Journal of pediatric and adolescent gynecology最新文献

{"title":"Oncofertility. A first world problem?","authors":"Sonia R Grover","doi":"10.1016/j.jpag.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.jpag.2024.12.003","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822288","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":"Assessing Practice Patterns Regarding Use of Norethindrone Acetate in Adolescents.","authors":"Lucy Rosenbaum, Rebekah Williams, Marcia L Shew","doi":"10.1016/j.jpag.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.jpag.2024.11.007","url":null,"abstract":"<p><strong>Background: </strong>Norethindrone acetate (NETA) is commonly used in adolescent patients for management of heavy menstrual bleeding, menstrual suppression, and endometriosis. Clinical guidelines do not address specific dosing strategies, clinical indications, contraindications, or monitoring. We sought to survey current prescribers of NETA to assess practice patterns of use among adolescent patients.</p><p><strong>Methods: </strong>An anonymous cross-sectional survey was sent via email list-serv to members of the North American Society for Pediatric and Adolescent Gynecology Providers (NASPAG). Participants were asked about their own demographics, patterns of use and monitoring of NETA.</p><p><strong>Results: </strong>Seventy-one providers participated in the survey including 46 gynecologists and 22 adolescent medicine trained clinicians. The most common indications for use were menstrual suppression and treatment of endometriosis. Most providers (n=51) used NETA in patients with estrogen contraindications, with over half limiting the maximum dose used (n=24). While 14%(n=9) of providers surveyed had concerns about effects on bone mineral density with prolonged NETA use, only 1 participant routinely obtained dual-energy X-ray absorptiometry (DEXA) scans. 43% of participants using NETA felt there were no absolute contraindications (n=27); others cited liver disease (n=15), active or prior venous thromboembolism (n=7), and inherited thrombophilia or increased clotting risk (n=3) as strict contraindications.</p><p><strong>Conclusions: </strong>NETA is commonly prescribed for adolescents by study participants. Despite widespread use, practice patterns vary regarding eligibility, monitoring, and perceived risks. This likely reflects limited data and highlights the need for further investigations of NETA use. Our study was limited by low response rate that may not be reflective of general clinical practice.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818462","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":"The Vaginal Microbiome and Reproductive Health in Adolescents and Adults.","authors":"Sofia Malave-Ortiz, Madison E Calvert, Indriati Hood-Pishchany, Natalie D Shaw","doi":"10.1016/j.jpag.2024.12.008","DOIUrl":"10.1016/j.jpag.2024.12.008","url":null,"abstract":"<p><strong>Study objective: </strong>The aim of this paper is to review our understanding of the vaginal microbiome (VM), the internal and external factors that influence its composition, and how it relates to adult and adolescent reproductive health.</p><p><strong>Methods: </strong>A literature review was conducted in March 2024 using Web of Science, PubMed, Embase, and Google Scholar.</p><p><strong>Results: </strong>The majority of studies focused on the VM in healthy adult women and demonstrated that the VM changes across the menstrual cycle, with the greatest species diversity during menses. In most women, the VM is dominated by lactobacilli, however, Black and Hispanic women are more likely to demonstrate a polymicrobial profile. The VM is also affected by lifestyle factors (e.g., diet, alcohol, smoking, sexual activity, vaginal hygiene) and contraception, whereas the role of endogenous reproductive hormones in shaping the VM is unclear. The VM of adolescents begins to resemble that of adults in mid- to late puberty.</p><p><strong>Conclusion: </strong>The VM is a complex and dynamic microbial community that has the potential to serve as an important clinical biomarker of adult as well as adolescent reproductive health, possibly aiding in the diagnosis of such conditions as polycystic ovarian syndrome. However, additional studies are needed in healthy adolescent girls.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818463","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":"Group support for parents of girls with Turner Syndrome - A pilot study.","authors":"Moran Shemesh-Iron, Myriam Safrai, Moran Shapira, Dror Meirow, Noah Gruber","doi":"10.1016/j.jpag.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.jpag.2024.12.009","url":null,"abstract":"<p><strong>Study objective: </strong>Parents of girls with Turner syndrome (TS) are coping with various challenges associated with caring for a child with a genetic disorder. We aimed to explore the importance of group support for parents of girls with TS in a small pilot study.</p><p><strong>Methods: </strong>Group support sessions for parents of girls with TS were divided into meetings regarding psychological aspects, medical aspects, and social aspects. Questionnaires about how the families perceive TS and what obstacles they are facing were given before and after the group support through the Mentimeter application. Questionnaires were given at the end of the group sessions to assess efficacy and satisfaction.