Journal of pediatric and adolescent gynecology最新文献

{"title":"Success of Menstrual Suppression for Patients with Obstructive Müllerian Anomalies.","authors":"Erin E Isaacson, Rebecca Richardson, Kate McCracken, Monica W Rosen, Melina Dendrinos","doi":"10.1016/j.jpag.2025.12.004","DOIUrl":"10.1016/j.jpag.2025.12.004","url":null,"abstract":"<p><strong>Background: </strong>Patients with obstructive Müllerian anomalies (OMAs) experience significant pain secondary to hematometrocolpos and often require menstrual suppression to achieve symptomatic pain control and to optimize timing before surgical intervention. Currently, there are limited data on menstrual suppression for these patients. We aimed to describe our institution's experience with the success of different menstrual suppression options for this population.</p><p><strong>Methods: </strong>A retrospective cohort study of patients diagnosed with and treated for an OMA from 2012 to 2024 was performed at a tertiary care center. Exclusion criteria included imperforate hymens, those with surgical intervention at outside institutions, and patients lost to follow-up. Demographic characteristics, type of OMA, total time of menstrual suppression, and methods used were collected. The primary outcome was successful pain management of at least 3 months, with unsuccessful management defined as changes in therapy or proceeding with surgical management due to pain.</p><p><strong>Results: </strong>Forty-two patients were included. The mean age was 15.7 years, and patients had a variety of OMAs. Of the patients, 57.1% (24/42) began menstrual suppression before surgical intervention. Most patients on suppression (66.7%, 16/24) began taking a combined oral contraceptive (COC) pill: 45.8% (11/24) took a 30-mcg ethinyl estradiol (EE) pill, and 20.8% (5/24) took a 20-mcg EE pill. Almost half (41.6%, 10/24) of those on menstrual suppression did not have adequate pain control with their initial method. Of the patients, 87.5% (21/24) ultimately achieved successful pain management using a variety of methods, including 30-mcg EE COCs (9/21), 20-mcg EE COCs (2/21), gonadotropin release hormone (GnRH) agonist depot leuprolide (3/21), progestin-only pills (4/21), and 1 patient each using the medroxyprogesterone acetate injection and the combined estrogen-progestin patch.</p><p><strong>Conclusion: </strong>Most patients who began menstrual suppression in this cohort took COC pills. Many patients reported effective suppression with COC pills containing 30 mcg of EE. Almost half of the patients reported poor pain control with the initial menstrual suppression method.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742891","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":"Gonadal Tissue Cryopreservation for a Girl with Complete Androgen Insensitivity Syndrome.","authors":"Magdalena Szybka, Aparna Balaji, Emily Gelson, Alka Prakash, Jane MacDougall","doi":"10.1016/j.jpag.2025.12.001","DOIUrl":"10.1016/j.jpag.2025.12.001","url":null,"abstract":"<p><strong>Background: </strong>Complete androgen insensitivity syndrome (CAIS) is a disorder of sex development characterized by a female phenotype in 46,XY individuals. Given the increased risk of testicular tumors, prophylactic bilateral orchiectomy is offered to patients with CAIS. While CAIS has traditionally been associated with infertility, recent evidence demonstrating the presence of germ cells in the testes of affected individuals raises the possibility of fertility preservation at the time of gonadectomy.</p><p><strong>Case: </strong>We present a case of gonadal tissue cryopreservation (GTC) following orchiectomy in a 16-year-old patient with CAIS. Half of each testis was sent for GTC, and the remaining tissue for histopathological examination, which revealed no definitive germ cells.</p><p><strong>Summary and conclusion: </strong>This case report discusses tumor risk, fertility potential and ethical considerations surrounding GTC in CAIS.