Journal of pediatric and adolescent gynecology最新文献

Menstrual health is a critical aspect of adolescent development, which encompasses physical, psychological, and social dimensions. While menstruation is a natural physiological process, problems such as dysmenorrhea and heavy menstrual bleeding can negatively affect the quality of life of an adolescent. Early education and timely recognition of menstrual problems are thus important. However, adolescent menstrual health needs remain unaddressed across diverse culture contexts and are underrecognized in low-income countries. Parents, particularly mothers, are often the primary source of information, yet their knowledge can vary greatly. This narrative review explores the current literature on parental knowledge about adolescent menstruation. Twenty-two qualitative and quantitative studies were synthesised, spanning diverse geographic, cultural, and socioeconomic contexts. Three main themes were identified: (1) parental knowledge of adolescent menstruation, (2) parent-adolescent communication, and (3) unmet parental needs. Parental knowledge was often limited to menarche and hygiene in many low- and middle- income countries. In high income countries, two Australian studies reported limited parental knowledge in recognising the severity of, and seeking management of, dysmenorrhea and heavy menstrual bleeding. Across countries, communication was constrained by limited knowledge, stigma, and discomfort. Strengthening parental knowledge is important to promote timely health-seeking behaviours, minimise stigma across cultures, and improve adolescent menstrual health.

Background: Omphalocele, cloacal exstrophy, imperforate anus, and spinal anomaly (OEIS) complex is a severe congenital defect that is associated with Müllerian anomalies and duplicated external genitalia. The creation of a neovagina for these patients is dependent on the extent of congenital malformations, available native tissue, age at reconstruction, and presence of functional Müllerian structures.

Case: We present a patient diagnosed with OEIS with bilateral hemivaginas that inserted into the bladder plate. We describe the use of urinary bladder tissue to separate reproductive and urinary tracts, maintaining known patent Müllerian systems.

Conclusion: This case highlights a unique anomaly in which the bladder and hemivaginas are intimately connected as well as the use of conveniently available urinary bladder tissue for the creation of a neovagina.

Study objective: To investigate which factors influence adolescents' participation in gynecological research.

Methods: A qualitative study utilizing four online focus group discussions (FGDs), each including three postmenarchal female adolescents between 10-22 years, was conducted between March and May 2024 in the Netherlands. Participants were purposively selected to ensure diversity in ethnicity and education level, including those who had declined participation in a previous scientific study but agreed to this one. FGDs were recorded, verbatim transcribed and thematically analyzed, using an artful interpretive approach (Big Q/non-positivist), to determine the factors influencing adolescents' participation in gynecological research.

Results: The four identified factors were intrinsic motivation, extrinsic motivation, time investment, and reliability. Adolescents experienced a lower threshold to participate in research if the subject of the research was interesting to them, if they benefited - in any form - from participating, if the research was conducted by someone they know personally and hence more trustworthy to them, and if their participation was helpful to someone they know. Adolescents can be motivated extrinsically when they perceive participation as mandatory or if they receive financial compensation. Adolescents are more willing to participate in research when it requires minimal time and personal involvement. When using social media, with short, visually appealing posts, to reach adolescents, careful consideration must be given to becoming part of their content stream and from which account it is posted to facilitate adolescents' trust.

Conclusion: The perspectives of adolescents regarding participation in gynecological research can be used to enhance adolescent engagement in research.

Study objective: To determine the characteristics of adolescent and young adult patients undergoing surgery for severe endometriosis.

