Journal of pediatric and adolescent gynecology最新文献

Study objective: Puberty is associated with important changes in secondary sexual characteristics, but the changes occurring in female external genitalia are not thoroughly described. The aim of this systematic review is to summarize and assess the current scientific knowledge regarding vulvar changes and development during puberty.

Methods: PubMed, Embase, Web of Science, and Cochrane were searched, using keywords related to "puberty", "vulva", and "morphology". Inclusion criteria were observational studies describing vulvar development in individuals between the ages of 8 and 16 years. The outcomes of interest were quantitative and/or qualitative descriptions of the vulva, including anatomical, physiological and histological changes.

Results: Of the 1658 articles screened, 10 were included. The mean clitoral glans diameter increases during puberty, as does the length of the clitoral hood. The clitoral hood changes, to become more retractile and rugose. The inner labia width and length increases throughout puberty, and the development of inner labia varies between individuals, with labial asymmetry being a common characteristic. The most frequent hymenal configuration found during puberty is the crescentic form, and features such as hymenal mounds, longitudinal intravaginal ridges, and most notches, are physiological.

Conclusion: Reliable data on pubertal development of the external female genital organs is scarce. Future research is needed in order to provide more precise data to help categorize vulvar development into stages. A detailed description of vulvar maturation into sequential stages throughout puberty (as done by the Tanner scale for the male homologous structures) can increase knowledge of its morphological diversity and help reach clinical consensus on the nature of pathological variants. In addition, better knowledge of vulvar diversity is of importance to both healthcare professionals and individuals, and may empower and promote self-esteem.

Background: Uterine leiomyomas are rare in the adolescent age group, with smooth muscle tumors of unknown malignant potential (STUMP) tumors being even exceedingly rarer in young patients.

Case: Three cases aged 19 years, two with abnormal uterine bleeding and one with pelvic pain, were admitted to the hospital. Uterine myomas measuring 5, 7 and 12 centimeters were detected in the patients. Myomectomy was performed in patients with complaints resistant to medical treatment. Pathologic examinations revealed that one of the complaints was a STUMP tumor, which is very rare in the adolescent and young age group. The other two examinations revealed benign uterine fibroids.

Summary and conclusion: Although uterine myomas are quite rare in the adolescent age group, they should be considered in patients with pelvic pain, pelvic mass, and abnormal uterine bleeding. In this age group, uterine myomas and even STUMP tumors should be included in the differential diagnosis.

Study objectives: Primary Dysmenorrhea (PD) is a prevalent gynaecological condition affecting young females, characterized by cyclic, cramping pelvic pain with no organic pathology. It can significantly impact their Quality of life (QOL) and academic performance. The study aimed to determine the effect of therapeutic taping on clinical symptoms, QOL and academic performance of students with PD.

Design: It was a single-blind, parallel design, Randomized controlled trial SETTING: Study conducted from May to September 2023 in Girls Hostel, Islamabad, Pakistan.

Participants: Women aged 18-25 years with PD and pain severity of VAS ≥4 were recruited. Those with other health conditions and having an allergy to Kinesio taping (KT) were excluded from the study.

Intervention: A total of 66 women have completed the study. They were randomly assigned to three groups: experimental (KT), sham tape (ST), and control group (CG). KT tape was applied to the suprapubic and sacral regions using the ligament technique in the KT group and without stretch in the ST group. Assessments were taken at baseline, 8th and 12th weeks.

Main outcome measures: The study tools were the visual analogue scale (VAS), menstrual symptoms questionnaire (MSQ), Health-related quality of life (SF-36) and Academic Performance Questionnaire (APQ). Data analysis was done using SPSS-25.

Results: The participants' mean age (years) was (KT: 22.04±2.13, Sham: 22.35±3.11 and CT: 23±2.52). Between-group analysis shows a statistically significant difference in VAS (p<0.05) and MSQ (p<0.01) after the 12^th week of intervention, whereas the APQ score was statistically significant (p <0.01) on the 8th and 12^th week. Similarly, the SF-36 score was significant for both physical (p<0.001) and mental (p<0.05) component summary between the intervention groups.

Conclusion: Kinesio Taping is an effective intervention option for pain reduction, menstrual symptom relief, and improved academic performance for individuals with PD.