</p>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742682","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":"Systemic Langerhans Cell Histiocytosis Revealed by Atypical Vulvar Lesions in a Child","authors":"Fouzia Hali MD ,&nbsp;Yasmine Mahdar MD ,&nbsp;Lemyaa Essolh Marhraoui MD ,&nbsp;Bouchra Baghad MD, PhD ,&nbsp;Siham Cherkaoui MD ,&nbsp;A. El Ouati MD ,&nbsp;D. Bentaleb MD ,&nbsp;S. Salam MD ,&nbsp;H. Alatawna MD ,&nbsp;Soumiya Chiheb MD","doi":"10.1016/j.jpag.2025.06.003","DOIUrl":"10.1016/j.jpag.2025.06.003","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 6","pages":"Pages 766-767"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555307","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":"Who is on Your Team? Team Medicine and Science in PAG","authors":"","doi":"10.1016/j.jpag.2025.11.001","DOIUrl":"10.1016/j.jpag.2025.11.001","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 6","pages":"Pages 645-646"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555309","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":"Piloting a Birth Control Navigator Program for Adolescents and Young Adults in Indiana","authors":"Tracey A. Wilkinson MD, MPH ,&nbsp;Faith Coleman MAE, BS, CCHW ,&nbsp;Natasha Chaku PhD ,&nbsp;Jeffrey F. Peipert MD, PhD ,&nbsp;Sarah E. Wiehe MD, MPH ,&nbsp;Aaron E. Carroll MD, MS ,&nbsp;J. Dennis Fortenberry MD, MS","doi":"10.1016/j.jpag.2025.07.004","DOIUrl":"10.1016/j.jpag.2025.07.004","url":null,"abstract":"<div><h3>Objectives</h3><div>While increasing access to contraception is important, young people often face barriers to access prior to, within and after engagement with clinical care. The objective was to examine the feasibility of a pilot adolescent and young adult (AYA) birth control navigator program.</div></div><div><h3>Methods</h3><div>An online and in-person outreach strategy was launched in central Indiana starting in June 2023 to reach AYA outside of clinical settings and connect them to a trained navigator. Various communication platforms were used and a link to a validated contraception decision aid and barrier assessment was sent. After program support, AYA were invited to participate in a research cohort and complete a baseline survey.</div></div><div><h3>Results</h3><div>The outreach strategy included social media advertising with 4,327,614 impressions and 30,210 clicks and 17 social media ambassadors with 96 posts. Of the 30 people who connected with the navigator, 18 (60%) participated in the post-programmatic research cohort. Participants had a mean age of 17.3 years (range 15-19), 33% identified as African American and 61% reported being sexually active. Addressed barriers included appointment booking (73%), access confidential care (67%) and support around transportation (30%). All participants (100%) reported that the navigator listened to them, provided helpful information, and made them feel comfortable. However, only 8 (67%) reported high-quality person-centered care was experienced during clinical encounters.</div></div><div><h3>Conclusions</h3><div>A human-centered designed birth control navigator pilot program can provide AYA’s personalized assistance with overcoming barriers faced. Recruitment outside of clinical environments of AYA in a restrictive state was challenging, despite online outreach strategies.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 6","pages":"Pages 700-704"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718084","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":"Navigating Complexity: Advanced Visualization for Müllerian Anomalies and its Implications for Diagnoses and Surgical Planning","authors":"Anat From MD ,&nbsp;Tania Dumont ,&nbsp;Sukhbir Singh ,&nbsp;Shauna Duigenan ,&nbsp;Teresa Flaxman","doi":"10.1016/j.jpag.2025.06.005","DOIUrl":"10.1016/j.jpag.2025.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive Müllerian anomalies present diagnostic and surgical-planning challenges, often requiring multiple imaging studies and prolonged medical management. Three-dimensional (3-D) modelling and virtual-reality (VR) visualization may improve anatomic understanding, counselling, and operative safety.</div></div><div><h3>Case</h3><div>A patient first evaluated at 15 years of age for primary amenorrhoea and cyclic pain underwent 8 MRIs and 6 ultrasounds over 7 years. Imaging progressively clarified complete proximal vaginal agenesis, a left unicornuate uterus with functioning endometrium, a non-communicating right rudimentary horn, bilateral hydrosalpinges, and, ultimately, obstructive haematometra. Despite sequential hormonal suppression (combined oral contraceptives, depot-medroxyprogesterone acetate, dienogest, norethindrone acetate) and vaginal dilation, pain recurred. Multidisciplinary consultations explored fertility-preserving reconstruction versus definitive surgery. At 23 years of age, severe acute pelvic pain, and a 12 cm haematometra led to admission.</div></div><div><h3>Intervention</h3><div>High-resolution T2-weighted MRI obtained 1 week before surgery was segmented post-operatively with ElucisNext to create a patient-specific 3-D model. Definitive management, selected because of intractable pain and complex congenital heart disease (repaired double-outlet right ventricle with Glenn shunt), was total abdominal hysterectomy, left salpingo-oophorectomy, right salpingectomy, bilateral ureterolysis, adhesiolysis, and cystoscopy.