Journal of pediatric and adolescent gynecology最新文献

The objective of this document is to provide guidance on the recognition, diagnosis and management of non-sexually acquired genital ulcers in the pediatric and adolescent patient. Commonly known as genital or vulvar aphthous ulcers, lesions are typically seen in the peri‑menarchal population, are exquisitely painful, generally self-limited and managed with supportive care. Details of ulcer physical appearance, proposed etiology and options for management are provided to familiarize clinicians with this entity, which can be alarming for patients and families.

Study objective: Bisexual adolescents have higher rates of unintended pregnancy than their heterosexual peers and increased rates of high-risk sexual behaviors. They may be less likely to use effective contraception, though limited data is available. This study sought to compare contraceptive choice and sexual risk behaviors of both-sex attracted and opposite-sex attracted adolescents and young adults (AYA) presenting to a contraception clinic.

Methods: A retrospective chart review of AYA aged 14-24 years who presented for an initial visit to a contraception clinic from 2014 to 2020. The primary outcome was contraceptive choice (long-acting reversible contraception (LARC), non-LARC, or nothing). Secondary outcomes included sexual behaviors. Results were analyzed using Pearson's chi-square and Wilcoxon tests.

Results: A total of 2369 AYA were included in this study. Both-sex attracted and opposite-sex attracted patients were similar in age, race, and ethnicity. There was no difference between groups in percentage selecting LARC (71% vs 66.1%, P = .11). Both-sex attracted patients reported a younger age at first sex (14.6 years vs 15.5 years, P < .001), more lifetime sexual partners (4.1 vs 2.8, P < .001), and a higher prevalence of forced intercourse (21.9% vs 8.8%, P < .001).

Conclusions: Both-sex attracted and opposite-sex attracted AYA patients chose LARCs at similar rates in a setting with standardized contraceptive counseling. Both-sex attracted patients had more sexual risk behaviors. Healthcare providers should be inclusive in their approach to obtaining sexual health histories and providing contraceptive counseling and be cognizant that adolescents with both-sex attraction may be at higher risk of forced intercourse.

Study objective: Lower urinary tract symptoms (LUTS) can have a pronounced impact on adolescent women's overall health and quality of life, both during adolescence and across the life course. Little research has examined adolescent women's knowledge, attitudes, and beliefs (KAB) about bladder health and preventing LUTS.

Methods: This study combines data from two large multi-site focus group studies of individuals born female, who identified as women, conducted by the Prevention of Lower Urinary Tract Symptoms Research Consortium. The first study included data from 8 focus groups conducted in 2018 with 44 adolescents aged 11 through 17 years. The second consisted of data from 20 focus groups conducted in 2020 with 123 adolescents aged 13 through 17 years. We used directed content analysis, including deductive and inductive approaches, to explore textual data and identify emergent insights. We present themes that emerged from analyzing coded data related to KAB.

Results: Themes included: (1) lack of information about bladder function, leading to limited knowledge, (2) hydration as a healthy behavior, (3) distinguishing healthy versus unhealthy voiding, (4) social and environmental barriers to voiding, and (5) shame and stigma of bladder related behaviors.

Conclusion: Our data suggests that adolescent women are aware of healthy and unhealthy behaviors related to bladder health, despite little exposure to formal education about the bladder. Social and environmental factors, including stigma, appear to be primary drivers of adolescents' behaviors around bladder health, suggesting that multi-level socio-ecological prevention interventions are needed to prevent LUTS in this population.

Study objective: To determine the natural history of menstrual pain without pelvic pathology, the role of progesterone in its pathophysiology, and associated risk factors in a longitudinal study of early postmenarchal girls in North Carolina.

Methods: Participants contributed daily urine samples for up to 3.5 years to measure pregnanediol-3-glucuronide (PdG) (mean 589 urines/participant), completed menstrual diaries, and reported menstrual pain using the Menstrual Symptom Questionnaire (MSQ) biannually. MSQ scores were log-transformed and generalized estimating equations assessed associations with gynecologic age, cycle peak PdG, presumed ovulation, physical activity, anxiety, and depression. Models were adjusted for age at menarche, baseline body mass index, race/ethnicity, parental education and employment, and gynecologic age.

