Journal of pediatric and adolescent gynecology最新文献

{"title":"45. FOXL2-induced BPES and POI with Hyperandrogenism and Normal Estradiol: A Clinical Conundrum","authors":"Jennifer Silk,&nbsp;Katelyn Day,&nbsp;Janeen Arbuckle","doi":"10.1016/j.jpag.2025.01.078","DOIUrl":"10.1016/j.jpag.2025.01.078","url":null,"abstract":"<div><h3>Background</h3><div>Patients with FOXL2 resulting in BPES (blepharophimosis, ptosis, epicanthus inversus syndrome) are at an increased risk of premature ovarian failure (POI). Hyperandrogenism alongside normal estradiol levels in the setting of POI is not noted in the literature.</div></div><div><h3>Case</h3><div>A 15-year-old female with a known history of FOXL2 gene and BPES presented to pediatric gynecology (PAG) due to secondary amenorrhea after experiencing only one episode of menses at age 12. Thelarche occurred at age 9 and prior workup was notable for elevated free and total testosterone, DHEAS, and FSH. She had a prior normal estradiol, prolactin, karyotype, 21-hydroxylase antibodies, thyroid antibodies, and Fragile X screen. Her physical exam was remarkable for tanner 4 tuberous breast and thick course hair on the face, check, and back consistent with hirsutism. Repeat FSH remained extremely elevated and estradiol remaining within normal pubertal range. Given persistent androgen excess on labs and physical exam findings, a pelvic ultrasound and CT abdomen/pelvis was completed to rule out tumors of the adrenal glands or ovaries which were unremarkable. Because her FSH remained persistently elevated with normal estradiol, an AMH was completed and noted to be 0.1. She also completed a DEXA scan which showed normal bone mineral density. She subsequently completed a congenital adrenal hyperplasia (CAH) panel which was normal with the exception of elevated testosterone. The patient attempted a Provera challenge with no withdrawal bleed. With known genetic predisposition and two FSH levels markedly elevated, patient formally met criteria for POI. Despite extensive workup, no etiology was identified for her persistent androgen excess but given her clinical and laboratory findings, she did meet criteria for PCOS. Interestingly her estrogen level remained within normal limits despite the diagnosis of POI. She was started on oral contraceptive pills for hirsutism, hormone replacement, and contraception.</div></div><div><h3>Comments</h3><div>Given the rarity of documented associations between BPES, hyperandrogenism, and normal estradiol levels in the setting of POI, other conditions like PCOS should be considered in said patients. This case emphasizes the importance of extensive laboratory and imaging workup for unique patients as well as the value of multidisciplinary teamwork between genetics, PAG, and reproductive endocrinology. In addition, the providers recognized the importance of monitoring bone health and contraceptive needs in this unusual clinical scenario.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 250"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"34. Entonox Sedation For IUD insertion In Adolescents - A pilot Project","authors":"Christine Osborne,&nbsp;Philippa Brain","doi":"10.1016/j.jpag.2025.01.067","DOIUrl":"10.1016/j.jpag.2025.01.067","url":null,"abstract":"<div><h3>Background</h3><div>The use of inhaled Entonox is a novel approach to providing patient-controlled sedation for an IUD insertion. Entonox sedation can be use in a clinic situation without the need for IV or Anesthetists. The tanks are portable and can refilled and the masks are inexpensive to purchase.</div></div><div><h3>Methods</h3><div>16 subjects were recruited for IUD insertion with patient-controlled Entonox. Informed consent for an IUD insertion and pilot study was obtained. Subjects were included with the following: age greater than 15, BMI less than 30, Patient has had failed attempts at IUD insertion in the clinic or it has been determined through patient assessment that sedation is required to support insertion. Developmentally able to self-administer Entonox. Exclusion criteria included: Patients less than 15, existence of co-morbidities, experienced sexual trauma, known anatomical concerns. Pregnancy tests were performed prior to insertion and routine vaginal swabs taken at time of insertion. Insertions took place in induction rooms and in outpatient clinics. Each patient received a satisfaction survey following insertion using a QR code in Redcap. IRB approval was obtained.</div></div><div><h3>Results</h3><div>16 patients were consented and 100% of them had an IUD successfully inserted under patient-administered Entonox in a clinic setting. The satisfaction survey revealed a satisfaction rate of 90% (range 7-10). 10/16 (62.5%) responded to the redcap survey. The patient's perception of success was 86% range (5-10).</div></div><div><h3>Conclusions</h3><div>Entonox patient-administered sedation is an excellent option for insertion of IUD in adolescents. This method allows sedation in a clinic setting and will significantly reduce the demands on expensive resources such as OR time or anesthesia lead procedural rooms. As this is a pilot study numbers are small, only 16 patients, and we recommend confirming outcomes with a larger cohort. Entonox patient-administered anesthesia could also be expanded to support IUD insertions in the adult clinics.