Journal of pediatric and adolescent gynecology最新文献

{"title":"Young People's Support for and Personal Interest in an Advance Provision Model for Medication Abortion","authors":"M. Antonia Biggs ,&nbsp;Katherine Ehrenreich ,&nbsp;Natalie Morris ,&nbsp;Lela Bachrach ,&nbsp;Jesus Crespin ,&nbsp;Daniel Grossman","doi":"10.1016/j.jpag.2024.07.012","DOIUrl":"10.1016/j.jpag.2024.07.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess young people's interest in advance provision (AP) of medication abortion—receiving mifepristone and misoprostol from a clinician in advance for their future use.</div></div><div><h3>Methods</h3><div>From November 2022-August 2023 we administered an electronic survey regarding advance provision to patients assigned female at birth at four Bay Area youth-serving clinics.</div></div><div><h3>Results</h3><div>Among 152 people ages 14-24 years (mean 17.9) surveyed, 73.7% (95% CI, 65.9%-80.5%) supported and 46.1% (95% CI, 37.9%-54.3%) were interested in the AP model. AP interest was higher among people who experienced three or more difficulties trying to access reproductive healthcare (70.6% [95% CI, 44.0%-89.7%]) and who experienced food or housing insecurity (60.3% [95% CI, 46.6%-73.0%]). Most youth (81.6%) had a safe place to store the pills for later use; this proportion was significantly higher among people ages 18-24 years (88.5%) than teens ages 14-17 years (74.3%, <em>P</em> = .025). The most common perceived advantages of AP included being able to have the abortion earlier in pregnancy (61.8%), privacy (57.9%) and convenience (50.7%). Common disadvantages noted included concern that people might take the pills incorrectly (50.0%) or lose the pills (40.1%).</div></div><div><h3>Conclusions</h3><div>Young people have considerable interest in AP of medication abortion. Further research is needed to document the AP model's feasibility, clinical outcomes, and effect on access for adolescents.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 614-618"},"PeriodicalIF":1.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NASPAG Clinical Opinion: The Care of Transgender and Gender Nonbinary Adolescents and Young Adults","authors":"Frances Grimstad MD, MS ,&nbsp;Gylynthia Trotman MD, MPH ,&nbsp;Chance Krempasky FNP-BC, WHNP-BC ,&nbsp;Uri Belkind MD ,&nbsp;Jason Jarin MD ,&nbsp;Stephanie Cizek MD ,&nbsp;NASPAG Education Committee","doi":"10.1016/j.jpag.2024.07.007","DOIUrl":"10.1016/j.jpag.2024.07.007","url":null,"abstract":"<div><div>Transgender and gender nonbinary (TGNB) adolescents and young adults (AYA) may present to clinicians with reproductive health expertise for the spectrum of gynecologic, sexual, and reproductive care. As such, clinicians should be knowledgeable in the many facets of gender-affirming care. This clinical opinion reviews language associated with gender diversity and gender-affirming care; current clinical, social, and political barriers faced by TGNB AYA; and the creation of welcoming and inclusive clinical spaces for TGNB AYA. It discusses social, medical, and surgical affirmation processes, and focuses on gynecologic care topics which may arise in the care of TGNB AYA, including those who undergo medical or surgical therapies. This includes menstrual suppression, breakthrough bleeding on testosterone, sexual health, fertility, and the pelvic care of individuals following gender affirming vulvovaginoplasty.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 533-541"},"PeriodicalIF":1.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902079","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":"Factors Affecting Willingness to Provide Medication Abortion Among North American Society for Pediatric and Adolescent Gynecology Members Caring for Adolescents and Young Adults Following the Dobbs Decision","authors":"Amanda E. Bryson MD, MPH ,&nbsp;Elizabeth R. Boskey PhD, MPH, MSSW ,&nbsp;Laura K. Grubb MD, MPH, FAAP ,&nbsp;Jessica Y. Shim MD ,&nbsp;Kathryn E. Fay MD, MSCI","doi":"10.1016/j.jpag.2024.07.013","DOIUrl":"10.1016/j.jpag.2024.07.013","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess willingness to provide medication abortion among North American Society for Pediatric and Adolescent Gynecology (NASPAG) clinicians caring for adolescents and young adults (AYA) following <em>Dobbs v. Jackson Women's Health Organization</em>.</div></div><div><h3>Design</h3><div>Cross-sectional online survey.