Pub Date : 2026-02-01DOI: 10.1016/j.jpag.2025.06.002
Oluwatosin O. Cooper (Tosin) MD, MPH , Elisabeth H. Quint MD , Yolanda R. Smith MD , Melina L. Dendrinos MD
Introduction
Secondary amenorrhea with high Follicle Stimulating Hormone (FSH) levels and low estradiol is typically diagnosed as primary ovarian insufficiency (POI) in individuals under the age of 40. Low anti-mullerian hormone (AMH) levels support the diagnosis of POI, but normal AMH levels warrant additional evaluation.
Case Presentation
A 19-year-old female with menarche at age 12 experienced secondary amenorrhea at age 14.5. Initial evaluation showed elevated gonadotropins and low estradiol, which were confirmed on repeat testing. Normal karyotype, no FMR1 repeat expansion, negative autoimmune markers, and normal AMH levels were found. Genetic testing revealed two Follicle Stimulating Hormone Receptor (FSHR) gene variants with high suspicion of pathogenicity.
Discussion
Pathogenic variants in the FSHR gene are an uncommon cause of secondary amenorrhea. Atypical POI cases with a normal AMH level should be evaluated with a genetic consultation.
{"title":"FSH Receptor Variant: An Unusual Cause of Secondary Amenorrhea","authors":"Oluwatosin O. Cooper (Tosin) MD, MPH , Elisabeth H. Quint MD , Yolanda R. Smith MD , Melina L. Dendrinos MD","doi":"10.1016/j.jpag.2025.06.002","DOIUrl":"10.1016/j.jpag.2025.06.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Secondary amenorrhea with high Follicle Stimulating Hormone (FSH) levels and low estradiol is typically diagnosed as primary ovarian insufficiency (POI) in individuals under the age of 40. Low anti-mullerian hormone (AMH) levels support the diagnosis of POI, but normal AMH levels warrant additional evaluation.</div></div><div><h3>Case Presentation</h3><div>A 19-year-old female with menarche at age 12 experienced secondary amenorrhea at age 14.5. Initial evaluation showed elevated gonadotropins and low estradiol, which were confirmed on repeat testing. Normal karyotype, no FMR1 repeat expansion, negative autoimmune markers, and normal AMH levels were found. Genetic testing revealed two Follicle Stimulating Hormone Receptor (FSHR) gene variants with high suspicion of pathogenicity.</div></div><div><h3>Discussion</h3><div>Pathogenic variants in the FSHR gene are an uncommon cause of secondary amenorrhea. Atypical POI cases with a normal AMH level should be evaluated with a genetic consultation.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 128-130"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248398","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}
Female genital tuberculosis (FGTB) is a form of extrapulmonary tuberculosis that predominantly affects women of reproductive age and is a significant cause of infertility in TB-endemic countries such as India. Tubercular pyosalpinx is a rare presentation of FGTB. Even more uncommon is its complication by isolated tubal torsion, which may mimic other causes of acute abdomen, making early diagnosis challenging.
We report the case of a 15-year-old girl who presented with acute lower abdominal pain and vomiting. She had a 2-month history of low-grade evening fever. Clinical evaluation and ultrasound findings suggested pyosalpinx or hematosalpinx with normal ovarian morphology, raising suspicion of isolated tubal torsion. Diagnostic laparoscopy revealed a torsed, distended fallopian tube filled with purulent material and multiple peritoneal tubercles. The tube was excised using a glove-made improvised endobag to prevent intra-abdominal spillage. Histopathology confirmed tubercular salpingitis with caseous necrosis, and GeneXpert was positive for Mycobacterium tuberculosis. The patient was started on standard anti-tubercular therapy and had an uneventful recovery.
This case underscores the importance of considering tuberculosis as an etiology in adolescent girls presenting with pyosalpinx, especially in TB-endemic regions. It also highlights the value of safe laparoscopic management with innovative surgical techniques in resource-limited settings. Early diagnosis, surgical intervention, and timely initiation of anti-tubercular therapy are crucial for effective management and preservation of reproductive health.