Methods: We analysed the British Society for Gynaecological Endoscopy (BSGE) database, a multicenter database of research-consented patients undergoing excision of surgically-confirmed deep endometriosis, from 2009 to 2021, which includes prospectively-collected preoperative questionnaire data and intraoperative findings reported by the surgical team at laparoscopy. Patients were divided into adolescent (10-19yrs), young adult (20-24yrs) and older adult (≥25yrs) groups. Preoperative questionnaires and intraoperative findings were compared between groups RESULTS: 14670 patients were included from 104 specialist endometriosis centers, of which 186 were adolescents and 892 were young adults. Young adults had worse premenstrual and menstrual pain, dyspareunia, dysuria and bladder voiding difficulty than older adults, despite higher use of hormonal contraceptives (35.1% vs 17.7%, p<.001) and opioids (32.5% vs 27.8%, p=0.004). Adolescent patients had lower prevalence of bowel (66.7% vs 81.1%, p<.001), ovarian (30.6% vs 51%, p<.001), deep sidewall (65.1% vs 78.1%, p<.001) and uterosacral ligament endometriosis (74.2% vs 85.0%, p<.001) compared to older adults. The same was true for young adults, who also had higher rates of superficial disease (79.7% vs 70.9%, p<.001) than older adults. Older adults had a higher number of pelvic sites affected by endometriosis than adolescents (6.0 vs 4.57, p<.001) and young adults (6.0 vs 4.9, p<.001).

Conclusions: Adolescent and young adult patients undergoing endometriosis surgery report severe pre-operative symptoms, but have fewer anatomical sites affected and fewer deep endometriotic lesions. These findings highlight differences in lesion distribution that warrant further investigation into disease progression.

Objective: To evaluate the effectiveness and safety of transcutaneous posterior tibial nerve stimulation (TC-TNS) to treat primary dysmenorrhea in adolescents.

Methods: Double-blind, block-randomized controlled clinical trial, approved by the local Ethical Committee was conducted. Adolescents between 12 to 19 years old with menstrual pain were included. Patients with secondary dysmenorrhea, who used hormonal contraception or intrauterine devices, who were pregnant, who requested contraception, who had contraindications to use non-steroidal anti-inflammatory drugs, or who had intellectual disabilities were excluded. A total of 87 adolescents were randomized into two groups: Group 1 received mefenamic acid during the first three days of the menstrual cycle and sham TC-TNS sessions (30 minutes each) three times per week for eight weeks, while Group 2 received an oral placebo during the first three days of menstruation and active TC-TNS sessions (30 minutes each) three times per week for eight weeks. Clinical evaluations were conducted after four and eight weeks. Main Outcome was the reduction in menstrual pain, assessed with the visual analog scale.

Results: Both groups experienced a clinically significant relief of their pain, with no differences between groups.

Conclusions: TC-TNS produces a reduction of primary dysmenorrhea in adolescents that is comparable to the effect achieved by mefenamic acid and could be considered as a therapeutic alterative as it free of adverse effects and self-applicable.

Study objective: Breast complaints in children are uncommon, and standardized management guidelines are lacking. Adult-based protocols are often extrapolated to pediatric patients despite differences due to breast development and different disease behavior. We aimed to review our institutional experience and propose a practical, evidence-informed diagnostic and management algorithm.

Methods: A retrospective review was conducted of all female pediatric patients who presented with breast-related complaints to a tertiary pediatric surgery clinic between June 2020 and June 2025. Demographic and clinical characteristics, imaging findings, treatments, and histopathological results were analyzed.

Results: A total of 293 female patients (mean age 14.2 ± 3.5 years; range 1-18) were evaluated. The most common presenting complaints were pain (47.4%) and palpable mass (41.9%). Ultrasonography was performed in 96.9% of patients, and breast masses were detected in 68.6%. During a mean follow-up of 31.4 ± 3.8 months, 81% of masses remained stable or regressed, and only 3.9% required surgery. Histopathology revealed fibroadenoma (55.6%), benign phyllodes tumor (22.2%), pseudoangiomatous stromal hyperplasia (11.1%), and accessory nipple tissue (11.1%).

Conclusion: No malignancy was detected in any patients who underwent biopsy or surgery in the present study. Most pediatric breast lesions are benign and can be managed conservatively with periodic clinical and ultrasonographic follow-up. Magnetic Resonance Imaging appears to be a valuable adjunct in selected cases with indeterminate imaging findings. A stepwise, risk-stratified algorithm was developed to guide the evaluation and management of breast masses in children. This approach may minimize unnecessary interventions while ensuring safe surveillance of pediatric breast lesions.