Journal of pediatric and adolescent gynecology最新文献

{"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}

{"title":"27. Diagnosis of Imperforate Hymen: A Case Study for Quality Improvement","authors":"Avanthi Ajjarapu,&nbsp;Jennifer Dietrich","doi":"10.1016/j.jpag.2025.01.060","DOIUrl":"10.1016/j.jpag.2025.01.060","url":null,"abstract":"<div><h3>Background</h3><div>Imperforate hymen, transverse vaginal septum, vaginal agenesis, and lower vaginal atresia are four common forms of vaginal outlet obstruction. Early differentiation between these anatomic variants is crucial to determine a correct diagnosis and ensure appropriate surgical timing to avoid unnecessary surgical revision or complication. Distinguishing between these variants relies initially on physical exam. When characteristic components are absent, it is critical to obtain imaging to distinguish between other obstructive vaginal anomalies as the presence of hematocolpos or hematometra may occur with many types of obstructive mullerian anomalies. A pelvic ultrasound may be ordered initially as it is more readily available but may not yield enough detailed information. In this circumstance, further imaging should be obtained prior to surgical intervention with Pelvic MRI; the gold standard imaging modality for reproductive tract anomalies. This case reminds the provider of the steps to take for the correct diagnosis as well as recommendations for specialist referral when the presentation is not that of a bulging membrane with blue hue at the introitus.</div></div><div><h3>Case</h3><div>A 13 yo female presented to an outside emergency room with severe, cyclic abdominopelvic pain. A pelvic ultrasound suggested hematometra. She was taken to the operating room due to pelvic exam findings concerning for no vaginal patency. A vaginal dimple was present without blue hue or bulging noted. Intraoperatively, an incision did not reveal release of menstrual contents. The surgery was aborted due to findings inconsistent with imperforate hymen. MRI Pelvis was ordered later and a diagnosis of cervicovaginal agenesis with hematometra was made. Menstrual suppression was then initiated with GnRh antagonist orally. A few years later, the patient was referred to Pediatric and Adolescent Gynecology.</div></div><div><h3>Comments</h3><div>For complex reproductive tract anomalies, pelvic MRI should be ordered following pelvic US as MRI best correlates with the type of anomaly. Avoid going to the operating room if the classic presentation of imperforate hymen is not visualized and confirmed to minimize complications. Optimize pain management to allow time to obtain adequate MRI Pelvis with contrast for optimal delineation of hymenal versus other vaginal and mullerian variants. This includes assessing distance from introitus to defect. Refer to a specialist with expertise in managing obstructive reproductive tract anomalies, when an anomaly other imperforate hymen is suspected.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 243"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519941","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":"8. Geospatial Distribution of Mullerian Anomalies in the State of Texas between 2012-2024: A Retrospective Cohort Study","authors":"Avanthi Ajjarapu ,&nbsp;Jennifer Dietrich ,&nbsp;Michael Jochum","doi":"10.1016/j.jpag.2025.01.020","DOIUrl":"10.1016/j.jpag.2025.01.020","url":null,"abstract":"<div><h3>Background</h3><div>Etiology of Mullerian anomalies (MA) has long been considered multifactorial, but the specific contributing factors remain unclear. Some genes have been correlated to certain MA, but no genes explain all anomaly types. The role of environmental pollutants (EP), specifically possible endocrine disruptors, has been considered, but not explored to date. We aimed to understand distribution of patients with any MA to assess proximity to EP.</div></div><div><h3>Methods</h3><div>An IRB approved retrospective cohort study was conducted among Pediatric and Adolescent Gynecology patients (</div></div><div><h3>Results</h3><div>526 patients met inclusion/exclusion criteria following initial population analysis with Epic SlicerDicer. A majority of patients identified as White (78%), and non-Hispanic and/or Latino (57%) (Table 1). 34.6% of the cohort was comprised of complex mullerian anomalies. Geographic coordinates by census tract code and anomaly type were plotted on a Texas State map, visually demonstrating MA distribution. Best Fit modeling of study cohort by optimal silhouette width revealed 43 distinct geographic clusters (Figure 1). Among zipcodes with the highest MA prevalence, one was noted in close proximity to a superfund site which is a high hazard EPA classification. Clusters 3 and 4 were of interest due to higher rates of OHVIRA and MRKH. Among waste sites within a 10-mile radius to each cluster, top chemicals emitted included known endocrine disruptors.