{"title":"Laparoscopic Management of Tubercular Pyosalpinx Torsion in an Adolescent Girl: A Case Report","authors":"Avantika Gupta MBBS, MS, MRCOG, Satish Choudhury MBBS, MS, DNB, Vandana Kattimani MBBS, Deepika Mangani MBBS","doi":"10.1016/j.jpag.2025.10.002","DOIUrl":"10.1016/j.jpag.2025.10.002","url":null,"abstract":"<div><div>Female genital tuberculosis (FGTB) is a form of extrapulmonary tuberculosis that predominantly affects women of reproductive age and is a significant cause of infertility in TB-endemic countries such as India. Tubercular pyosalpinx is a rare presentation of FGTB. Even more uncommon is its complication by isolated tubal torsion, which may mimic other causes of acute abdomen, making early diagnosis challenging.</div><div>We report the case of a 15-year-old girl who presented with acute lower abdominal pain and vomiting. She had a 2-month history of low-grade evening fever. Clinical evaluation and ultrasound findings suggested pyosalpinx or hematosalpinx with normal ovarian morphology, raising suspicion of isolated tubal torsion. Diagnostic laparoscopy revealed a torsed, distended fallopian tube filled with purulent material and multiple peritoneal tubercles. The tube was excised using a glove-made improvised endobag to prevent intra-abdominal spillage. Histopathology confirmed tubercular salpingitis with caseous necrosis, and GeneXpert was positive for <em>Mycobacterium tuberculosis</em>. The patient was started on standard anti-tubercular therapy and had an uneventful recovery.</div><div>This case underscores the importance of considering tuberculosis as an etiology in adolescent girls presenting with pyosalpinx, especially in TB-endemic regions. It also highlights the value of safe laparoscopic management with innovative surgical techniques in resource-limited settings. Early diagnosis, surgical intervention, and timely initiation of anti-tubercular therapy are crucial for effective management and preservation of reproductive health.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 141-144"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258510","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}
Even before the Dobbs Supreme Court decision, minors experienced a wide variety of barriers to abortion care in the United States, including legal, financial, cultural, transportation, and misinformation barriers as well as pressure from parents and partners. This scoping review summarizes the literature on barriers to abortion among minors in the United States prior to the Dobbs decision.
Methods
We conducted a database search to identify original research in the United States published between 2007 and 2022. We included quantitative and qualitative empirical articles and assessed their quality. We created categories for the barriers to abortion among minors identified in the articles. We screened 7584 records and included 70 articles in the scoping review. We charted study aims, study designs, data sources, analytic samples, and results.
Results
The articles explored factors related to abortion access and identified several categories of barriers to abortion among minors. These included legal barriers (41 articles found them to be a barrier), financial barriers (14 articles), cultural barriers (13 articles), transportation barriers (12 articles), pressure from parents (11 articles), misinformation (8 articles), and pressure from a partner (8 articles). Legal barriers, including laws that require minors to inform or get permission from an adult guardian, were the most commonly identified barrier.
Conclusion
These findings suggest that minors need policy and interpersonal support to overcome general and age-specific barriers to abortion care. Future research should examine if and how barriers for minors have intensified post-Dobbs, informing targeted policy responses.