</p><p><strong>Results: </strong>Parents of 18 girls, with a median (interquartile range) age of 9 (5.5,12) years old, participated in the group, 56% with 45X karyotype. On average 72% of the participants said that the sessions much/very much contributed, and 10% said that the sessions hardly contributed (p<0.05). At the end of the sessions, parents shared that they felt more confident, less isolated, and gained more knowledge regarding TS, and a community-based sharing process was initiated. At the end of the support group, fifteen (83%) versus 3 (17%) said they would like to continue the meetings of the support group (p= 0.0001).</p><p><strong>Conclusions: </strong>A support group specifically designed for parents of girls diagnosed with TS enhanced cooperation and empathy through diminishing feelings of isolation, offering crucial information, and fostering a secure environment for sharing and support.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813628","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":"Beliefs and behaviors regarding abortion counseling among U.S. clinicians caring for adolescents.","authors":"Danielle G Tsevat, Brooke W Bullington, Kavita S Arora, Bianca A Allison","doi":"10.1016/j.jpag.2024.12.004","DOIUrl":"10.1016/j.jpag.2024.12.004","url":null,"abstract":"<p><strong>Study objective: </strong>To determine clinician factors associated with discussing abortion during pregnancy options counseling among adolescents.</p><p><strong>Methods: </strong>We recruited and surveyed a convenience sample of U.S. clinicians who care for pregnant adolescent patients (N=146). Clinicians were recruited at a national conference, through listservs, and via a physician mailing list. We used chi-square tests to analyze differences in our primary outcomes (routinely discussing abortion, routinely providing abortion referrals, and not routinely advising patients seeking abortion against termination) by clinician demographics, beliefs, and practice settings.</p><p><strong>Results: </strong>Fifty-seven percent of clinicians reported routinely discussing abortion with adolescent patients, 58% routinely referred for abortion, and 76% did not routinely advise against termination. Female gender, pediatric specialty, and practicing in an academic setting were associated with routinely referring for abortion and not routinely counseling against abortion (p<0.05). Additionally, state abortion laws at the time of the survey were associated with abortion discussion and referrals. Having \"a personal objection to abortion\" or \"belief that abortion will harm patients\" were negatively associated with each outcome (p <0.05).</p><p><strong>Conclusion: </strong>Clinician demographics and personal beliefs were associated with differences among counseling. Although this was a small exploratory study, our findings highlight important clinician-level barriers to adolescents' access to abortion counseling and care.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801191","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":"DISTAL URETHRAL DUPLICATION IN A FEMALE CHILD: A UNIQUE CASE REPORT WITH DIVERTICULAR COMPONENT.","authors":"Gokhan Arkan, Cem Kaya, Leyla Nur Turker, Fatma Nur Aracıer Ucaner, Ramazan Karabulut, Zafer Turkyilmaz, Kaan Sonmez","doi":"10.1016/j.jpag.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.jpag.2024.12.006","url":null,"abstract":"<p><strong>Study objective: </strong>To report a rare case of urethral duplication in a 5-year-9-month-old girl and describe the surgical approach and outcomes.</p><p><strong>Methods: </strong>A 5-year-9-month-old girl presented with post-void dribbling and clitoral swelling. Physical examination and imaging were performed. During surgery, a fistula tract was identified, dissected, and excised. This tract was found to be a urethral duplication extending between the distal urethra and the clitoris. The procedure involved advancing a polypropylene suture through the fistula and observing its course via cystoscopy.</p><p><strong>Results: </strong>The fistula tract was successfully excised, resolving both the clitoral swelling and dribbling. The patient recovered without complications and showed no recurrence at the two-month follow-up.</p><p><strong>Conclusion: </strong>Urethral duplication, though exceedingly rare in females, should be considered in cases of urinary incontinence. Surgical excision is an effective treatment with favorable outcomes.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801193","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":"\"Don't give up, advocate for yourself\": A pilot study examining healthcare experiences of people with Mayer Rokitansky Küster Hauser syndrome (MRKH).","authors":"Nisha Marshall, Zwetlana Rajesh, Kate Hunker, Jessica Merletti, Melody Garas, Ashley Clark, Sunni Anne Ball, M E Sophie Gibson, Caroline F Pukall","doi":"10.1016/j.jpag.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.jpag.2024.12.001","url":null,"abstract":"<p><strong>Study objective: </strong>Mayer Rokitansky Küster Hauser syndrome (MRKH) is characterized by the underdevelopment or absence of the uterus and upper vagina. Navigating healthcare interactions may present unique challenges for those with MRKH as there appears to be sparse clinical education and research available to healthcare providers. Additionally, limited research exists on the healthcare experiences of people with MRKH. This pilot study investigated the diagnostic journeys, post-diagnosis experiences, current healthcare interactions, and attitudes toward the healthcare system among individuals with MRKH.