</div></div><div><h3>Conclusions</h3><div>This is the first study of its kind to assess geospatial distribution of mullerian anomalies and proximity to environmental pollutants. We hope that this data provides the groundwork to further elucidate impact of environmental factors on MA.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 224"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520007","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":"3. Cardiovascular Risk in Females with Endometriosis","authors":"Madeline Smith ,&nbsp;Margaret Bolan ,&nbsp;Catherine Stamoulis ,&nbsp;Shannon Lyon ,&nbsp;Amy DiVasta","doi":"10.1016/j.jpag.2025.01.015","DOIUrl":"10.1016/j.jpag.2025.01.015","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with endometriosis are at higher risk of cardiovascular (CV) disease, hypertension, high cholesterol, and atherosclerosis. While CV disease is rare in young people, surrogate markers such as the pulse wave velocity (PWV), a measure of arterial stiffness, can predict future CV dysfunction. We sought to determine if females with endometriosis had elevated PWV values, and thus increased CV risk, compared with healthy control subjects. We also investigated whether additional predictors of future CV risk correlated with PWV measurements.</div></div><div><h3>Methods</h3><div>At the baseline visit of a multi-site, randomized clinical trial, n=70 females with laparoscopically-confirmed endometriosis and persistent pelvic pain provided health history and anthropometric measures. Blood samples were obtained for measurement of inflammatory markers (hs-CRP, ESR), lipid profiles (HDL, LDL), and hormonal concentrations (estradiol). PWV was collected by using two pressure probes placed at the carotid artery and femoral artery. The time it takes the pressure wave to go from the upstream probe to the downstream probe provides the Pulse Transit Time. PWV is calculated by dividing the distance traveled by the transit time. Previously obtained normative data from n=1455 from healthy controls were used as reference. Generalized linear regression models with adjustments for age, endometriosis stage and BMI were developed to test the associations of interest. We had local IRB approval.</div></div><div><h3>Results</h3><div>Of the n=70 participants, n=63 (median (interquartile (IQR)) age 25.3 (13.2) y, range 16.1–39.2y)) had PWV scans adequate for analysis. All were using hormonal therapy: 10 (15.9%) combined-hormonal contraception, 27 (42.9%) oral progestin, 31(49.2%) LNG IUD, and 11 (17.5%) other. Participants were excluded for other CV disease risk (n=2 high cholesterol, n=1 hypertension). Demographic and clinical characteristics are summarized in Table 1. About 30% of participants had stage I endometriosis. Median (IQR) PWV was 5.1 (1.2) m/s, lower than normative values for this age range (median=6.1-6.4 m/s for ages &lt; 30 – 39). Respective associations between PWV and hs-CRP, ESR, HDL, and estradiol were nonsignificant (p&gt; 0.15). LDL was positively associated with PWV (regression coefficient (β)=0.02, 95% CI=[0.01, 0.03], p&lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Females with endometriosis had lower PWV measurements compared to age-matched control subjects. LDL was positively associated with PWV; other CV risk markers were not. In this sample, young females with endometriosis did not demonstrate early signs of increased CV risk as measured by PWV. Future studies should investigate the impact of duration of disease and use of hormonal treatment on these findings.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 220-221"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520111","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. Effect of GLP-2 Coated Vaginal Expansion Sleeves (VES) in a Rat Model","authors":"Joshua Colvin,&nbsp;Rachel Cline,&nbsp;Hannah Meyer,&nbsp;Donald Sorrells,&nbsp;Jonathan Alexander,&nbsp;Mila Shah-Bruce","doi":"10.1016/j.jpag.2025.01.016","DOIUrl":"10.1016/j.jpag.2025.01.016","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal atresia is the congenital absence of the vaginal canal. Current treatments include at-home dilation therapy and surgical vaginoplasty. In our previous studies we have created a novel vaginal expansion sleeve (VES) that progressively elongated and retained vaginal expansion with only minor procedural intervention. This study aims to further explore the effect of the VES device on vaginal lengthening utilizing Glucagon-like peptide 2 (GLP-2). GLP-2 is known to promote intestinal tissue proliferation however the research exploring GLP-2′s role in non-intestinal tissues including female reproductive tissue is sparse.