{"title":"A Scoping Review of Barriers to Accessing Abortions among Adolescents in the United States","authors":"Julie Maslowsky PhD , Naomi Harada Thyden PhD, MPH , Renee Odom-Konja MPH , Catherine Gimbrone MPH , Joanna Paul MPH, MSW , Eleanor Esbrook MD , Rosie Hanneke MLS , Laura D. Lindberg PhD","doi":"10.1016/j.jpag.2025.10.003","DOIUrl":"10.1016/j.jpag.2025.10.003","url":null,"abstract":"<div><h3>Study Objective</h3><div>Even before the <em>Dobbs</em> Supreme Court decision, minors experienced a wide variety of barriers to abortion care in the United States, including legal, financial, cultural, transportation, and misinformation barriers as well as pressure from parents and partners. This scoping review summarizes the literature on barriers to abortion among minors in the United States prior to the <em>Dobbs</em> decision.</div></div><div><h3>Methods</h3><div>We conducted a database search to identify original research in the United States published between 2007 and 2022. We included quantitative and qualitative empirical articles and assessed their quality. We created categories for the barriers to abortion among minors identified in the articles. We screened 7584 records and included 70 articles in the scoping review. We charted study aims, study designs, data sources, analytic samples, and results.</div></div><div><h3>Results</h3><div>The articles explored factors related to abortion access and identified several categories of barriers to abortion among minors. These included legal barriers (41 articles found them to be a barrier), financial barriers (14 articles), cultural barriers (13 articles), transportation barriers (12 articles), pressure from parents (11 articles), misinformation (8 articles), and pressure from a partner (8 articles). Legal barriers, including laws that require minors to inform or get permission from an adult guardian, were the most commonly identified barrier.</div></div><div><h3>Conclusion</h3><div>These findings suggest that minors need policy and interpersonal support to overcome general and age-specific barriers to abortion care. Future research should examine if and how barriers for minors have intensified post-<em>Dobbs</em>, informing targeted policy responses.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 4-16"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274901","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jpag.2025.10.009
Laura C. Seidman BS , Laura A. Payne PhD
Study Objective
To evaluate multi-site pain (i.e., number of painful body regions) during menstruation in a sample of adolescents, and to assess relationships between multi-site pain during menstruation and other menstrual cycle, pain, and psychosocial factors.
Methods
Participants in this cross-sectional observational study included 141 girls ages 13-19 years with varying levels of menstrual pain. Participants indicated on a body map the areas where they usually experience pain when menstruating. Participants also completed a set of validated self-report questionnaires. Menstruation-associated multi-site pain was calculated as the total number of body regions reported (out of 21). Partial correlations controlling for baseline menstrual pain intensity were conducted between menstruation-associated multi-site pain and other variables of interest.
Results
The average number of body regions reported was 2.8 (SD = 1.5; min = 0; max = 8). Menstruation-associated multi-site pain was significantly positively correlated with number of pre-menstrual syndrome symptoms, non-menstrual multi-site body pain, pain interference over the prior week, fatigue, sleep disturbance, somatization, and multisensory sensitivity. Menstruation-associated multi-site pain was not significantly correlated with age, age at menarche, gynecologic age, menstrual pain interference, and non-menstrual body pain intensity.
Conclusion
Pain during menstruation in adolescents is not limited to the abdominal and pelvic regions, and many girls experience pain in numerous body locations during their periods. The associations between menstruation-associated multi-site pain and other pain and psychosocial measures provide preliminary evidence for the existence of a sub-group of adolescents who may be at increased risk for future pain problems.
{"title":"Multi-Site Pain During Menstruation in Adolescents is Associated With Impaired Functioning Across Various Domains: A Cross-Sectional Observational Study","authors":"Laura C. Seidman BS , Laura A. Payne PhD","doi":"10.1016/j.jpag.2025.10.009","DOIUrl":"10.1016/j.jpag.2025.10.009","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate multi-site pain (i.e., number of painful body regions) during menstruation in a sample of adolescents, and to assess relationships between multi-site pain during menstruation and other menstrual cycle, pain, and psychosocial factors.</div></div><div><h3>Methods</h3><div>Participants in this cross-sectional observational study included 141 girls ages 13-19 years with varying levels of menstrual pain. Participants indicated on a body map the areas where they usually experience pain when menstruating. Participants also completed a set of validated self-report questionnaires. Menstruation-associated multi-site pain was calculated as the total number of body regions reported (out of 21). Partial correlations controlling for baseline menstrual pain intensity were conducted between menstruation-associated multi-site pain and other variables of interest.</div></div><div><h3>Results</h3><div>The average number of body regions reported was 2.8 (SD = 1.5; min = 0; max = 8). Menstruation-associated multi-site pain was significantly positively correlated with number of pre-menstrual syndrome symptoms, non-menstrual multi-site body pain, pain interference over the prior week, fatigue, sleep disturbance, somatization, and multisensory sensitivity. Menstruation-associated multi-site pain was not significantly correlated with age, age at menarche, gynecologic age, menstrual pain interference, and non-menstrual body pain intensity.</div></div><div><h3>Conclusion</h3><div>Pain during menstruation in adolescents is not limited to the abdominal and pelvic regions, and many girls experience pain in numerous body locations during their periods. The associations between menstruation-associated multi-site pain and other pain and psychosocial measures provide preliminary evidence for the existence of a sub-group of adolescents who may be at increased risk for future pain problems.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 50-56"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318361","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}
To describe patterns of postpartum contraception use among primiparous and multiparous adolescent mothers.