Results: Forty-three girls, aged 12.6 ± 1.1 years (mean ± SD) at enrollment with a gynecologic age 0.3 ± 0.2 years, participated. Total MSQ scores were higher for every 1-year increase in gynecologic age (MSQ score ratio: 1.12; 95% CI: 1.08, 1.17; P < .0001). Overall MSQ (ratio: 1.04; 95% CI: 1.02, 1.06; P = .0002) and abdominal pain-specific (ratio: 1.04; 95% CI: 1.01, 10.7; P = .004) scores were higher for every 1000 ng/mg creatinine increase in peak PdG in the preceding cycle. Overall MSQ scores were higher (ratio 1.26; 95% CI: 1.11, 1.44; P = .0005) if the preceding cycle was presumed ovulatory. Menstrual pain was not associated with physical activity, anxiety, or depression.

Conclusions: In early postmenarchal girls, gynecologic age and PdG were associated with menstrual pain, suggesting a pathophysiologic role for progesterone and other unknown factors in the development of menstrual pain.

Objective: The objective of this study is to understand whether clinicians who provide contraceptive counseling to adolescent patients perceive that the Dobbs decision has influenced their counseling.

Study design: We conducted in-depth interviews with a convenience sample of 16 clinicians who provide contraceptive counseling to adolescents at the American Academy of Pediatrics annual conference in October 2022. We used thematic content analysis and an iterative process of constant comparison to identify themes inductively. This analysis focused on participants' perception of if and how the Dobbs decision has or will influence their contraceptive counseling with adolescents.

Results: Most clinicians in our study reported that the Dobbs decision influenced their contraceptive counseling. This included promoting long-acting reversible methods more so than pre-Dobbs, and explicitly considering changing state-level abortion laws and restrictions. Many clinicians openly noted that their personal preferences influence their counseling, such as prioritizing pregnancy prevention and encouraging patients to use particular methods.

Conclusion: We found that most clinicians in our sample acknowledged that the Dobbs decision has influenced their contraceptive counseling practices with adolescents. Clinicians' responses demonstrate that, in many instances, the Dobbs decision motivated them to focus on method effectiveness, leading to tiered and directive contraceptive counseling. We recommend practice changes to support comprehensive contraceptive care provision, provider trainings in unbiased counseling, and developmentally tailored decision aids are needed to ensure that adolescent patients' autonomy is prioritized over a singular focus on pregnancy prevention.

Clostridium perfringens is responsible for 5% of septic abortions. Emergent hysterectomy is often required for patient survival. This can be devastating to patients desiring future fertility. We report a 15-year-old female patient at 17 weeks and 6 days of gestation with a diagnosis of sepsis on admission. She was managed with broad-spectrum antibiotics followed by immediate evacuation of the retained placenta. Blood and placental cultures confirmed clostridial species. Successful conservative management allowed for a term pregnancy 2 years later, resulting in a healthy newborn. Few reports describe effective conservative management resulting in uterine sparing and good subsequent pregnancy outcomes.

Background: Patients with intellectual and developmental disabilities (IDD) experience greater unmet medical service needs and decreased care satisfaction compared to those without these diagnoses. There are no evidence-based resources widely available to prepare children with IDD for menarche.

Methods: This IRB approved embedded mixed methods study investigated the efficacy of "period kits" for patients with IDD to ease anxiety and improve preparedness for menarche. Custom kits included a colorful pouch, an original social story, a resource list, and common period management items. Nine family pairs (child/adult) were enrolled. Surveys performed before and after kit exploration queried participants' understanding of menarche, and feedback about the kit itself. Data were analyzed using thematic analysis.

Results: Surveys of the children showed limited knowledge about periods at baseline. Additional themes prior to provision of the "period kit" included limited knowledge, negative perceptions and emotional responses about menstruation and puberty and hesitancy approaching period conversations. After kit exposure, there was an improvement in period related knowledge and promotion of interhousehold discussion with continued room for conversation.

Conclusions: Many kids with IDD have limited baseline knowledge about menstruation. Custom "period kits" may be helpful in stimulating conversation within families and promoting increased knowledge about menses to children and families. Limitations of this study are small size and qualitative nature, potentially limiting generalizability and external data validity.

Study objective: Compare the length of hospital stay of adolescents admitted for severe anemia (hemoglobin ≤ 8 g/dL) due to acute abnormal uterine bleeding (AUB) treated with high-dose combined oral contraceptive pills (HD-OCPs) versus those treated with HD-OCPs and intravenous conjugated equine estrogen, also referred to as dual therapy.