</div></div><div><h3>Methods</h3><div>The VES is a cylindrical, spring-like device with resin caps. Each VES was cut to 1.3x the current vaginal canal length, coated with 50µg GLP-2 via cross-linking with polyvinyl alcohol, inserted into the vaginal canals of 4 Sprague Dawley rats, and anchored with nonabsorbable sutures. Each week, the sleeves were removed and replaced with a serially longer VES over three weeks measuring 1.3x the current length of the vaginal canal. Rats were monitored for another 2 weeks to assess for any decrease in vaginal length. Vaginal lengths were measured prior to initial VES insertion and weekly during the 5-week trial.</div></div><div><h3>Results</h3><div>Serial deployment of GLP-2 coated VES devices resulting in an increase in vaginal length from 26.25 ± 0.96 mm to 35.5 ± 3.11 mm (p&lt; 0.001, week 5). Histologically, diffuse vaginal wall thinning with preservation of the epithelial, mucosal, and muscular layers was seen. Mild to moderate inflammation was also noted as evidenced by intraepithelial and and subepithelial lymphoid infiltrate.</div></div><div><h3>Conclusions</h3><div>The serial implantation of GLP-2 VES resulted in significant and retained expansion of the rat vagina comparable to the previous non-GLP-2 VES with both rounds of devices producing an average vaginal length of 35.5 mm with retained tissue architecture. The GLP-2 VES suggests a minimally invasive alternative for vaginal atresia treatment.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 221"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520112","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":"6. Evaluating the diagnostic work-up of heavy menstrual bleeding and hemostatic efficacy of norethindrone acetate in improving menstrual suppression among adolescent girls with obesity","authors":"Julia Shuford ,&nbsp;Maeve McNamara ,&nbsp;Anna Schwartz ,&nbsp;Morgan Buchanan ,&nbsp;Robert Sidonio ,&nbsp;Nancy Sokkary ,&nbsp;Megan Brown","doi":"10.1016/j.jpag.2025.01.018","DOIUrl":"10.1016/j.jpag.2025.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent obesity continues to rise in prevalence and is a risk factor for many etiologies of heavy menstrual bleeding (HMB), yet comprehensive guidelines on the evaluation and management of HMB in obese adolescents is lacking. This study aims to (1) characterize the prevalence of obesity and menstrual characteristics among adolescents presenting to the emergency department (ED) with HMB, (2) investigate the hemostatic efficacy of norethindrone acetate (NA) relative to IV conjugated estrogen in obese adolescents.</div></div><div><h3>Methods</h3><div>A retrospective chart review with collection of demographic and clinical data was performed, including all ED encounters (2017-2022, excluding 2020 due to COVID-19 pandemic) at three affiliates of a large tertiary children's hospital that utilized an acute HMB clinical pathway. Obesity was defined by BMI equal to or greater than the 85th percentile. Hemostatic efficacy was defined as follows: red blood cell (RBC) transfusion, tranexamic acid (TXA) utilization, and length of stay (LOS) &gt;36 hours. TXA use was a surrogate for poorly controlled HMB at 24 hours; the clinical pathway recommended adding TXA if HMB persisted despite primary hemostatic agent at 24 hours. T tests and chi squared statistics were used to compare continuous and categorical variables, respectively. Multivariate logistic regression models were used to predict adjusted odds ratios of outcome variables (NA vs. IV conjugated estrogen) separately among all non-obese and obese individuals.</div></div><div><h3>Results</h3><div>Between 2017-2022, 402 adolescents were admitted from the ED for HMB with documented BMI measurements. Over half were obese. Obese adolescents disproportionately identified as Black and reported younger onset of menarche. When adjusting for admission hemoglobin, receiving NA alone was associated with significantly decreased odds of RBC transfusion (AOR: 0.265, 95% CI: 0.104-0.674; p=0.005) relative to receiving IV conjugated estrogen among non-obese individuals. When adjusting for platelet levels, receiving NA alone was associated with significantly decreased odds of TXA utilization (AOR: 0.107, 95% CI: 0.013-0.859; p=0.036) among non-obese individuals. However, among obese individuals, we observed no association with odds of transfusion (p=0.267), TXA utilization (p=0.265) or LOS &gt;36 hours (p=0.472) by hemostatic agent.</div></div><div><h3>Conclusions</h3><div>In the setting of acute HMB, treatment with NA is associated with reduced odds of RBC transfusion and TXA utilization among non-obese but not obese individuals, highlighting the potential disparities in treatment response based on obesity status.