Methods
Cross-sectional data came from the Pregnancy Risk Assessment Monitoring System Phase 7 (2012-2015). The analytic sample included postpartum respondents ages 15-19 in 40 US states (N = 5535). Exposures included age, race, parity, intimate partner violence, psychosocial stressors, prenatal care utilization, postpartum home health visits, and insurance type. The primary outcome was postpartum use of effective contraception. The secondary outcome was reasons for not using postpartum contraception.
Results
Adolescents who attended postpartum check-ups (AOR = 2.12; 95% CI 1.58-2.84) or received home health visits (AOR = 1.37; 95% CI 1.06-1.77) were more likely to use effective contraception postpartum, whereas those experiencing more stressors were less likely (AOR = 0.93; 95% CI: 0.86-1.00). Non-Hispanic Black adolescents were less likely to use effective contraception (AOR = 0.69; 95% CI 0.50-0.94) compared to non-Hispanic White adolescents. Among those who did not use contraception postpartum, having a postpartum home health visit was associated with lower odds of endorsing contraceptive side effects (AOR = 0.33; 95% CI 0.18-0.60) or not wishing to use contraception (AOR = 0.43; 95% CI 0.22-0.86) as reasons for nonuse.
Conclusion
Access to postpartum care via home health and postpartum clinic visits was associated with significantly higher likelihood of using effective contraception. However, disparities persisted among non-Hispanic Black adolescents and those experiencing high levels of psychosocial stress. For postpartum adolescents who do not desire a subsequent birth, increasing their ability to obtain effective contraceptives can be achieved through increased access to postpartum care, particularly for underserved populations.
研究目的：描述初产和多产青少年母亲产后避孕的使用模式。方法：横断面数据来自妊娠风险评估监测系统第7期（2012-2015）。分析样本包括美国40个州15-19岁的产后受访者（N= 5535）。暴露因素包括年龄、种族、胎次、亲密伴侣暴力、心理社会压力源、产前护理利用、产后家庭健康访问和保险类型。主要结局是产后有效避孕的使用情况。次要结果是未使用产后避孕措施的原因。结果：参加产后检查（AOR=2.12; 95% CI: 1.58-2.84）或接受家庭健康访问（AOR=1.37; 95% CI: 1.06-1.77）的青少年更有可能在产后使用有效的避孕措施，而经历更多压力源的青少年更不可能（AOR=0.93; 95% CI: 0.86-1.00）。与非西班牙裔白人青少年相比，非西班牙裔黑人青少年较少使用有效避孕措施（AOR=0.69; 95% CI 0.50-0.94）。在那些产后没有使用避孕措施的妇女中，产后家庭健康访问与赞同避孕副作用（AOR=0.33; 95% CI 0.18-0.60）或不希望使用避孕措施（AOR=0.43; 95% CI 0.22-0.86）作为不使用原因的几率较低相关。结论：通过家庭保健和产后门诊就诊获得产后护理与使用有效避孕措施的可能性显著增加相关。然而，在非西班牙裔黑人青少年和那些经历高水平社会心理压力的青少年中，差异仍然存在。对于不希望再生育的产后青少年，可以通过增加获得产后护理的机会来提高他们获得有效避孕药具的能力，特别是对服务不足的人群。
{"title":"Postpartum Contraception Use among Adolescent Mothers","authors":"Julie Maslowsky PhD , Eleanor Esbrook MD , Renee Odom-Konja MPH , Haley Stritzel PhD , Catherine Gimbrone MPH , Dorothy Mandell PhD","doi":"10.1016/j.jpag.2025.10.011","DOIUrl":"10.1016/j.jpag.2025.10.011","url":null,"abstract":"<div><h3>Study Objective</h3><div>To describe patterns of postpartum contraception use among primiparous and multiparous adolescent mothers.</div></div><div><h3>Methods</h3><div>Cross-sectional data came from the Pregnancy Risk Assessment Monitoring System Phase 7 (2012-2015). The analytic sample included postpartum respondents ages 15-19 in 40 US states (<em>N</em> = 5535). Exposures included age, race, parity, intimate partner violence, psychosocial stressors, prenatal care utilization, postpartum home health visits, and insurance type. The primary outcome was postpartum use of effective contraception. The secondary outcome was reasons for not using postpartum contraception.