</p><p><strong>Methods: </strong>Participants with MRKH residing in the United States or Canada took part in semi-structured interviews on their MRKH-related healthcare experiences. Interview transcripts were thematically analyzed.</p><p><strong>Results: </strong>People with MRKH conveyed that: 1) MRKH was not well known by healthcare providers and they were seldom provided with information and resources about MRKH, 2) they often needed to advocate for themselves in the healthcare system to receive adequate care, 3) sensitivity, inclusion, and knowledge from healthcare providers was invaluable, and 4) healthcare-system level barriers prohibited access to adequate care.</p><p><strong>Conclusions: </strong>Information and resources for MRKH patients should be age appropriate, patient-centered, trauma informed, and locally based. Providers should have access to evidence-based information and resources about MRKH, which includes knowledge of local specialist physicians, mental health specialists, pelvic health physical therapists, and other allied health professionals. Providers should also limit assumptions and use sensitive and inclusive language when communicating with patients around MRKH diagnosis, education, and development of treatment plans. Lastly, strategies for mitigating healthcare barriers should consider those with MRKH.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801190","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":"Virilization, Ovarian Hyperthecosis, and Torsion Masquerading as Malignancy: A Case Report.","authors":"Aimee Morrison, Taryn Wassmer, Sarah Swauger, Lara Berklite, Christine Pennesi","doi":"10.1016/j.jpag.2024.12.005","DOIUrl":"10.1016/j.jpag.2024.12.005","url":null,"abstract":"<p><strong>Background: </strong>Premenopausal females with signs of androgen excess and oligomenorrhea are commonly evaluated for polycystic ovarian syndrome or for an androgen-secreting tumor if a pelvic mass is present. Ovarian hyperthecosis (OHT) as a cause of these symptoms in adolescents is rare.</p><p><strong>Case: </strong>A 15 year-old female with primary amenorrhea and signs of virilization was referred to Pediatric and Adolescent Gynecology after pelvic imaging demonstrated a pelvic mass, suspected to be arising from the right ovary, and an adjacent paratubal cyst. Preoperative laboratory evaluation revealed markedly elevated testosterone levels (free testosterone 81.5 pg/mL [normal <7.5 pg/mL]; total testosterone 279.6 ng/mL [normal <52.0 ng/mL]). Ovarian tumor markers were otherwise normal. Surgical evaluation revealed bilaterally enlarged ovaries and right paratubal cyst with right ovarian torsion. Rather than demonstrating an androgen-secreting tumor, pathologic evaluation following right salpingo-oophorectomy resulted in an unexpected diagnosis of OHT.</p><p><strong>Summary and conclusion: </strong>Our case demonstrates that OHT should be considered in the differential in the setting of a large pelvic mass and virilization in an adolescent.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801195","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":"Intimate Partner Violence in Latin America: The Gap between Policy and Reality.","authors":"S Bellizzi, K Molek, C M Panu Napodano, A Nivoli","doi":"10.1016/j.jpag.2024.12.007","DOIUrl":"10.1016/j.jpag.2024.12.007","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794927","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":"Qualitative assessment of provider approaches to dilation following vaginoplasty.","authors":"Frances W Grimstad, Elizabeth R Boskey, Chapin Spence, Hadley Beauregard","doi":"10.1016/j.jpag.2024.11.006","DOIUrl":"https://doi.org/10.1016/j.jpag.2024.11.006","url":null,"abstract":"<p><strong>Study objective: </strong>Most surgical vaginoplasties are followed post-operatively, when age appropriate, by patient-led dilation to maintain patency, but there is a lack of both standardized protocols and research comparing dilation practices within and across surgical routes. This study's objective is to determine surgeon attitudes about dilation and learn what protocols they use and endorse to take steps towards addressing the literature gap around dilation practices and outcomes.</p><p><strong>Methods: </strong>We performed semi-structured interviews with ten providers (nine surgeons, one nurse) involved in vaginoplasty at a single tertiary care children's hospital about their dilation practices. These recordings were then transcribed, and thematic analysis was performed using an iterative process of coding, re-coding, and generation of themes RESULTS: Three major themes were generated from analysis. First, interviewees described variable definitions of success regarding dilation post-vaginoplasty describing both patient-centered and anatomically objective outcomes. They also discussed a lack of standardization of techniques, with many echoing confusion or frustration regarding this, both in training and in practice. Finally, they described the ad hoc inclusion of behavioral health as a collaborator for patient dilation education. This was reviewed as something often felt necessary to dilation success while not explicitly included in dilation protocols.</p><p><strong>Conclusion: </strong>This study of clinicians' experiences with dilation following vaginoplasty highlights the diversity of approaches used, the lack of standardization in training, and the gaps in existing research to inform best practices.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791834","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}