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 246"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"4. A Qualitative Needs Assessment for the Research of Reproductive Tract Anomalies","authors":"Lauryn Roth ,&nbsp;Kendra Hutchens ,&nbsp;Veronica Alaniz","doi":"10.1016/j.jpag.2025.01.037","DOIUrl":"10.1016/j.jpag.2025.01.037","url":null,"abstract":"<div><h3>Background</h3><div>Adolescence is a critical period for the clinical diagnosis, management, treatment, and research of reproductive tract anomalies. There are critical gaps in knowledge regarding best treatment approaches, particularly regarding surgical management and associated long-term outcomes. This qualitative study was conducted to assess the feasibility of a multi-institutional database or registry of children and adolescents with reproductive tract anomalies.</div></div><div><h3>Methods</h3><div>We purposively recruited geographically diverse focus group participants based on their publication record, clinical experience, and knowledge in reproductive tract anomalies. Two virtual focus groups were conducted in March of 2024. The PI moderated the focus groups and a co-investigator served as the observer/note-taker. The focus groups were one hour in duration and followed a semi-structured format. Focus group participants were compensated for their time. Focus group audio recordings were transcribed by a professional transcription company. After an initial familiarization with the data, the investigators developed a codebook and applied codes line-by-line to transcriptions to allow prominent themes to emerge.</div></div><div><h3>Results</h3><div>A total of nine participants joined the two focus groups. See table for themes and illustrative quotes. Participants reported there is very limited research and outcome data available to guide counseling of patients with reproductive tract anomalies. Participants identified a myriad of important and unanswered questions regarding the diagnosis and management of reproductive tract anomalies, linked to differences in management across different institutions. They identified several challenges and barriers to research, including the heterogeneity of these conditions and limited clinician time dedicated to complete this research, which make the development of a multi-institutional database or registry difficult. Participants discussed the need for patients to be involved in developing research agendas and identifying important outcomes. See table for themes and illustrative quotes.</div></div><div><h3>Conclusions</h3><div>There is significant variability in the presentation and management of reproductive tract anomalies with limited outcome data. Surgeons and researchers recognize the need for high-quality data and to develop patient-centered outcomes. A collaborative research database focused on rare and difficult to manage anomalies (i.e. obstructive or vaginal anomalies) is needed but will require overcoming several barriers.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 231"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"24. Contraceptive Education in Pediatric Residency: Exploring the Knowledge, Barriers, and Initiatives that Contribute to Effective Adolescent Healthcare","authors":"Hannah Gordon,&nbsp;Eric Whitney","doi":"10.1016/j.jpag.2025.01.057","DOIUrl":"10.1016/j.jpag.2025.01.057","url":null,"abstract":"<div><h3>Background</h3><div>The adolescent population makes up a significant portion of the outpatient panel seen by pediatric residents during their training. Pediatric residency programs notoriously lack the exposure to gynecology and the education needed to address adolescents in regards to contraception care. With this study, we aim to assess contraceptive education practices from the lens of pediatric residents contributing to the enhancement of education in pediatric residency programs.</div></div><div><h3>Methods</h3><div>A questionnaire was distributed to residents from four pediatric residency programs across the United States. It was used to survey experiences and attitudes on contraceptive education, prescribing comfortability, educational gaps, and future directions. The data was collected anonymously and analyzed categorically by percentages and descriptive statistics, as well as multivariate analysis in search of statistical significance.