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 222-223"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520114","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":"48. Gynecology Concerns for Children and Adolescents with Genitourinary Perineal Vascular Anomalies: A Retrospective Analysis","authors":"Anna Ujvary ,&nbsp;Maya Younoszai ,&nbsp;Xing Wang ,&nbsp;Shane Morrison ,&nbsp;Jonathan Perkins ,&nbsp;Katherine Debiec","doi":"10.1016/j.jpag.2025.01.081","DOIUrl":"10.1016/j.jpag.2025.01.081","url":null,"abstract":"<div><h3>Background</h3><div>We investigated the prevalence, management, and outcomes of genitourinary-perineal vascular anomalies (GUP-VAs), focusing on gynecologic concerns in pediatric patients with vulvar anatomy. We compared infantile hemangiomas (IHs) and vascular malformations (VMs) regarding symptom prevalence, functional impairment, treatment approaches, and outcomes. We hypothesized that VMs are associated with more significant gynecologic symptoms, functional impairment, and a higher likelihood of reproductive health counseling. The study aims to further understand gynecologic and developmental needs to improve clinical outcomes and personalized care.</div></div><div><h3>Methods</h3><div>Following IRB approval, we conducted a retrospective chart review of 119 patients treated for GUP-VAs at Seattle Children's between 1998 and 2024. Patients aged 0-21 years with vulvar anatomy and a GUP vascular anomaly diagnosis were included. Data on demographics, anatomic location, symptoms, functional impairments, treatment modalities, and gynecologic concerns were analyzed. Statistical comparisons between IHs and VMs were conducted using Mann-Whitney U tests for continuous variables and Fisher's exact test for categorical variables, focusing on symptoms, impairments, and treatment outcomes.</div></div><div><h3>Results</h3><div>Of the 119 patients, 98 (82.4%) had IHs and 21 (17.6%) had VMs. VMs were significantly associated with symptoms of mass (p &lt; 0.001), dyspareunia (p = 0.030), and functional impairments such as pain (p = 0.001) and emotional concerns (p = 0.005). Observation (p = 0.003) and pharmacotherapy (p = 0.004) were more common for IHs, while more invasive treatments like sclerotherapy (p &lt; 0.001) and excision (p = 0.057) were used more frequently for VMs. Post-treatment, patients with VMs showed significant improvements in pain (p = 0.043) and emotional well-being (p = 0.030). Gynecologic issues, such as menstrual irregularities, were prevalent in venolymphatic (100%) and lymphatic malformations (50%), while 50% of patients with lymphatic malformations reported sexual dysfunction. Contraceptive and pregnancy counseling were more common in patients with VMs, particularly those with Klippel-Trenaunay syndrome (66.7%).</div></div><div><h3>Conclusions</h3><div>VMs in the GUP region are associated with more severe symptoms and greater functional impairments compared to IHs. These findings highlight the physical and emotional impact of VMs and the importance of addressing gynecologic and reproductive health in this population. Treatment outcomes showed significant improvements in pain and emotional well-being, emphasizing the need for early diagnosis and multidisciplinary management to optimize patient outcomes.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 251-252"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520217","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":"40. Feasibility of Nurse Practitioner Led Vaginal Dilation Therapy: A Retrospective Cohort Study","authors":"Jemimah Raffe-Devine,&nbsp;Aalia Sachedina,&nbsp;Rachel Ollivier,&nbsp;Natasha Prodan Bhalla,&nbsp;Nicole Todd","doi":"10.1016/j.jpag.2025.01.073","DOIUrl":"10.1016/j.jpag.2025.01.073","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal dilator therapy is the recommended first line management in patients with vaginal agenesis to increase vaginal length and improve sexual function and has been demonstrated to be highly effective with minimal risks. A barrier to successful vaginal dilator therapy is the long-term nature of treatment and the requirement for extended follow up over multiple visits. Nurse practitioner led clinics have been shown to have positive clinical outcomes in other disciplines, and use of a multidisciplinary clinic has been shown have an 88% functional success rate in patients undergoing vaginal dilator therapy. Our objective was to assess if nurse practitioner led vaginal dilator therapy is a feasible alternative to pediatric gynecologist led therapy and create an evidence-based model of care.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study. Electronic medical records were searched using the ICD codes for vaginal agenesis and uterine agenesis. Patients were included who had participated in vaginal dilator therapy led by a pediatric gynecologist or by a nurse practitioner at our institution's Women's Health Clinic. The primary outcomes were patient satisfaction, change in vaginal length, and sexual function throughout treatment. We also collected visit details including number and timing of visits, prescribed dilation schedule. This study was approved by the Research Ethics Board.