</div></div><div><h3>Results</h3><div>Adolescents who attended postpartum check-ups (AOR = 2.12; 95% CI 1.58-2.84) or received home health visits (AOR = 1.37; 95% CI 1.06-1.77) were more likely to use effective contraception postpartum, whereas those experiencing more stressors were less likely (AOR = 0.93; 95% CI: 0.86-1.00). Non-Hispanic Black adolescents were less likely to use effective contraception (AOR = 0.69; 95% CI 0.50-0.94) compared to non-Hispanic White adolescents. Among those who did not use contraception postpartum, having a postpartum home health visit was associated with lower odds of endorsing contraceptive side effects (AOR = 0.33; 95% CI 0.18-0.60) or not wishing to use contraception (AOR = 0.43; 95% CI 0.22-0.86) as reasons for nonuse.</div></div><div><h3>Conclusion</h3><div>Access to postpartum care via home health and postpartum clinic visits was associated with significantly higher likelihood of using effective contraception. However, disparities persisted among non-Hispanic Black adolescents and those experiencing high levels of psychosocial stress. For postpartum adolescents who do not desire a subsequent birth, increasing their ability to obtain effective contraceptives can be achieved through increased access to postpartum care, particularly for underserved populations.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 76-83"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145401321","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jpag.2025.10.007
Maja Banović MD, PhD , Dina Gržan MD , Vladimir Banović MD, PhD
{"title":"Focal Adenomyosis in a 17-Year-Old Patient: A Case Report","authors":"Maja Banović MD, PhD , Dina Gržan MD , Vladimir Banović MD, PhD","doi":"10.1016/j.jpag.2025.10.007","DOIUrl":"10.1016/j.jpag.2025.10.007","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 135-136"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102860","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jpag.2025.08.004
Laura Kirkpatrick MD
{"title":"Authors’ Response to “Responding to Adolescents’ Emotional Needs in Abortion: The Importance of Empathy-Based Counseling and Flexible Choice”","authors":"Laura Kirkpatrick MD","doi":"10.1016/j.jpag.2025.08.004","DOIUrl":"10.1016/j.jpag.2025.08.004","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Page 147"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102858","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jpag.2025.09.014
Julia H. Raney MD , Amanda E. Bryson MD, MPH , Chelsea A. Garnett MD , Lisa Mihaly FNP, MS , Sara M. Buckelew MD, MPH , Marissa Raymond-Flesch MD, MPH
Study Objective
Over 2 years post-Roe, 22 states have banned or significantly limited abortion access, exacerbating existing structural barriers to abortions for adolescents and young adults (AYAs), including cost, transportation, parental notification requirements, and confidentiality concerns. We provide a roadmap for and demonstrate the feasibility of implementing no-test medication abortions (MABs) to expand abortion access in an adolescent-focused pediatric primary care setting.