Study objective: Despite falling teen birth rates in the United States, there is a disproportionate burden of teen births in rural regions. The study aims to investigate the characteristics of teenage mothers and examine the relationships between teen birth and adverse birth outcomes in the rural Appalachian state of West Virginia (WV).

Methods: Data was obtained from a population-based cohort (Project WATCH) of all singleton live births in WV between May 2018 and April 2023. The primary exposure variable was mothers who gave birth when they were less than 20 years old (teenage births v. adult). Primary outcomes included birthweight, gestational age, NICU admission, 5-minute Apgar score, and breastfeeding status.

Results: Of 86,447 live births, 5,310 (6.15%) were birth to teenage mothers. Maternal characteristics of teenage mothers included minority racial groups, lower education, Medicaid, rural residence, and inadequate prenatal care. Teenage births were associated with lower mean birthweight aMD [b = -49.31g. (-65.37, -33.24)], low birthweight [<2500g. vs. ≥2500 g., aRR = 1.11 (1.0, 1.24)], and small for gestational age [v. appropriate for gestational age, aRR = 1.21 (1.12,1.30)]. Teenage mothers were less likely to exclusively breastfeed at discharge [aRR, 1.20 (1.11, 1.28)]. Analyses adjusted for maternal race/ethnicity, education, health insurance, smoking, substance use, prenatal care, diabetes, and residence type.

Conclusions: Teenage births are high in WV and are linked to adverse infant outcomes. These findings may help identify at-risk groups for support and provide policymakers with information to design effective interventions to prevent teenage births and its negative outcomes.

Study objective: To explore menstrual cycle symptoms, information sources and menstrual health literacy in young women (aged 13-25) and those who menstruate in Aotearoa New Zealand.

Design and setting: Cross-sectional online survey in Aotearoa New Zealand.

Participants: 1334 respondents (age 13-25 years, mean age 19.8), who have had at least three periods and were currently living in New Zealand.

Interventions: Online survey hosted by Qualtrics between October 2021, and January 2022.

Main outcome measures: Information on menstrual cycle characteristics and symptoms, and menstrual health literacy.

Results and conclusions: Respondents reported high rates of regular dysmenorrhoea (89%), fatigue/tiredness (78.1%) and mood changes (72.5%) associated with menstruation. A higher proportion of rangatahi (younger generation) Māori reported irregular cycles (53.5%) compared to non-Māori respondents (41.7%). Normalisation of symptoms, especially pain (80.2%), was high. Most respondents recognised the need to see a doctor for period pain which impacted their daily lives (84.7%). However, non-cyclical pelvic pain (45.7%), heavy bleeding (39%) and intermenstrual bleeding (29%) were less likely to be recognised as symptoms that require a doctor's visit. The main sources of menstrual health knowledge prior to menarche were a family member (74.2%) and health and physical education classes at school (63.7%). Many young people reported receiving little or no information about periods prior to menarche (37.9%), with very few respondents receiving information on how to manage menstrual symptoms (15.1%). Menstrual symptoms are common and the provision of culturally safe information and opportunities to learn is important for young people, whānau, schools and healthcare practitioners.

Background: Individuals with disabilities experience a higher prevalence of sexually transmitted infections (STIs) compared to their counterparts without disabilities; however, there is limited data on whether they are screened for STIs at the same rate. The aim of this study was to determine whether adolescents and young adults with disabilities undergo routine screening for STIs at lower rates than individuals without disabilities.

Methods: We performed a retrospective cohort study of female patients aged 16-21 years who were seen between July 2021 and August 2023 by pediatrics, internal medicine/pediatrics, or family medicine at a single institution. Disability status was determined via ICD-10 codes. STI testing information was obtained by chart review. Data were analyzed using multiple logistic regression, and adjusted odds ratios were reported for race, ethnicity, age, and disability.

Results: Among 6906 eligible patients, 90 (1.3%) had a disability. Individuals with disabilities underwent STI screening at lower rates (60% vs 77.2%, p<.001). There were lower odds of STI screening for individuals with any disability (aOR 0.38, 95% CI 0.24-0.61, p<.001), a physical disability (aOR 0.26, 95% CI 0.09-0.72, p=.008), or an intellectual disability (aOR 0.37, 95% CI 0.21-0.64, p<.001) when adjusting for race, ethnicity, and age.

