Pediatric Adolescent Gynecology Research Articles

Consenting, competence and confidentiality in paediatric adolescent gynaecology

Key content Clinicians can often face dilemmas in the care of adolescents owing to the lack of understanding over the legal rights and ethical responsibilities involved in their care. A clinician looking after an adolescent should have a good understanding of the principles of adolescent consenting. Often it is necessary to involve the multidisciplinary team and, in extreme circumstances, the court when there is a dispute regarding the competence of the adolescent to consent. Every unit should ensure that they have guidelines for paediatric adolescent gynaecology (PAG) consenting. Areas requiring specific consideration in PAG consent are discussed in this article. Learning objectives To understand the issues and ethical dilemmas a clinician can face in PAG consent. To understand the current guidance and principles. To develop a problem‐based approach to sharing information with adolescents. Ethical issues Healthcare professionals must balance the duty of confidentiality with the duties of safeguarding. There can be challenges in influencing the parental authority over the adolescent and balancing this with the child's best interest. Care must be taken in judging the capacity of the adolescent to make decisions.

107. Rates of Inflammatory Bowel Disease in Patients with Endometriosis in the Pediatric Adolescent Gynecology Population at Texas Children's Hospital, Houston, Texas

107. Rates of Inflammatory Bowel Disease in Patients with Endometriosis in the Pediatric Adolescent Gynecology Population at Texas Children's Hospital, Houston, Texas

Adnexal Torsion Salvage Rates During the COVID-19 Pandemic in a Pediatric and Adolescent Gynecology Population

Background: Early diagnosis and surgical intervention for adnexal torsion (AT) increases the likelihood of ovarian salvage. The COVID-19 pandemic has introduced barriers that may delay time from symptom onset to intervention due to delayed presentation and requirement for COVID-19 testing preoperatively. The objective of this study was to determine any differences in ovarian salvage rates during the COVID-19 pandemic in a pediatric & adolescent gynecology (PAG) population compared to prior to the pandemic.

Pediatric Adolescent Gynecologic and Obstetric Presentations in Hospital Emergency Departments

Background: Little is known about disparities in diagnoses and dispositions of pediatric patients that present to emergency departments (ED), especially in hospitals that likely do not have access to pediatric adolescent gynecology (PAG) specialists. We sought to assess how pediatric and adolescent gynecologic and obstetric diagnoses and dispositions differ by metropolitan and teaching hospital status.

Novel Approach to Improving Confidence in Providing Sexual and Reproductive Healthcare to Adolescents for Pediatric Residents: A Pilot Study

Background: A recent study showed that about only 1/5 of recent graduates feel well trained to care for adolescent patients. There is an insufficient amount of data assessing the confidence of pediatric residents in providing sexual and reproductive healthcare (SRH) services to adolescents. We aimed to assess pediatric residents’ confidence in providing SRH education and services to adolescent patients before and after participating in clinic sessions in a Pediatric Adolescent Gynecology (PAG) Clinic.

Simulation Training in Pediatric Adolescent Gynecology

Simulation Training in Pediatric Adolescent Gynecology

Characteristics Among Premenarchal Girls With Lichen Sclerosus.

Lichen sclerosus (LS), a chronic inflammatory dermatosis localized in the anogenital region, is known to be associated with lower urinary tract symptoms (LUTS) in postmenopausal women; however, there is a paucity of data on prepubertal girls. We sought to characterize the relationship between LS, LUTS, and constipation among premenarchal girls. We conducted a retrospective chart review of premenarchal girls presenting at the pediatric adolescent gynecology and pediatric urology clinics at our institution diagnosed with vulvar LS during a 4-year period. Demographics, clinical presentation, time from onset of urinary and/or bowel symptoms to LS diagnosis, and treatment response were assessed. Analysis was completed using median, range, and nonparametric statistical analysis where appropriate. Nineteen premenarchal girls with LS met inclusion criteria. The median age at LS diagnosis was 6.2 years (range = 3.3-13.3 yrs). Most girls (12/19, 63.2%) presented with LUTS during LS evaluation, and 11 (57.9%) of 19 patients had constipation. Pruritus and hypopigmentation were the most frequently encountered LS symptom and sign, respectively. Fourteen (73.7%) of the 19 girls had resolution/improvement of LS symptoms after LS treatment. Of the 12 patients with LUTS, 7 (58.3%) had resolution/improvement of LUTS symptoms, 3 (25.0%) had unchanged voiding symptoms, and 2 (16.7%) had unknown changes. Although further studies are needed to better characterize the relationship between LUTS, constipation, and LS, our findings suggest that premenarchal subjects presenting with LUTS should be assessed for LS. Likewise, patients presenting with LS should be assessed for LUTS and constipation.