</div></div><div><h3>Results</h3><div>Of the over 300 pediatric residents who received the questionnaire, 42 responded to the survey. Only 66% of residents reported having formal education on contraceptive counseling in medical school, although the majority of residents (59.5%) prescribe it up to 5 times per month. In terms of education, 69% of residents report learning most about contraception in residency on rotations such as Adolescent Medicine. For those who received their contraceptive education during residency, roughly 71% report &lt; 10 hours of education was provided. Of the residents expressing discomfort with prescribing one or more methods, 42.9% related that it was due to inadequate knowledge of the topic. A large majority express the desire to have more hands-on procedural labs to enhance their contraceptive training. Overall, 73% of respondents desired more contraception during their residency training with trends suggesting that contraceptive prescription comfortability increases with PGY year, implying that increased exposure may strengthen skills and knowledge.</div></div><div><h3>Conclusions</h3><div>Many of the residents involved in this study will go on to become primary care providers who will be expected to prescribe contraception independently, bolstered with knowledge gained during their training. However, the data suggests that residents are not receiving equal training in contraception across the spectrum. This in turn is impacting the frequency in which counseling and prescription of contraception occurs in their clinic. This study reinforces the need for a standardized curriculum set in place to ensure residents are gaining the tools needed to provide adequate reproductive healthcare to their adolescent patients and beyond.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 241-242"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"11. Knowledge and Awareness of Gender-Affirming Language Among Cisgender Adolescents and Their Guardians","authors":"Blair Lacy ,&nbsp;Jennifer Silk ,&nbsp;Christina Blanchard ,&nbsp;Janeen Arbuckle","doi":"10.1016/j.jpag.2025.01.023","DOIUrl":"10.1016/j.jpag.2025.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Relative to their age-matched cisgender peers, transgender adolescents are more likely to suffer from mental health disorders and are at higher risk of self-harm and suicide. Social support, including use of gender-affirming language, from peers and family has been shown to be protective against these untoward mental health outcomes. We hypothesize that adolescents are more likely to positively relate to gender-affirming language than their guardian. We aim to assess the baseline knowledge and awareness of gender-affirming language among cisgender adolescents and their guardian and to examine the respective concordance or dissonance within the adolescent-guardian dyad.</div></div><div><h3>Methods</h3><div>Adolescents aged 14-21 seen in the Pediatric and Adolescent Gynecology clinic and their guardians were invited to participate in a voluntary survey regarding gender-affirming language. Adolescents ages 18-21 completed the survey without parental consent. No protected health information was gathered. Respondents completed the survey via a tablet with access to a RedCap-based questionnaire. Patients were asked to self-report their demographics including age, race, ethnicity, extent of education, and religion. Assuming a rate of acceptance of gender-affirming language among adolescents of 25% and 12.5% among guardians, 152 dyad respondents were needed to reach a power of 80%. Aggregate data from each generation and paired dyad data were analyzed using a Chi-square test for categorical data and student's t-test for continuous variables. Institutional IRB approval was obtained.</div></div><div><h3>Results</h3><div>Adolescent respondents were more likely to have pronouns they prefer (p&lt; 0.0001) and to recognize the importance of using a person's preferred pronouns (p=0.002) compared to adult respondents (Table 1). Adolescents were also more receptive to being asked their preferred pronouns, relative to the adult respondents (p=0.001). These questions were statistically significant when comparing adolescents to guardians in the paired dyad (Table 2). Self-reported level of education positively correlated with having preferred pronouns, being receptive to being asked their preferred pronouns, and utilizing a person's preferred pronouns (all p&lt; 0.05). Black race was also associated with having preferred pronouns (p=0.03).</div></div><div><h3>Conclusions</h3><div>Adolescents in this cohort demonstrated a greater awareness of the importance of gender-affirming language compared to adults. Limitations of this study are that it is single site and may not be representative of all patient populations. Surveys were also obtained with both adolescent and guardian present which may have influenced responses from either or both groups.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 226"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"15. Asking About Gender Identity in Pediatric and Adolescent Gynecology Clinic: Patient, Family and Provider Perspectives (The REFLECTIVE Study).","authors":"Madeline Ross ,&nbsp;H. Sema Baghaki ,&nbsp;Hannah Suffian ,&nbsp;Lauren Roth ,&nbsp;Jeanette Higgins ,&nbsp;Tazim Dowlut-McElroy","doi":"10.1016/j.jpag.2025.01.048","DOIUrl":"10.1016/j.jpag.2025.01.048","url":null,"abstract":"<div><h3>Background</h3><div>The provision of medical and psychosocial supports requires the identification of gender diverse individuals in health care settings. However, in primary care settings, some adolescents and parents expressed that gender identity screening (GIS) was offensive and clinicians expressed that GIS negatively affected their workflow. We sought to assess the acceptability and feasibility of GIS in Pediatric and Adolescent Gynecology (PAG) clinics of a large tertiary care children's hospital in the United States (US) Midwest.