Methods
An interdisciplinary team in an AYA-focused primary care clinic developed and implemented a no-test MAB protocol. Iterative rounds of protocol development engaged stakeholders including hospital leadership, OBGYN consultants, nurses, and program directors for residency, fellowship, and nursing trainees. Frequent interdisciplinary debriefs identified facilitators, barriers, and solutions to optimize care.
Results
Over 6 months, we identified clinic champions, built relationships with key stakeholders, developed clinic protocols, and disseminated MAB clinical training. In our first 6 months of implementation, we provided 4 MABs. Facilitators identified by staff include provider expertise in AYA development and patient and parent preferences for MABs in their medical home. System-level barriers (eg, timely scheduling challenges), staff factors (eg, fear of complications), and patient factors (eg, ambivalence about pregnancy) were identified. Solutions developed include establishing scheduling procedures, formalizing consultative pathways with gynecology, and integrating social work support.
Conclusion
It is feasible for adolescent primary care practices to provide no-test MABs. Through interdisciplinary planning and iterative design, barriers from the health system, clinic staff, and patient levels can be identified and addressed, expanding equitable access to safe, AYA-focused abortion care.
{"title":"Implementation of No-Test Medication Abortions in Primary Care: A Roadmap from an Adolescent and Young Adult Medicine Clinic","authors":"Julia H. Raney MD , Amanda E. Bryson MD, MPH , Chelsea A. Garnett MD , Lisa Mihaly FNP, MS , Sara M. Buckelew MD, MPH , Marissa Raymond-Flesch MD, MPH","doi":"10.1016/j.jpag.2025.09.014","DOIUrl":"10.1016/j.jpag.2025.09.014","url":null,"abstract":"<div><h3>Study Objective</h3><div>Over 2 years post-Roe, 22 states have banned or significantly limited abortion access, exacerbating existing structural barriers to abortions for adolescents and young adults (AYAs), including cost, transportation, parental notification requirements, and confidentiality concerns. We provide a roadmap for and demonstrate the feasibility of implementing no-test medication abortions (MABs) to expand abortion access in an adolescent-focused pediatric primary care setting.</div></div><div><h3>Methods</h3><div>An interdisciplinary team in an AYA-focused primary care clinic developed and implemented a no-test MAB protocol. Iterative rounds of protocol development engaged stakeholders including hospital leadership, OBGYN consultants, nurses, and program directors for residency, fellowship, and nursing trainees. Frequent interdisciplinary debriefs identified facilitators, barriers, and solutions to optimize care.</div></div><div><h3>Results</h3><div>Over 6 months, we identified clinic champions, built relationships with key stakeholders, developed clinic protocols, and disseminated MAB clinical training. In our first 6 months of implementation, we provided 4 MABs. Facilitators identified by staff include provider expertise in AYA development and patient and parent preferences for MABs in their medical home. System-level barriers (eg, timely scheduling challenges), staff factors (eg, fear of complications), and patient factors (eg, ambivalence about pregnancy) were identified. Solutions developed include establishing scheduling procedures, formalizing consultative pathways with gynecology, and integrating social work support.</div></div><div><h3>Conclusion</h3><div>It is feasible for adolescent primary care practices to provide no-test MABs. Through interdisciplinary planning and iterative design, barriers from the health system, clinic staff, and patient levels can be identified and addressed, expanding equitable access to safe, AYA-focused abortion care.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 109-113"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213124","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}
Although more than half of cases are asymptomatic or mild in symptoms, mesenteric cysts can present clinically and radiologically similar to gynecologic diseases.
Case
A female child presented with worsening episodes of abdominal pain 1 day before admission. Abdominal x-ray suggested mechanical obstruction of the small bowel, and CT scan suggested ileal abnormality.