Conclusions: The rate of STI screening among adolescents and young adults with disabilities was lower compared to those without disabilities. Universal testing may help normalize STI screening so that individuals with a higher risk of STIs are not missed. Further research is indicated to identify and mitigate factors that lead to lower rates of screening.

Objectives: To assess the level of awareness among Malaysian healthcare providers (HP) regarding Paediatrics and Adolescent Gynaecology (PAG) services. Additionally, the study evaluates HP's knowledge of the HEADSS¹ questionnaire (Home Environment, Education and Employment, Activities, Drugs, Sexuality, Suicide and depression) and their understanding of acute abdominal pain in female adolescents.

Methods: A simple, 5-question online survey was conducted nationwide among registered Malaysian HP, including doctors, nurses, assistant medical officers (AMO) and medical attendants (MA).

Results: A total of 529 HP participated in the survey, with a median age of 35 years. Majority had more than 5 years working experience (74.7%), worked in specialist hospitals (66.7%). Only 56.3% of HP had heard of PAG services, while 43.7% were familiar with the HEADSS tool, with 60.2% using it in practice. Awareness was higher among doctors (61.4%), senior HP (59.2%), and those in specialist hospitals (69.7%). Among doctors, both experience and workplace significantly impacted their awareness. Notably, 2% of doctors were unsure about which specialty for referrals when managing acute abdomen in adolescents.

Conclusion: Overall, awareness of PAG services is low, with only 56.3% of HP and 61.4% of doctors familiar with the specialty. Management practices vary and lack standardization. We recommend implementing standardized training programs to improve the awareness and care for adolescent patients.

Study objective: Anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are eating disorders (EDs) characterized by extreme restriction of energy intake. However, in contrast to AN, those with AAN are not underweight. Although individuals with either AN or AAN can experience associated functional hypothalamic amenorrhea (FHA) that may prompt them to seek gynecological care, little is known about OBGYNs' knowledge and approach to these patients; this study sought to fill this gap.

Methods: A total of 119 OBGYNs read vignettes describing an underweight patient with AN and a normal weight patient with AAN presenting with FHA. OBGYNs then responded to items assessing their approaches, knowledge, and attitudes towards amenorrheic patients and EDs more broadly.

Results: Participants ranked FHA as significantly more likely in the underweight vignette than in the normal weight vignette. Participants reported that they more frequently ask about weight, eating, exercise, and body image in the underweight amenorrheic patient relative to normal or overweight patients. Overall, participants demonstrated low knowledge of AN and AAN and reported less familiarity with AAN.

Conclusion: OBGYNs may be less likely to identify FHA and assess for an ED in non-underweight patients with secondary amenorrhea. Therefore, AAN patients with complications of malnutrition may be less likely to be properly evaluated and treated. Future research should investigate educational interventions that aim to improve OBGYN assessment and management of ED patients of varying weights.

Study objective: Adolescents and young adults (AYA) with chronic medical conditions (CMC) have similar sexual behaviors to their healthy peers but are less likely to use contraception. Provision of CMC-specific sexual and reproductive health (SRH) care within pediatric subspecialty clinics may improve access for this population, although system and provider level barriers exist. The purpose of this cross-sectional study was to assess the attitudes, practices, and knowledge of SRH among providers in a variety of pediatric subspecialities.

Methods: Listservs were used to recruit pediatric subspecialists caring for pregnancy capable AYA (12-24 years-old) who use teratogenic medications or have CMC that pose significant pregnancy health risk, as defined by the World Health Organization. Participants completed an online survey about their contraceptive attitudes and practices and rated their knowledge and comfort discussing contraception.

Results: A total of 510 pediatric subspecialists participated. Although 92% said addressing SRH is important for pediatric subspecialists, most believed their role included SRH discussion(78.1%) and referral(82.2%) rather than provision(12.1%). Only 4.3% felt totally comfortable with contraceptive counseling. Identified facilitators included time(64.2%), referral resources(67.5%), and training in contraceptive options(62.9%). Most participants would recommend long-acting reversible contraception if medically appropriate, but few reported confidence in their knowledge and ability to counsel about them.

Conclusion: SRH is an important part of comprehensive care for youth with CMC. Discomfort and lack of knowledge decrease a provider's ability to confidently provide SRH care in subspecialty clinics. Expanding collaborations between subspecialty and SRH providers may increase access to quality SRH tailored to these young people's unique medical needs.