Health-related quality-of-life questionnaire for women with polycystic ovary syndrome: a Chinese translation and validation study.

To evaluate the reliability, validity, and responsiveness of the Chinese version of the polycystic ovary syndrome questionnaire (PCOSQ). Translation and validation study. Gynaecology clinic and paediatric adolescent gynaecology clinic at the study institute. Chinese women, 16 years of age or older, with polycystic ovary syndrome (PCOS). Women completed the Chinese version of the PCOSQ and the Short-Form Health Survey (SF-36). Their sociodemographic details, clinical parameters, and biochemical results were recorded. A subset of 50 women repeated the PCOSQ 1 week later to evaluate test-retest reliability. Women subsequently received treatment for the symptoms of PCOS. Six months later, 100 women completed the PCOSQ and clinical parameters were assessed to evaluate the responsiveness of the PCOSQ. Internal reliability, test-retest reliability, convergent validity, criterion validity, and responsiveness. A total of 262 Chinese women completed the study. Values of Cronbach's alpha coefficient were all above 0.7, demonstrating a good standard of internal consistency in all subscales. For the test-retest reliability, intraclass correlation coefficients showed excellent stability among the subscales (range 0.82-0.92, P < 0.001). Convergent validity was demonstrated by positive correlations with the subscales of SF-36 and clinical parameters like body mass index (BMI), waist-hip ratio (WHR), hirsutism score, menstrual regularity, and infertility, and the respective subscales. Improvement in PCOSQ scores was seen in women with improvements in BMI and menstrual patterns; however, these findings did not reach statistical significance. The Chinese version of PCOSQ is reliable and valid for use in women with PCOS. The Chinese version of the PCOSQ is reliable and valid for use.

Literature Review of Benign Müllerian Papilloma Contrasted With Vaginal Rhabdomyosarcoma

Study ObjectivesBenign müllerian papillomas of the genital tract are rare and, hence, can be mistaken for vaginal rhabdomyosarcoma on initial clinical review. This review of the literature will consolidate the previous cases of müllerian papilloma reported and looks for clues to differentiate the 2 entities. Design and SettingWe provide a case report and literature review, with patients from a pediatric adolescent gynecology clinic in a tertiary center. MethodsWe conducted a search of English-language publications from 1951 (the first case report) until January 2014 by using the search words “Müllerian papilloma” and “prepubertal bleeding.” References from previous published reports were also obtained for completeness. Main OutcomeLiterature review of benign müllerian papilloma. ResultsSince 1951, 56 cases of müllerian papilloma were reported, including 4 cases at our institution. Comorbid conditions were found in 31.5% of cases (with 3 cases associated with mesenchymal tumors). The average length of time from onset of symptoms (primarily vaginal bleeding) to diagnosis was 6.7 months (range, 1 day to 3 years), with only 1 case diagnosed incidentally. Median age of presentation was 5 years (range, 1 day to 52 years). Most cases were localized and resected with ease. Histology reveals complex papillary lesions without cytologic atypia. ConclusionBenign müllerian papilloma is distinguished from the more significant diagnosis of vaginal rhabdomyosarcoma by initial length of vaginal bleeding at presentation, lack of vaginal wall extension, ease of resection, and histopathology. This is compared with vaginal rhabdomyosarcoma which commonly exhibits both localized and distant spread.

Managing the reproductive health of pediatric and adolescent patients

The field of pediatric–adolescent gynecology addresses the gynecologic needs of a female from the beginning of infancy to the young-adult years. It relies heavily upon the expertise of gynecologists, pediatricians, geneticists, surgeons and psychiatrists as well as allied health professionals. Specifically, social workers play a critical role in ensuring the welfare of this population. Issues such as abuse, neglect, poverty, nutrition and education are constant influences on the reproductive health status of children. A multidisciplinary approach to pediatric–adolescent gynecology is discussed in this article. By reviewing how to manage basic, as well as complex pathologies, guidelines for providing quality care are established, with the goal of securing healthy physical, cognitive and emotional development of children.

Successful pregnancy in a Swyer syndrome patient with preexisting hypertension

To report a case of a successful pregnancy and delivery of a patient with 46,XY pure gonadal dysgenesis (Swyer syndrome) and preexisting chronic hypertension who underwent in vitro fertilization (IVF) and embryo transfer (ET). Case report and review of the literature. 2nd Department of Obstetrics and Gynecology, University of Athens, Medical School, "Aretaieion" Hospital. Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery. A 35-year-old woman with Swyer syndrome and chronic idiopathic hypertension. Karyotype analysis due to primary amenorrhea; gonadectomy, hormone therapy, investigation of hypertension, IVF using donor oocytes, embryo transfer and caesarean delivery for fetal distress. Successful pregnancy and live birth. We present a rare case of a successful pregnancy of a patient with Swyer syndrome accompanied by idiopathic chronic hypertension. A woman with Swyer syndrome, hypoplastic uterus, and chronic hypertension delivered a healthy newborn.