Design, setting, and participants: This is a single institution retrospective cohort study of adolescents hospitalized for the management of acute AUB and severe anemia between July 1^st, 2004, to January 1^st, 2020. Subjects were excluded if they were pregnant, had a malignancy, thrombocytopenia, treated with other hormonal therapies, or if bleeding stopped prior to admission.

Main outcome measures: Primary outcome was length of hospital stay. Secondary outcomes were rates of complications and side effects secondary to the hormonal medication.

Results: There were 113 subjects included in the study. Seventy-four (65%) received HD-OCPs only, and the remainder received dual therapy. Mean subject age was 13.8 years for both groups. Those who received HD-OCPs alone were hospitalized for an average of 38.4 hours versus 45.6 hours for those who received dual therapy (p=0.0007). The only reported side effect in either group was nausea and/or vomiting, which was higher in the group who received dual therapy than those treated with HD-OCPs alone (85% versus 51.4% respectively, p-value=0.001).

Conclusion: Adolescents who received dual therapy had a longer hospital stay than those who received HD-OCPs alone. There were no complications related to the medication regimens in either group, but those receiving dual therapy had significantly higher rates of anti-emetic use.

Background: Adolescence is a crucial phase in a person's life. The purpose of this study was to evaluate the efficacy of gamification in the education of teenage females on pubertal health.

Methods: This clinical trial, conducted on 90 adolescent girls in XXX, XXX, during the 2023-2024 year, used a multistage cluster sampling method to assign participants randomly to intervention and control groups. The intervention group received weekly puberty health education over four weeks through a gamification platform. Data collection involved a socio-demographic questionnaire as well as puberty awareness and practice assessments, completed by both groups before the intervention, immediately, and one month after study.

Findings: The average puberty awareness and practice scores of the students in the intervention group significantly increased significantly, immediately and four-week after the intervention compared to the control group (P<0.001). The standardized effect sizes for awareness and practice were 0.74 and 0.25, respectively. In the intervention group, puberty awareness siginificanlty increased by 5.28 (95% CI:4.51 to 6.06) and 5.06 points (95%CI:4.31to 5.82) when comparing the two time periods before and immediately after, and before and four weeks after the intervention, respectively. Similarly, the puberty practice score significanly increased by 6.82 (95% CI:4.24 to 9.40) and 8.73 points (95% CI:5.94 to 11.51) in the same time comparisons (P<0.001).

Conclusion: This study demonstrated the effectiveness of using gamification in puberty health education on increasing puberty awareness and practice among adolescent girls. This innovative educational approach can enhance puberty health education programs, leading to better health outcomes for adolescent girls.

Study objective: Imperforate hymen (IH) is a rare congenital anomaly that results in vaginal outlet obstruction. IH can cause significant morbidity if not managed appropriately, which depends on accurate identification of the condition. However, data on the accuracy of IH diagnosis is limited. This study aimed to investigate the accuracy of IH diagnosis at a single referral center.

Methods: Institutional Review Board approval was obtained for this retrospective chart review. ICD-10 codes identified patients with "hymenal abnormalities" between 2018 and 2023 at a single children's hospital. The primary outcome was rate of misdiagnosis of IH through comparison of diagnosis codes and chart review. Descriptive statistics and Chi-square or Fischer's exact test were utilized as appropriate.

Results: 165 patients met inclusion criteria. 57 were initially diagnosed with IH and of those patients, 28 (49.1%) were misdiagnosed. Additionally, 5 patients initially diagnosed with a different condition were later found to have IH. There was no significant difference in misdiagnosis rate between premenarchal and menarchal patients (p=0.77). There was a significantly higher rate of misdiagnosis amongst generalist Ob/Gyn providers compared to pediatric gynecologists (p=0.04).

Conclusion: Many patients with IH may initially be seen by primary care providers. Due to the rarity of the condition and a lack of provider exposure to IH, misdiagnosis is common. IH is important to distinguish from other anomalies of the reproductive tract, as the management differs. Misdiagnosis of IH may lead to incorrect surgical approach and subsequent complications. Training and education surrounding IH, along with referral to pediatric gynecology, may help reduce misdiagnosis.