Gynecological care for the young

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For those interested in purchasing or referring to a book covering the relatively specialized field of pediatric and adolescent gynecology, several textbooks, published within the last few years, can be found on the shelves. Now comes yet another entry into the fray.Pediatric and Adolescent Gynecology: Evidence Based Clinical Practice is a single volume from the Endocrine Development series. The editor of this volume, Charles Sultan, is a pediatric endocrinologist rather than a gynecologist. Hence, I anticipated that this book would differ from the competition, most of which are primarily edited or written by gynecologists. Sultan has amassed an international group of experts (mostly European) in a concise 261 page text that addresses common problems encountered in the clinical practice of pediatric gynecology. The ‘clinical’ part of the title is telling; this book does not delve deeply into basic science but cuts directly to material that many clinical practitioners might be seeking.Three broad areas are addressed: (i) gynecological examination and imaging; (ii) care of the pre-pubertal female; and (iii) gynecological disorders of adolescence. Logically, the first two chapters address examination and imaging techniques and are notable for clear and unambiguous photographs and illustrations. The imaging section makes a clear and convincing plea for the use of ultrasound as a primary imaging modality in the assessment of pelvic masses and ovarian cysts in children. The authors also effectively present sound data addressing the imaging of uterine and ovarian growth during sexual maturation. These chapters provide a robust platform for the subsequent discussions.Like many books with numerous contributors, some sections are better than others. Individual chapters addressing ambiguous genitalia, child sexual abuse, dysmenorrhea, disorders of androgen excess, breast development and anomalies, sexually transmissible diseases and the psychological issues associated with teenage pregnancy are each informative discussions that succinctly summarize current understanding. The section by Bernhard Hermann and Francesca Navratil on childhood sexual abuse is nothing less than outstanding and I will highly recommend that our residents in training read it.A strength of this book is the authors' capacity to present concise but usually satisfying presentations of the subject at hand. However, on a few occasions this approach fails. The topic of labial adhesions, a relatively common disorder, is afforded only a single paragraph. The use of topical estrogen cream as a treatment is mentioned but many readers could well ask, ‘How much? How long? Will the condition recur?’. One or two sentences of explanation would have clarified these questions for the novice reader.Later in the book, another author's approach to the clinical evaluation of precocious and pseudoprecocious puberty is well presented but there is little to guide the reader in the interpretation of laboratory and imaging studies (fortunately, subsequent chapters covering menstrual dysfunction and hyperandrogenism do a better job). The chapter addressing ovarian cysts would have benefited from a discussion of neonatal ovarian cysts. Finally, the chapter covering delayed puberty offers a first-rate discussion of etiological aspects while virtually ignoring the diagnostic evaluation.Ordinarily, I would not comment on the stylistic aspects of a textbook but several sentences throughout the book are vague (e.g. clinical evaluation of abnormal uterine bleeding should begin when the ‘menstrual disturbance is beyond the normal spectrum of the physiologic variability’), confusing (e.g. repeated characterizations of many conditions as ‘hormone imbalances’) or unsubstantiated by the current literature (e.g. the statement that there is no cure for endometriosis ‘short of a hysterectomy’). Various estimates of the teen pregnancy rate in the USA were stated as 96% and 177% in different populations. I suspect that the contributor intended to say 96 and 177 teenage girls per 1000 (‘U.S. Teenage Pregnancy Statistics’ from the Alan Guttmacher Institute, www.guttmacher.org/pubs/state_pregnancy_trends.pdf.).This textbook is best suited for pediatricians, family practitioners, and pediatric endocrinologists interested in extending their understanding of pediatric gynecological disorders. Pediatric and Adolescent Gynecology: Evidence Based Clinical Practice works well as part of a series of endocrinology texts but those who desire more detailed clinical guidance addressing evaluation and treatment of various gynecological conditions, including surgical approaches, could be disappointed with this book. This new book fails to distinguish itself from four other pediatric and adolescent gynecology textbooks in my personal library, and I would recommend that clinicians first ‘shop around’ to see if this book fits their individual needs.