</div></div><div><h3>Methods</h3><div>Potential participants received an e-mail invitation via the NASPAG listserv. A 43-item questionnaire queried demographics, practice setting, abortion training and practice, willingness to provide medication abortion, potential or real barriers to providing medication abortion, and sentiments of abortion. Descriptive statistics, <em>χ</em>², and Fisher's exact tests were used.</div></div><div><h3>Results</h3><div>Of the 70 participants, 51% were willing to provide a medication abortion for an adolescent who requested it in their clinical practice. The most common barriers to providing medication abortion were legislative restrictions (47%) and dispensing pills from clinic (33%). Participants’ willingness to provide a medication abortion differed by type of practice (<em>P</em> = .001), availability of mifepristone (<em>P</em> = .006), perception of state's abortion policy (<em>P</em> = .001), concern about legislative restrictions (<em>P</em> = .008), experience providing abortion (<em>P</em> = .04), and receipt of medication abortion training (<em>P</em> = .02). Willingness to provide medication abortion also differed based on various sentiments of abortion measured but not on opinion regarding legality of abortion for adolescents (<em>P</em> = .49).</div></div><div><h3>Conclusions</h3><div>Perception of state's abortion rights and concern about legislative restrictions influenced NASPAG clinicians’ willingness to provide medication abortion for adolescents. Interventions to minimize legislative interference with medical care, increase abortion training, and implement medication abortion in pediatric settings may expand AYA medication abortion access.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 586-594"},"PeriodicalIF":1.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric and Adolescent Gynecology Experience in Obstetrics and Gynecology Residency Training Across the United States","authors":"Bianca Georgakopoulos MD ,&nbsp;Yueyang Frances Fei MD","doi":"10.1016/j.jpag.2024.08.001","DOIUrl":"10.1016/j.jpag.2024.08.001","url":null,"abstract":"<div><h3>Study Objective</h3><div>The purpose of this study is to better understand the pediatric and adolescent gynecology (PAG) experience from the obstetrics and gynecology (OBGYN) resident perspective and its impact on physician comfort with caring for younger patients.</div></div><div><h3>Methods</h3><div>This is a cross-sectional survey study of physicians enrolled in OBGYN residency programs in the United States. For each program, an internet search was also performed to identify the closest PAG providers. Chi-square and Fisher's exact tests were performed to compare categorical variables. This study was IRB approved.</div></div><div><h3>Results</h3><div>A total of 74 resident responses from 42 unique OBGYN training programs were included. The majority (62%) of programs offered no PAG clinical experience. Of programs with no PAG clinical experience, 45% had unaffiliated self-identified PAG providers within 30 miles of their institution. Only 26% of residents reported having a dedicated PAG rotation. 68% of residents felt they did not have enough PAG exposure in training. Residents who had a dedicated PAG rotation were more comfortable caring for patients &lt;7 years old (<em>P</em> = .016) and patients 8-14 years old (<em>P</em> = .019) than residents without a rotation. The majority (88%) of residents believe that PAG experience will be useful for their future practice.</div></div><div><h3>Conclusion</h3><div>Residents with PAG training are more comfortable in caring for patients &lt;14 years than those in programs who lack this training. Residencies without PAG-trained staff physicians could consider partnering with PAG-practicing community physicians with the aim of broadening clinical experience. Improvement in PAG education helps provide graduating obstetrician-gynecologists with the necessary knowledge to provide needed care to younger patients.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 549-554"},"PeriodicalIF":1.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Physician Practices and Preferences Using Vaginal Stents to Prevent Postoperative Vaginal Stenosis in Pediatric and Adolescent Patients","authors":"Julie C. Friedman MD,&nbsp;Kendra Hutchens PhD,&nbsp;Karen Hampanda PhD,&nbsp;Stephen Scott MD,&nbsp;Patricia Huguelet MD,&nbsp;Leslie Appiah MD,&nbsp;Veronica I. Alaniz MD, MPH","doi":"10.1016/j.jpag.2024.07.010","DOIUrl":"10.1016/j.jpag.2024.07.010","url":null,"abstract":"<div><h3>Study Objective</h3><div>The purpose of this study is to describe practices to prevent vaginal stenosis in pediatric and adolescent patients and to evaluate the strengths and weaknesses of available vaginal stents.