-generated videos also found throughout the website. A breast self-exam is when you use your eyes and hands to check for any changes in the look and feel The iBreastExam by nurses showed a high sensitivity and NPV, but lower specificity than surgeon's clinical breast examination for identifying suspicious breast lesions. Most girls experience breast budding somewhere around 10-12 years of Jan 12, 2024 · Breast cancer is the most common cancer among female adolescents and young adults (age 15 to 39 years), but less than 5% of all breast cancers occur in this age group. It's rare for teen girls to have breast problems. We are open weekdays 9am to 4pm. Ages 40-49. Use your right hand to examine your left breast, then vice versa. You might find yourself looking at your Sep 23, 2019 · Parents, you may want to sit down for this. An extra breast ( polymastia) or extra nipple ( polythelia) occurs in about 1 percent of Aug 17, 2023 · Breast cancer is the most prevalent malignancy among female populations and is responsible for the second-highest number of cancer-related deaths in American women. Learn About the Book. While detailed breast self-exams no longer are recommended as part of formal screening for breast cancer, it is still important for you to know how your breasts usually look and feel. Look at your breast skin to check for dimpling, pitting, puckering or redness. Doctors don't usually start doing breast exams until a woman is in her 20s. Seventeen is the average age girls start having sex. Try to relax your pelvic muscles. Call your doctor if your breast lumps get bigger or harder or don't go away. But if you have a family history of breast problems, your doctor or nurse might give you a breast exam. Breast pain that doesn’t go away with the menstrual cycle. “Often, girls will not need any sort of pelvic exam at their first visit,” says Dendrinos. Clinical breast examinations are also used to check for other breast problems. Change arms and place your left hand behind your head. You can start getting a mammogram every 1 to 2 years at 40, or you can wait until you turn 50. While this is to be expected and is something to be celebrated (boobs are great, after all), it’s natural to feel self-conscious at times about the way your body is changing. Early in puberty, most boys experience soreness or tenderness around their nipples. Sep 24, 2022 · A milky-white leakage from both breasts can also happen before menopause. Sep 15, 2017 · Here are 20 women's real-life stories of humiliation at the gynecologist office. Nipple discharge. This video covers the introduction to the pelvic exam and the external genitalia exam. Sep 28, 2022 · One way you can be aware of how your breasts look and feel is by doing a breast self-exam (BSE). Young people have specialized needs compared to adults. Once you turn 40, get a breast exam every year. First, a nurse or assistant will measure things like your daughter's weight, heart rate, and blood pressure. Jun 20, 2022 · This is the most common cause of breast pain. What to look May 23, 2023 · Breast cancer is very rare in teens. Use your left hand to examine your right breast. To avoid missing potential findings, the external pelvic exam should be performed in a systematic approach consisting of two main components: a visual inspection of the vulva ( Figure 1 ), and internal palpation and assessment of glands and tone. This will give the doctor a sense of her general health and a baseline to use for comparisons in future exams. MSK does not recommend doing a BSE as part of routine breast cancer screening. Yet, you shouldn’t wait for a clinical exam to get to know your breasts. 5 Common causes include fibroadenoma, cysts, hamartoma, fat necrosis, or abscess. Sep 1, 2007 · A routine breast examination and simple external inspection of the genitalia should be considered essential components of the regular health supervision visit for adolescent girls. Then with your arms up in the air. If you still menstruate, the best time to do a BSE is a few days after your period ends, when your breasts are not tender or swollen. Jun 7, 2023 · Manual breast self-exam while standing: Remove your shirt and bra. It can tell an experienced provider a great deal, as it may lead to the discovery of abnormalities, such as cysts, fibroids, or malignancies. However, for young women who have a history of chest irradiation, annual clinical breast examinations beginning at the onset of puberty are recommended with annual mammography and breast MRI beginning at age 25 or 8 years following the completion of therapy, whichever is later. Most of the time the breast enlargement amounts to a firm Women should begin practicing breast self-exam by age 20, and continue the practice throughout their lives, even during pregnancy and after menopause. This includes feeling a girl's uterus and ovaries to be sure everything's normal. Jan 5, 2023 · Pediatric gynecology is a branch of medicine that focuses on the gynecologic care of infants, children and adolescents. Preventive Services Task Force has found evidence that suggests BSEs do not lower the risk for death from breast cancer. The physical exam of the breast can be divided into three components: inspection, palpation and lymph node exam. In rare cases, breast abnormalities can occur from birth. Cover every part of the breast and your underarm. [1] The need for early detection has manifest several screening initiatives intent on curtailing morbidity and mortality associated with the disease. Dec 6, 1998 · Teen Girls Learn to Do Breast Exams. Breast pathology is an abnormal area of development or an abnormal growth in the breast. Benign thelarche is most commonly seen in girls who are under 2 or older than 6 years of age. The need for early detection has manifest several screening initiatives intent on curtailing morbidity and mortality associated with the disease. Aug 23, 2017 · Eight women in Alberta have reported calls from a fraudster trying to get them to conduct breast self-exams while on the phone with him. to 6 p. Most are either secondary to normal developmental changes or neoplastic processes with a relatively benign behavior. A speculum would be used to complete this portion of the exam. This is due to hormones. Pediatric breast masses are relatively rare and most are benign. Knowing how your breasts normally look and feel, also called breast Mar 3, 2024 · A thorough breast exam will be performed. May 17, 2017 · The university and other stakeholders should develop educational programs that can increase knowledge and practice of breast self-examination among young female university students. Comen stresses the importance of getting a good physical exam from either your primary doctor or gynecologist. It’s not uncommon. But if the discharge is bloody, greenish, or clear; if it affects only one Get to know how your breasts feel. Auscultation, child. Look at your breasts to check for new changes in their symmetry, size, shape or volume. Physical examination and targeted history Explore the Video 8-02: Examination of the Breast and Nipples learning module on AccessMedicine. He's called women in Edmonton, Barrhead and Athabasca. The man claims to be an employee of a medical imaging facility. Pregnancy, especially during the first trimester. Palpate the abdomen for masses and the inguinal areasfor a hernia or gonad. “Make sure they do a full exam of the breast, including around the collarbone and underneath the armpit,” she says. The prevalence of breast masses among teenage girls is approximately 3. With the pads of your three middle fingers, press on every part of one breast. Puberty is the stage of adolescence when your child begins to develop physically into an adult. The American Cancer Society recommends 1 : women over 20 should do a monthly breast self exam. The healthcare professional will examine the entire area and will need to use some pressure to get at the deeper tissue. Look at yourself with your arms down at your sides. Try to do a TSE every month so you become familiar with the Jun 14, 2022 · The overwhelming majority of breast masses in children and adolescents are benign and self-limited. Remove your upper garments, including your bra. 6, 1998 12 AM PT. Alberta Health Services warned women of the scam on Wednesday. 1/20. The earliest sign of puberty in most girls is the development of breast "buds," nickel-sized bumps under the nipple. ywkaoxyytlkhkgppgsus