</div></div><div><h3>Results</h3><div>Thirteen patients were included ranging from 15 to 33 years of age. The most common diagnosis was MRKH (92%). 92% of patients were recorded as unsatisfied with their sexual activity and vaginal length before treatment. Among patients who were seen by a nurse practitioner in association with pediatric gynecology, 80% reported normal sexual function, normal vaginal length, or overall satisfaction with vaginal dilator therapy at time of discharge. This is comparable to 84.6% of patients who were followed by either a nurse practitioner or pediatric gynecology alone. Patients were followed for a mean of 15.6 months and required a mean of 4.7 visits prior to discharge. Optimal spacing between visits was monthly with a prescribed dilation schedule of one to two times per day for 10 minutes at a time.</div></div><div><h3>Conclusions</h3><div>Nurse practitioner led vaginal dilator therapy is a comparable alternative to pediatric gynecology led therapy with similar outcomes as previously reported in the literature. This is a reasonable option to increase access to care for patients with vaginal agenesis without requiring routine specialist involvement.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 248"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520845","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":"33. Enhancing Clinical Documentation for DSD Patients: A Retrospective Evaluation of a Standardized Physical Exam Template","authors":"Alexandra Herweck ,&nbsp;Brittany Jean-Louis ,&nbsp;Anisha Chada ,&nbsp;Nancy Sokkary","doi":"10.1016/j.jpag.2025.01.066","DOIUrl":"10.1016/j.jpag.2025.01.066","url":null,"abstract":"<div><h3>Background</h3><div>Disorders of Sex Development (DSD) encompass a wide spectrum of phenotypes, making individualized treatment challenging. The DSD Translational Research Network (TRN) has advocated for standardized documentation of physical exam findings to better tailor management. One institution's DSD clinic identified limitations in its existing documentation practices, which hindered comprehensive care. In response, the clinic developed and implemented a standardized physical exam template in the Electronic Medical Record for use in both clinical visits and the operating room, aiming to improve data collection and inform more specific treatment recommendations. The primary objective of this study is to assess the use of a newly implemented template to capture DSD-specific exam findings, in alignment with TRN recommendations. The frequency of documentation of each specific data point on the recommended exam will be evaluated.</div></div><div><h3>Methods</h3><div>Institutional Review Board approval was obtained. A retrospective chart review was conducted on all patients seen in the DSD clinic, including those who underwent a DSD-related surgeries, from January 2019 to June 2024. Data collected included demographics (age, race), clinical details (hormonal therapies, prior surgeries, diagnosis, karyotype, assigned/reared gender, gender identity), and the presence of gender dysphoria. Eighteen physical exam specifics recommended by the DSD TRN were evaluated, covering measurements related to internal and external genital anatomy. The use of the standardized physical exam template and whether clinical photographs were taken to document these findings were also recorded.</div></div><div><h3>Results</h3><div>Preliminary data revealed that prior to template implementation, common diagnoses were classical CAH and complete AIS, while the least common was 5-alpha reductase deficiency. Clitoral measurement was the most frequently assessed genital finding, recorded in 60.6% of cases. Documentation of external gonadal evaluation and urogenital sinus was recorded in only 27.2% and 21.2 % of cases respectively. Data collection from post-implementation encounters is ongoing, and we aim to compare the frequency of documentation before and after the template's introduction, along with the use of clinical photographs.</div></div><div><h3>Conclusions</h3><div>We anticipate that the implementation of a standardized template will significantly improve documentation of DSD-specific physical exam findings and aid in the management of this diverse population. This successful approach can be adapted by other DSD clinics, enhancing research capabilities and improving patient outcomes nationwide.</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":"143519880","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}