</div></div><div><h3>Methods</h3><div>An online survey was distributed to North American Society for Pediatric and Adolescent Gynecology (NASPAG) members with an optional follow-up focus group. Quantitative and qualitative data were synthesized to highlight physician practices and preferences using vaginal stents, strengths and weakness of stents, and ideal stent properties.</div></div><div><h3>Results</h3><div>Twenty physicians completed at least 50% of the survey, and 4 participated in the focus group. Most were pediatric and adolescent gynecology specialists (95%) with fellowship training (60%) and experience in managing Müllerian anomalies (80%). Physicians reported they “always” used a vaginal stent when performing vaginoplasty for distal vaginal agenesis with a graft (62.5%) or without a graft (37.5%) and for transverse vaginal septa (57.1%). The most common type of stents used were packed condoms (60%), tracheobronchial stents (40%), Foley catheters (35%), and custom stents (35%). Participants described an ideal vaginal stent as something that would stay in place, cause little discomfort, expand, and come in a variety of lengths.</div></div><div><h3>Conclusion</h3><div>There are limited vaginal stent options for the pediatric and adolescent gynecology population. Participants reported variability in stents used to prevent vaginal stenosis, with commonly used vaginal stents having significant weaknesses. Future efforts are needed to identify and develop postoperative clinical guidelines to prevent vaginal stenosis.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 608-613"},"PeriodicalIF":1.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889563","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":"Racial and Ethnic Equity, Diversity, and Inclusion in Pediatric and Adolescent Gynecology: A Call to Action From a North American Perspective","authors":"Danielle T. Cipres MD ,&nbsp;Melicia Y. Whitley MM ,&nbsp;Valerie L. Ward MD, MPH","doi":"10.1016/j.jpag.2024.07.011","DOIUrl":"10.1016/j.jpag.2024.07.011","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 542-545"},"PeriodicalIF":1.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893634","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":"Comparison between 3D-Enhanced Conventional Pelvic Ultrasound and Magnetic Resonance Imaging in the Evaluation of Obstructive Müllerian Anomalies and Its Concordance with Surgical Diagnosis.","authors":"Chenglu Qin, Pohching Lee, Licong Luo","doi":"10.1016/j.jpag.2024.07.004","DOIUrl":"10.1016/j.jpag.2024.07.004","url":null,"abstract":"<p><strong>Study objective: </strong>This study aimed to assess the practical application of conventional 2D pelvic ultrasound in conjunction with 3D ultrasound for evaluating obstructive Müllerian abnormalities.</p><p><strong>Design: </strong>Retrospective study in a tertiary referral hospital METHODS: Computerized stored data were used to collect surgically confirmed obstructive Müllerian anomaly cases between December 2022 and October 2023 with evaluation of presurgical imaging. Acute presentation with abdominal pain and clinical suspicion of an obstructive Müllerian abnormality were required for inclusion. All study participants underwent pelvic ultrasound before the definitive surgery, with or without a repeat MRI if one was performed before admission. Those situations where both MRI and ultrasound were not conducted were excluded, such as transverse vaginal septum, imperforate hymen, iatrogenic cervical injury, or Müllerian malformation alone without obstructive outflow anomalies such as didelphys, bicornuate, or septate uterus.</p><p><strong>Main outcome measures: </strong>Concordance between the surgically confirmed diagnosis and the pelvic ultrasound was reported in 27 of 29 women (93.1%). In contrast, only 24 of 29 cases were correctly diagnosed with MRI in this study (82.8%). This pilot study presents a comparison of 2 techniques, with a specific focus on obstructive Müllerian anomalies. The use of pelvic ultrasound not only assisted in our surgical practice but also significantly improved patient-doctor counseling.