</div></div><div><h3>Outcomes</h3><div>VR review highlighted a blind cervix, absent proximal vagina, and ureters coursing in close proximity to the dilated horn. These findings underscored the prudence of prophylactic ureterolysis and illustrated anatomical barriers to creating a functional neovaginal-cervical connection. Although the model was constructed post-operatively, prospective use could have enhanced fertility counselling, guided earlier surgical decisions, and served as a rehearsal tool for trainees.</div></div><div><h3>Conclusions</h3><div>Post-operative VR reconstruction of pre-operative MRI demonstrated tangible educational and planning value. Routine prospective VR adoption for complex Müllerian anomalies may optimize counselling, resident education, and surgical safety.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 6","pages":"Pages 747-749"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340225","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":"Traditional Remedy Gone Wrong: A Case of Rectovaginal Fistula in an Infant Due to Cultural Healing Practices","authors":"Nasra Ibrahim Said MD ,&nbsp;Abdirahman Ibrahim Said MD ,&nbsp;Asma Mohamoud Koshin MBBS ,&nbsp;Najwa Ibrahim Said MBBS ,&nbsp;Hassan Sh Abdirahman Elmi PhD","doi":"10.1016/j.jpag.2025.06.004","DOIUrl":"10.1016/j.jpag.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Traditional medicine remains prevalent in Somali culture, often influencing healthcare decisions. One such practice involves inserting solid salt (“Cusbo”) into the anus to treat constipation. While commonly believed to be safe, this practice may contribute to severe complications, such as rectovaginal fistula (RVF).</div></div><div><h3>Case Presentation</h3><div>A 1-year, 6-month-old female presented with persistent stool incontinence for 1 year. History revealed prolonged constipation treated with repeated salt insertions per traditional healing practices. Over time, the mother observed stool passage through the vagina, leading to medical evaluation. A dye test confirmed a midvaginal RVF. Surgical repair was performed using a transvaginal approach, with successful postoperative recovery.</div></div><div><h3>Discussion</h3><div>RVF typically results from obstructed labor, gynecological surgery, or malignancy, with foreign body insertion being a rare cause. Cultural remedies, such as salt insertion, may contribute to fistula formation, highlighting the need for awareness and preventive education. Diagnosis involves clinical examination and imaging, with surgical intervention often required.</div></div><div><h3>Conclusion</h3><div>This case underscores the impact of traditional practices on health outcomes. While cultural beliefs shape healthcare behaviors, awareness and education are essential in preventing complications. Clinicians must remain vigilant in recognizing such cases and ensuring timely intervention.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 6","pages":"Pages 739-742"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560358","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":"Adolescents’ Contraceptive Choice in the Immediate Postpartum Period: A Cohort Study","authors":"Elaine M.C. Maia PhD ,&nbsp;Raquel A.C. Peixoto MD ,&nbsp;Francisco H.C. Carvalho MD ,&nbsp;Cristina A.F. Guazzelli MD","doi":"10.1016/j.jpag.2025.06.011","DOIUrl":"10.1016/j.jpag.2025.06.011","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess contraceptive preferences, acceptance, continuity, and satisfaction with contraceptive use among postpartum adolescents who desired contraception in Fortaleza, Brazil.</div></div><div><h3>Design</h3><div>This prospective observational study included 166 postpartum adolescents (≤48 hours after delivery) at a public hospital in Brazil between November 2019 and March 2022. Participants were interviewed twice: before discharge (in person) and 6 months after delivery (via telephone). Pearson’s chi-squared and Fisher’s exact tests assessed associations between categorical variables and satisfaction with long-acting contraceptives (LARCs). Logistic regression identified factors influencing early contraception initiation.</div></div><div><h3>Results</h3><div>The most preferred methods in the immediate postpartum period were implants (45.8%), intrauterine devices (IUDs) (34.3%), injectables (16.3%), and pills (3.0%). Nearly half (47.6%) initiated LARCs before discharge. Six months postdelivery, 81.3% were using a contraceptive method. Among implant users, continuity was 100%, and for IUDs initiated before discharge, 70%. A higher satisfaction level was observed in LARC users compared to non-LARC users.