</div></div><div><h3>Methods</h3><div>A GIS survey developed in the US West Coast was modified with permission. After IRB approval, the anonymous single-site cross-sectional survey was administered to patients ages 12-25 years (AYA), parents of the 12-to-17-year-olds, and healthcare providers (HCPs) in our PAG clinics from July through September 2024. Statistical analysis was performed using SPSS version 29 (IBM Corp, Armonk, NY). Categorical variables were compared using the Chi-Square test /Fishers’ exact test or the Kruskal-Wallis test as appropriate. Continuous variables were compared using the ANOVA test. Statistical significance was defined as P &lt;.05.</div></div><div><h3>Results</h3><div>Fifty-six participants completed the survey (Table1). The majority were 12-to17-year-olds (27, 48.2%) and their parents (16, 28.6%). The mean (SD) age of 12-to-17-year-olds, 18-to-25-years-olds, parents of 12-to-17-year-olds, and healthcare providers (HCPs) was 14.9 (1.6), 18.4 (.79), 46.8 (15.4), and 46.8 (15.4) years, respectively. Most AYA did not find GIS confusing, uncomfortable, or offensive (Table 2). An equal number of parents did/did not want parental permission prior to GIS screening for their children. Although more parents than HCPs preferred informing parents about the content of GIS before AYA were asked questions, the difference was not significant (10, 62.5% vs. 2, 33.3%, p=.348). Most 18-to-25-years-olds (4, 57.1%), parents of 12-to-17-year-olds (12, 75%), and HCPs (6, 100%) did not think that GIS should be performed in front of parents as compared to only 9 (33.3%) of 12-to-17-year-olds (p=.005). There was a statistically significant difference between the preferred method of GIS with 16 (80%) of 12-to-17-year-olds and 6 (100%) of HCPs preferring direct communication between patient and provider as compared to most 18-to-25-years-olds (5, 71.4%) who preferred to enter GIS on a computer or tablet (p=.008). HCPs did not think that GIS affected their workflow.</div></div><div><h3>Conclusions</h3><div>AYA have differing preferences for the method of GIS in PAG clinics which HCPs should take into consideration.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 236"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"13. Pain outcomes in adolescents with surgically confirmed endometriosis: A single-site retrospective cohort analysis","authors":"Madeline Ross ,&nbsp;Priyanka Suvarna ,&nbsp;Adam Booser ,&nbsp;Ashli Lawson","doi":"10.1016/j.jpag.2025.01.025","DOIUrl":"10.1016/j.jpag.2025.01.025","url":null,"abstract":"<div><h3>Background</h3><div>Endometriosis is a leading cause of dysmenorrhea globally, with two thirds of women reporting symptoms beginning in adolescence. Despite increased awareness of adolescent endometriosis, there is a paucity of data regarding best practice for surgical and medical management to improve pain outcomes. This study aims to analyze pain outcomes at one year post index surgery in adolescent patients with surgically diagnosed endometriosis.</div></div><div><h3>Methods</h3><div>This was a single-site, IRB-approved (STUDY2514), retrospective cohort study reviewing the care of natal females (12-22 years old) with surgically diagnosed endometriosis from 2009 to 2021. Baseline characteristics (demographics and preoperative clinical characteristics) were gathered from chart review. Surgery was classified as diagnostic laparoscopy only, versus ablation and/or excisional biopsy based on the surgeon's operative report. Subset analysis of post-op hormonal management with an intrauterine device (IUD) or leuprolide was performed. Changes in pain status (defined as resolved, improved, same, or worse) were gathered from the subjective documentation within gynecology appointment notes one year post-op. Statistical analysis was performed using independent t-tests and Chi-Squared/Fisher's Exact tests. Statistical significance was defined as p&lt; 0.05.</div></div><div><h3>Results</h3><div>53 patients were identified in this study period. Mean age at time of index surgery was 15 (SD 1.7) years old, and the majority had stage 1 endometriosis. 66% of patients reported their pain was improved one year after their index surgery. There was no significant difference in pain outcome at one year based on whether a patient had a diagnostic surgery only compared to ablation and/or excisional biopsy of endometriosis lesions (p=0.43). There was no significant difference in pain based on the type of hormonal regimen implemented after the index surgery, including those who had an IUD (p=0.76) or received a post-operative course of leuprolide (p=0.7). There was no statistically significant difference in pain outcomes regarding patient demographics, including age (p=0.34) and BMI (p=0.36). Regarding pre-operative clinical characteristics, patients who reported worse pain had seen one additional specialist prior to diagnosis (p=0.005).