Discussion
During open surgery, we found 2 rotated chylous mesenteric cysts, accompanied by adhesions and jejunal perforation 57 cm from the ligament of Treitz. Cyst excision, adhesiolysis, ileo-ileal resection, and anastomosis were performed.
Conclusion
Although rare and challenging to identify, mesenteric cysts should be kept in the differential diagnosis of female children presenting with abdominal pain.
{"title":"Perforated Rotated Mesenteric Cyst Presenting as Acute Abdominal Pain in a Female Pediatric Patient: A Case Report","authors":"Valerie Josephine Dirjayanto MRes , Astrid Indrafebrina Sugianto MD, BMedSci , Riana Pauline Tamba MD, PhD","doi":"10.1016/j.jpag.2025.09.011","DOIUrl":"10.1016/j.jpag.2025.09.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Although more than half of cases are asymptomatic or mild in symptoms, mesenteric cysts can present clinically and radiologically similar to gynecologic diseases.</div></div><div><h3>Case</h3><div>A female child presented with worsening episodes of abdominal pain 1 day before admission. Abdominal x-ray suggested mechanical obstruction of the small bowel, and CT scan suggested ileal abnormality.</div></div><div><h3>Discussion</h3><div>During open surgery, we found 2 rotated chylous mesenteric cysts, accompanied by adhesions and jejunal perforation 57 cm from the ligament of Treitz. Cyst excision, adhesiolysis, ileo-ileal resection, and anastomosis were performed.</div></div><div><h3>Conclusion</h3><div>Although rare and challenging to identify, mesenteric cysts should be kept in the differential diagnosis of female children presenting with abdominal pain.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 137-140"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191642","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jpag.2025.09.012
Megan F. Sumida MD , Olivia K. Winfrey MD, MPH , Julie Hakim MD , Jennifer E. Dietrich MD, MSc
In pediatric populations large ovarian cysts are often benign, and minimally invasive approaches are preferred to minimize perioperative pain and recovery, allow for same day discharge, and improve incision cosmesis. Ovarian preservation is also prioritized and cystectomy is preferred over oophorectomy. While tactile sensation and dexterity are improved in mini laparotomy cases, there are limitations with visualization that are improved with laparoscopy. We describe a technique that employs both diagnostic laparoscopy and mini laparotomy using the GelPOINT Mini™ Advanced Access Platform for single site laparoscopy in pediatric patients. This case series includes cysts ranging 7-24 cm with benign preoperative risk stratification, in patients aged 3-16 years, who underwent successful same-day, ovarian-sparing surgery with the benefits of both open and laparoscopic procedures.
{"title":"Improving Minimally Invasive Surgical Approaches to Large Adnexal Masses in Pediatric Gynecology: Combining Mini-Laparotomy With Single Port Laparoscopy","authors":"Megan F. Sumida MD , Olivia K. Winfrey MD, MPH , Julie Hakim MD , Jennifer E. Dietrich MD, MSc","doi":"10.1016/j.jpag.2025.09.012","DOIUrl":"10.1016/j.jpag.2025.09.012","url":null,"abstract":"<div><div>In pediatric populations large ovarian cysts are often benign, and minimally invasive approaches are preferred to minimize perioperative pain and recovery, allow for same day discharge, and improve incision cosmesis. Ovarian preservation is also prioritized and cystectomy is preferred over oophorectomy. While tactile sensation and dexterity are improved in mini laparotomy cases, there are limitations with visualization that are improved with laparoscopy. We describe a technique that employs both diagnostic laparoscopy and mini laparotomy using the GelPOINT Mini™ Advanced Access Platform for single site laparoscopy in pediatric patients. This case series includes cysts ranging 7-24 cm with benign preoperative risk stratification, in patients aged 3-16 years, who underwent successful same-day, ovarian-sparing surgery with the benefits of both open and laparoscopic procedures.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"39 1","pages":"Pages 88-93"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186110","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}
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