Creation of a neovagina after Creatsas modification of Williams vaginoplasty for the treatment of 200 patients with Mayer-Rokitansky-Kuster-Hauser syndrome

To present and evaluate the results of the Creatsas modification of Williams vaginoplasty for the creation of a neovagina in young women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Retrospective study. Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery, Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Two hundred patients with the MRKH syndrome. Clinical examination, pelvic ultrasound, intravenous urography and/or renal ultrasound, laparoscopy, karyotyping, orthopedics and ears, nose, and throat examination, magnetic resonance imaging, and Creatsas modification of Williams vaginoplasty. Neovaginal functional dimentions, neovaginal axis deviation, and quality of sexual life. A functioning vagina of 10-12 cm in depth and 5 cm in width was created in 191 cases (95.5%). A vagina between 7 and 9 cm in depth and 2 and 3 cm in width was created for the remaining nine patients (4.5%). In addition, 94.5% declared themselves to have a satisfactory quality of sexual life, while only 5% of the cases reported an adequate one. Creatsas modification of Williams vaginoplasty is a simple, quick, and effective method for the treatment of vaginal agenesis.

Genome Movement and Pediatric-Adolescent Gynecology: “Genomic Techniques”

The “Big Tools” for science generated in the wake of the Human Genome Project allow one to carry out large-scale, global experiments of all types. Instead of dissecting a process piece by piece or gene by gene to identify a putative single effector, the more subtle analyses based on monitoring the expression of a single cell, a single tissue, or the entire genome can be performed. Scientific investigation is gradually moving from the laboratory bench to the computer station. In the future, comprehensive genomics-based health care will be standard, and individualized preventive medicine will be available. Medicine is no longer only for the sick. This “genome perspective” is likely to characterize many areas of biomedical research and clinical care on an accelerating scale. The purpose of this presentation is to discuss the uses of this global view of biology, and to review the potential impact of these technical developments on scientific investigation and clinical medicine in the decades to come.

Creation of a neovagina following Williams vaginoplasty and the Creatsas modification in 111 patients with Mayer-Rokitansky-Küster-Hauser syndrome

Objective: Evaluation of the Creatsas modification of Williams vaginoplasty for the creation of neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome). Design: Record of perioperative and postoperative results and complications. Follow-up evaluations of patients yearly after the operation. Setting: Division of Pediatric-Adolescent Gynecology and Gynecologic Corrective Surgery, University of Athens (tertiary referral center). Patient(s): One hundred eleven patients with MRKH syndrome. Intervention(s): Surgical creation of neovagina using the Williams vaginoplasty technique (group A: 10 patients) or the Creatsas modification of the previous method (group B: 101 patients). Main Outcome Measure(s): Length and width of the neovagina, and the quality of sexual life postoperatively. Result(s): A functioning vagina of 10 to 12 cm depth and 5 cm width was created in eight of the patients in group A (80%) and in 98 of those in group B (97.02%). A vagina of 7 to 9 cm depth and 2 to 3 cm width was created in the rest of the patients in both groups. In group A, two wound openings were reported (20%); in two of the patients hemorrhage occurred during the first intercourse, compared to none in group B. A satisfactory sexual life was reported from 94.4% of the patients and an adequate one from 4.16% of them. Conclusion(s): The Creatsas modification of Williams vaginoplasty is a simple and effective technique for the creation of a functioning neovagina in young women with vaginal aplasia.

Obstruction of the Female Genital Tract Because of Vaginal Septum in Adolescence

The purpose of the study was to present a case series reporting the clinical presentation, evaluation, and management of seven adolescent girls with symptomatic vaginal septa who were treated in the Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery of the 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, from September 1997 to June 2000. The patients were divided in two groups depending on the type of vaginal septum. Group A consisted of three patients with transverse vaginal septum, all with hematometra, endometriosis, and congenital abnormalities of the urinary tract. One patient had a bicornuate uterus. Group B consisted of four patients with oblique vaginal septum, three with hematometra and congenital abnormalities of the urinary tract, all with endometriosis, two with didelphys uterus, and one with a bicornuate uterus. The patients of both groups underwent total excision of the septum followed by the administration of GnRH analogues for 6 mo...