</div></div><div><h3>Conclusions</h3><div>Over two thirds of patients who underwent surgical management of endometriosis reported their pain had improved one year following surgery. Patients who had worsening pain, had seen more specialists prior to their index surgery. There was no difference in pain outcomes based on the type of surgical or hormonal intervention, or other baseline patient characteristics.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 227-228"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"14. Quantitative Sensory Testing in Females with Endometriosis and Chronic Pelvic Pain","authors":"Sinah Esther Kim ,&nbsp;Catherine Stamoulis ,&nbsp;Christine Sieberg ,&nbsp;Jenny Gallagher ,&nbsp;Beth Schwartz ,&nbsp;Stephen Scott ,&nbsp;Michele Hacker ,&nbsp;Amy DiVasta","doi":"10.1016/j.jpag.2025.01.027","DOIUrl":"10.1016/j.jpag.2025.01.027","url":null,"abstract":"<div><h3>Background</h3><div>Chronic pelvic/abdominal pain (CPP) due to endometriosis can be unresponsive to standard therapies due to excessive sensitivity to pain known as central sensitization. We studied whether quantitative sensory testing (QST), a psychophysical method examining how the somatosensory nervous system responds to stimuli, differed between females with endometriosis and pain-free individuals.</div></div><div><h3>Methods</h3><div>Females with laparoscopically-confirmed endometriosis and CPP despite hormonal medication use (pain ≥3/ 0-10 scale, ≥14 days/mo) were eligible, and underwent baseline QST for an IRB-approved, multi-site clinical trial. We measured pressure pain threshold (minimum pressure evoking pain) using an algometer, and wind-up temporal summation (perception of pain due to repetitive equally intense stimuli) using electronic Von Frey, in the lower abdomen and control areas (non-dominant third finger nailbed/deltoid). Age-matched data from 107 pain-free females were used as a reference sample. Unadjusted statistical comparisons were conducted using the Mann–Whitney U test. Statistical models with adjustments for age, race, and BMI were developed to examine statistical differences in pain outcomes. Data are reported as median (interquartile range).</div></div><div><h3>Results</h3><div>We enrolled n=85 females with endometriosis (age: 25.3 (13.4)y). Our pain-free cohort included n=107 females (age: 20 (30.0)y; Table 1). Females with endometriosis experienced median (IQR) 3(3) intensity pain, &gt;1 day/week, had lower median pain pressure thresholds (7.4 (8.1)) than the pain-free sample (16.0 (12.9); p&lt; 0.01 based on unadjusted comparisons), and higher median temporal summation of pain (2.0 (2.5) vs. 0.5 (1.0); p&lt; 0.01). These differences remained in adjusted analyses: lower pressure-pain thresholds (regression coefficient (β)=-0.28, 95% confidence interval (CI)= [-0.39, -0.18]) and higher temporal summation (β=1.69, 95% CI= [1.06, 2.31]). In females with endometriosis, median pressure pain threshold was lower on the abdomen compared with the finger (7.4 (8.1) vs. 17.1 (14.7), p&lt; 0.01). No site difference (abdomen vs. deltoid) in temporal summation was estimated (p=0.15).</div></div><div><h3>Conclusions</h3><div>Females with endometriosis had lower pressure-pain thresholds, indicating higher sensitivity to pain, and higher temporal summation measures, reflecting greater increase in pain perception from exposure to repetitive stimuli, compared with pain-free females. The pressure-pain threshold was lower at the lower abdomen vs. finger in those with endometriosis, but temporal summation was the same. Clinicians should consider treatments aimed at reducing central sensitization to pain in those with CPP due to endometriosis.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 228"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2. Availability and Accessibility of an Over-The-Counter Oral Contraceptive Pill in Retail Pharmacies in a Single Midwest US County: An Exploratory Study","authors":"Taylor Argo ,&nbsp;Tracey Wilkinson ,&nbsp;Julie Maslowsky ,&nbsp;Alana Otto","doi":"10.1016/j.jpag.2025.01.014","DOIUrl":"10.1016/j.jpag.2025.01.014","url":null,"abstract":"<div><h3>Background</h3><div>An over-the-counter (OTC) oral contraceptive pill (OCP) containing 75 μg of norgestrel became available without a prescription in US retail stores in March 2024. OTC access to an OCP has the potential to reduce barriers to contraceptive access and improve reproductive health equity, particularly for adolescents; however, removing the requirement for a prescription does not guarantee accessibility. The purpose of this study was to assess the availability and accessibility of the OTC OCP in pharmacies in a single midwest US county.