</div></div><div><h3>Conclusion</h3><div>The postpartum period is an ideal time to offer safe contraceptive options. LARC methods, particularly implants and IUDs, are highly valued by adolescents, showing high satisfaction and continuity rates.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 6","pages":"Pages 712-716"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575718","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":"Pubertal Development as a Marker of Gonadal Neoplasm in 46XY Complete Gonadal Dysgenesis","authors":"Cristina Villena MD ,&nbsp;Carolyn D Brookhart MDMPH ,&nbsp;Kirsten Das MD ,&nbsp;Swetha Naroji MD ,&nbsp;Veronica Gomez-Lobo MD","doi":"10.1016/j.jpag.2025.07.003","DOIUrl":"10.1016/j.jpag.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>46XY Complete Gonadal Dysgenesis (CGD), also known as Swyer syndrome, is characterized by nonfunctional streak gonads and an increased risk of gonadal neoplasms. While spontaneous puberty is not expected, hormonally active gonadal tumors can mimic normal puberty delaying diagnosis.</div></div><div><h3>Case Presentation</h3><div>We present two adolescents with 46XY CGD and tumor-driven puberty: a 16-year-old with spontaneous thelarche and adrenarche found to have a left gonadoblastoma, and a 14-year-old with spontaneous menarche and pelvic pain who was subsequently diagnosed with a dysgerminoma and a sex cord tumor with annular tubules (SCTAT).</div></div><div><h3>Discussion &amp; Conclusion</h3><div>Puberty in patients with 46XY CGD should prompt suspicion for gonadal tumors. Early recognition and gonadectomy are crucial to prevent malignant transformation and optimize outcomes.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 6","pages":"Pages 743-746"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667854","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":"Has the COVID-19 Pandemic Affected Vulvovaginitis in Prepuberty and Adolescent Females in China? A Retrospective Study of 4644 Cases during 2018-2021","authors":"Huihui Gao PhD ,&nbsp;Sunyi Wang BM ,&nbsp;Mingming Zhou MD ,&nbsp;Yuchen Zhang MBBS ,&nbsp;Charleen Cheung MD ,&nbsp;Symphorosa S.C. Chan MD ,&nbsp;Changzheng Yuan ScD ,&nbsp;Liying Sun MBBS","doi":"10.1016/j.jpag.2025.06.006","DOIUrl":"10.1016/j.jpag.2025.06.006","url":null,"abstract":"<div><h3>Objective</h3><div>Vulvovaginitis (VV) is one of the most common gynecologic complaints in prepubertal and adolescent girls. However, data on the impact of the COVID-19 pandemic on VV in this population are limited. This study aimed to explore changes in the epidemiology, pathogenic patterns, and antibiotic susceptibility of VV in girls before and during the COVID-19 pandemic in China.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted in girls aged 0-18 years who were diagnosed with VV from January 2018 to December 2021.</div></div><div><h3>Results</h3><div>A total of 4644 cases of VV were identified, including 2427 cases from 2018 to 2019 (before the COVID-19 pandemic) and 2217 cases from 2020 to 2021 (during the COVID-19 pandemic). The proportion of VV cases in the 0-6-year age group decreased significantly from 40.2% to 31.3%, whereas the proportion in the 10-18-year age group increased from 30.1% to 39.6%. The major pathogens identified from 2020 to 2021 were similar to those detected from 2018 to 2019. The detection rates of <em>Haemophilus influenzae, Streptococcus pyogenes,</em> and <em>Streptococcus pneumoniae</em> decreased during the COVID-19 pandemic. In contrast, the detection rates of <em>Escherichia coli, Klebsiella pneumoniae,</em> and <em>Candida albicans</em> increased. Antibiotic susceptibility testing revealed that the sensitivity of <em>H. influenzae</em> to ampicillin/sulbactam and amoxicillin/clavulanate increased by 5.6% and 13.4%, respectively, after the pandemic. In contrast, levofloxacin sensitivity in <em>E. coli</em> decreased by 20.3% after the pandemic.</div></div><div><h3>Conclusion</h3><div>Our findings provide evidence‐based guidance for appropriate antibiotic use and facilitate the optimization of therapeutic strategies and lifestyle recommendations for prepubertal and adolescent girls with VV.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 6","pages":"Pages 661-666"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528447","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}