</p><p><strong>Conclusion: </strong>In managing obstructive Müllerian abnormalities, 3D-enhanced conventional pelvic ultrasound was found to be effective in diagnosis and was comparable to MRI.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889562","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":"A Rare Ovarian Mixed Sex Cord Stromal Tumor in a Patient with Ollier Disease: A Case Report","authors":"Kyle M. Devins MD ,&nbsp;Allan M. Goldstein MD ,&nbsp;Amanda V. French MD","doi":"10.1016/j.jpag.2024.07.009","DOIUrl":"10.1016/j.jpag.2024.07.009","url":null,"abstract":"<div><div>This is a case report of a 10-year-old with Ollier disease and an ovarian mass. Ollier disease, a rare disorder characterized by multiple enchondromas resulting in bone deformities, has been occasionally associated with ovarian juvenile granulosa cell tumor. This patient developed signs of precocious puberty and was found to have an ovarian tumor; however, pathology revealed a mixed sex-cord stromal tumor with components of juvenile granulosa and Sertoli-Leydig cell tumor. Tumor genomic testing revealed an <em>IDH1</em> mutation. Mixed sex-cord stromal tumors of this type, also called “gynandroblastomas,” have been associated with <em>DICER1</em> mutations and <em>DICER1</em> tumor predisposition syndrome but never with Ollier disease. Our findings expand the known spectrum of syndromic associations with this tumor type, with implications for tumor screening.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 629-631"},"PeriodicalIF":1.7,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889558","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":"Experiences of Pelvic and Generalized Persistent Pain Syndromes in MRKH: A Scoping Review","authors":"R.U. Gaikaiwari MBBS (Hons) ,&nbsp;C. Prinsloo MBBS (Hons) ,&nbsp;S.R. Grover MBBS, FRANZCOG, MD, FFPMANZCA ,&nbsp;I. Wright MBBS, DCH, MRCP(UK)Paeds, FRACP ,&nbsp;N. Drever MBBS, BMedSci, FRANZCOG","doi":"10.1016/j.jpag.2024.07.002","DOIUrl":"10.1016/j.jpag.2024.07.002","url":null,"abstract":"<div><h3>Study Objective</h3><p>Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by the congenital absence of the uterus and vagina, sometimes with associated extragenital anomalies. Currently, there is limited literature on pelvic pain and comorbid pain syndromes in people with MRKH. The aims of this scoping review were to summarize existing literature on pelvic and generalized persistent pain syndromes associated with MRKH and to identify knowledge gaps for further research into this field.</p></div><div><h3>Methods</h3><p>This scoping review followed the Joanna Briggs Institute framework. The population of interest was patients with a diagnosis of MRKH. MEDLINE, CINAHL, Scopus, Cochrane, Embase, and Emcare databases were searched. Articles that did not meet the inclusion criteria or critical appraisal standards were excluded. The resultant articles were reviewed by 2 independent researchers, and a third was used in cases of disagreement. A descriptive analytical method was used for data analysis.</p></div><div><h3>Results</h3><p>We screened 3348 articles for eligibility. Of these, 39 articles, which described 1353 cases of MRKH, met the criteria. Four studies described baseline pelvic pain in MRKH, 19 described acute presentations, and 13 described postintervention pain levels.</p></div><div><h3>Conclusion</h3><p>Despite the paucity of research, this review found that cyclic pelvic pain was mostly present in women with uterine remnants, whereas pelvic pain in those without remnants was poorly understood. There were no studies exploring generalized persistent pain syndromes in MRKH. Further cross-sectional studies are needed to elucidate the prevalence and levels of pain syndromes in MRKH.</p></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 5","pages":"Pages 477-494"},"PeriodicalIF":1.7,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1083318824002547/pdfft?md5=afc4e110156725144d8f2db3a35e56cf&pid=1-s2.0-S1083318824002547-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Composing a Life as a Pediatric and Adolescent Gynecologist","authors":"","doi":"10.1016/j.jpag.2024.07.001","DOIUrl":"10.1016/j.jpag.2024.07.001","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 4","pages":"Pages 381-382"},"PeriodicalIF":1.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639315","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}