</div></div><div><h3>Methods</h3><div>We used our state's licensing database to identify all licensed retail pharmacies in our county and visited these pharmacies between August and October 2024; we excluded pharmacies embedded in clinics and hospitals. We observed the availability, price, and accessibility of the OTC OCP (“the pill”), including availability for purchase of one- and three-month packs, price, and location (on the shelf with no security measures; behind the pharmacy counter; or in a locked security box that requires an employee to open at checkout). We present descriptive statistics of our findings.</div></div><div><h3>Results</h3><div>We visited a total of 44 retail pharmacies, including 16 standalone chain pharmacies, 14 independent local pharmacies, 12 mass merchandise retailers/supermarkets, and two wholesale clubs. The pill was available in 33 pharmacies (75% of those visited). Only three of 14 independent pharmacies (21%) carried the pill. Prices ranged from $18.97- $22.59 for one-month packs (manufacturer's suggested retail price [MSRP]: $19.99) and $47.99 - $55.99 for three-month packs (MSRP: $49.99). In 12 pharmacies (36%), the pill was available on the shelf with no security measures. In 13 pharmacies (39%), the pill was in locked security boxes. In 4 pharmacies (12%), some packs were available on the shelf, while others were in locked security boxes. Four pharmacies (12%) had the pill behind the pharmacy counter.</div></div><div><h3>Conclusions</h3><div>The OTC OCP was available at most pharmacies (75%) in our single US county at the time of data collection; however, few independent pharmacies stocked the product, and only 27% of all pharmacies had the product available without security measures. Prices in our county were generally similar to the MSRP. In more than half (63%) of pharmacies that stocked the pill, the OTC OCP was locked in security boxes or behind the pharmacy counter, requiring an individual to seek an employee to access the pill. Whether these measures affect adolescents' willingness to purchase the OTC OCP or contribute to stigma around contraception are important areas for future study.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 220"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"25. Correlation of serum inhibin B and radiographic hemorrhagic cyst: A case for conservative management","authors":"Jennifer Silk,&nbsp;Sarah Hill,&nbsp;Laura Stafman,&nbsp;Blair Lacy","doi":"10.1016/j.jpag.2025.01.058","DOIUrl":"10.1016/j.jpag.2025.01.058","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian neoplasms occur 2.6 per 100,000 in the child and adolescent population and are usually benign in nature. The incidence of pediatric ovarian malignancy is poorly understood, as it is exceedingly rare, though when present, adnexal masses are diagnosed as gynecologic malignancy 3-8% of the time. Tumors markers like inhibins can be used to differentiate between benign and malignant lesions. Inhibin B is generally thought to be elevated in granulosa cell malignancies and can be a cause of primary or secondary amenorrhea. No literature, however, has demonstrated an association with an elevation of inhibin B with benign pathologies as discussed in this case.</div></div><div><h3>Case</h3><div>A 12-year-old female presented to pediatric gynecology with a left adnexal mass incidentally noted on renal ultrasound while undergoing evaluation for pediatric hypertension. Menarche occurred at age 11 with regular monthly cycles. An abdominal ultrasound and CTAP were notable for a 5.3 × 4.9 × 4.2cm thin walled cyst in left ovary concerning for hemorrhagic cyst. Labs demonstrated normal estradiol, testosterone, aldosterone, bHCG, inhibin A, and AFP. Inhibin B was elevated to 464. Given patient age and reassuring findings on ultrasound, it was ultimately decided to trend serum inhibins, mass size with ultrasound, and consult pediatric surgery given possible gynecologic malignancy. Repeat imaging 4 weeks later showed a stable hemorrhagic cyst and down trending inhibin B at 180. At 8 weeks from onset, imaging demonstrated interval resolution hemorrhagic cyst and inhibin B at 118. Given the improvements, repeat imaging and inhibin was obtained five months later with no evidence of recurrence of hemorrhagic cyst and normalized inhibin B at 35.</div></div><div><h3>Comments</h3><div>Limited data exists regarding conservative treatment of adnexal masses that are benign in nature in the setting of elevated tumor markers in pediatric and adolescent patients. In this case, a benign appearing lesion was associated with elevations of inhibin B, which raised concern for gynecologic malignancy. In absence of high-risk ultrasonographic features or symptoms of hyperestrogenism that one would expect in juvenile granulosa cell tumor, the clinical picture was consistent with benign pathology. Thus, inhibin was trended to normal range and correlated with simultaneous resolution of the cyst. An unnecessary surgical procedure was avoided in this asymptomatic patient. Further studies need to be collected to validate the use of trending inhibin B in the setting of benign adnexal pathologies like hemorrhagic cysts.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 242"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}