Journal of pediatric and adolescent gynecology最新文献

{"title":"11. Knowledge and Awareness of Gender-Affirming Language Among Cisgender Adolescents and Their Guardians","authors":"Blair Lacy ,&nbsp;Jennifer Silk ,&nbsp;Christina Blanchard ,&nbsp;Janeen Arbuckle","doi":"10.1016/j.jpag.2025.01.023","DOIUrl":"10.1016/j.jpag.2025.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Relative to their age-matched cisgender peers, transgender adolescents are more likely to suffer from mental health disorders and are at higher risk of self-harm and suicide. Social support, including use of gender-affirming language, from peers and family has been shown to be protective against these untoward mental health outcomes. We hypothesize that adolescents are more likely to positively relate to gender-affirming language than their guardian. We aim to assess the baseline knowledge and awareness of gender-affirming language among cisgender adolescents and their guardian and to examine the respective concordance or dissonance within the adolescent-guardian dyad.</div></div><div><h3>Methods</h3><div>Adolescents aged 14-21 seen in the Pediatric and Adolescent Gynecology clinic and their guardians were invited to participate in a voluntary survey regarding gender-affirming language. Adolescents ages 18-21 completed the survey without parental consent. No protected health information was gathered. Respondents completed the survey via a tablet with access to a RedCap-based questionnaire. Patients were asked to self-report their demographics including age, race, ethnicity, extent of education, and religion. Assuming a rate of acceptance of gender-affirming language among adolescents of 25% and 12.5% among guardians, 152 dyad respondents were needed to reach a power of 80%. Aggregate data from each generation and paired dyad data were analyzed using a Chi-square test for categorical data and student's t-test for continuous variables. Institutional IRB approval was obtained.</div></div><div><h3>Results</h3><div>Adolescent respondents were more likely to have pronouns they prefer (p&lt; 0.0001) and to recognize the importance of using a person's preferred pronouns (p=0.002) compared to adult respondents (Table 1). Adolescents were also more receptive to being asked their preferred pronouns, relative to the adult respondents (p=0.001). These questions were statistically significant when comparing adolescents to guardians in the paired dyad (Table 2). Self-reported level of education positively correlated with having preferred pronouns, being receptive to being asked their preferred pronouns, and utilizing a person's preferred pronouns (all p&lt; 0.05). Black race was also associated with having preferred pronouns (p=0.03).</div></div><div><h3>Conclusions</h3><div>Adolescents in this cohort demonstrated a greater awareness of the importance of gender-affirming language compared to adults. Limitations of this study are that it is single site and may not be representative of all patient populations. Surveys were also obtained with both adolescent and guardian present which may have influenced responses from either or both groups.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 226"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520010","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":"15. Asking About Gender Identity in Pediatric and Adolescent Gynecology Clinic: Patient, Family and Provider Perspectives (The REFLECTIVE Study).","authors":"Madeline Ross ,&nbsp;H. Sema Baghaki ,&nbsp;Hannah Suffian ,&nbsp;Lauren Roth ,&nbsp;Jeanette Higgins ,&nbsp;Tazim Dowlut-McElroy","doi":"10.1016/j.jpag.2025.01.048","DOIUrl":"10.1016/j.jpag.2025.01.048","url":null,"abstract":"<div><h3>Background</h3><div>The provision of medical and psychosocial supports requires the identification of gender diverse individuals in health care settings. However, in primary care settings, some adolescents and parents expressed that gender identity screening (GIS) was offensive and clinicians expressed that GIS negatively affected their workflow. We sought to assess the acceptability and feasibility of GIS in Pediatric and Adolescent Gynecology (PAG) clinics of a large tertiary care children's hospital in the United States (US) Midwest.</div></div><div><h3>Methods</h3><div>A GIS survey developed in the US West Coast was modified with permission. After IRB approval, the anonymous single-site cross-sectional survey was administered to patients ages 12-25 years (AYA), parents of the 12-to-17-year-olds, and healthcare providers (HCPs) in our PAG clinics from July through September 2024. Statistical analysis was performed using SPSS version 29 (IBM Corp, Armonk, NY). Categorical variables were compared using the Chi-Square test /Fishers’ exact test or the Kruskal-Wallis test as appropriate. Continuous variables were compared using the ANOVA test. Statistical significance was defined as P &lt;.05.</div></div><div><h3>Results</h3><div>Fifty-six participants completed the survey (Table1). The majority were 12-to17-year-olds (27, 48.2%) and their parents (16, 28.6%). The mean (SD) age of 12-to-17-year-olds, 18-to-25-years-olds, parents of 12-to-17-year-olds, and healthcare providers (HCPs) was 14.9 (1.6), 18.4 (.79), 46.8 (15.4), and 46.8 (15.4) years, respectively. Most AYA did not find GIS confusing, uncomfortable, or offensive (Table 2). An equal number of parents did/did not want parental permission prior to GIS screening for their children. Although more parents than HCPs preferred informing parents about the content of GIS before AYA were asked questions, the difference was not significant (10, 62.5% vs. 2, 33.3%, p=.348). Most 18-to-25-years-olds (4, 57.1%), parents of 12-to-17-year-olds (12, 75%), and HCPs (6, 100%) did not think that GIS should be performed in front of parents as compared to only 9 (33.3%) of 12-to-17-year-olds (p=.005). There was a statistically significant difference between the preferred method of GIS with 16 (80%) of 12-to-17-year-olds and 6 (100%) of HCPs preferring direct communication between patient and provider as compared to most 18-to-25-years-olds (5, 71.4%) who preferred to enter GIS on a computer or tablet (p=.008). HCPs did not think that GIS affected their workflow.</div></div><div><h3>Conclusions</h3><div>AYA have differing preferences for the method of GIS in PAG clinics which HCPs should take into consideration.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 236"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520018","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":"13. Pain outcomes in adolescents with surgically confirmed endometriosis: A single-site retrospective cohort analysis","authors":"Madeline Ross ,&nbsp;Priyanka Suvarna ,&nbsp;Adam Booser ,&nbsp;Ashli Lawson","doi":"10.1016/j.jpag.2025.01.025","DOIUrl":"10.1016/j.jpag.2025.01.025","url":null,"abstract":"<div><h3>Background</h3><div>Endometriosis is a leading cause of dysmenorrhea globally, with two thirds of women reporting symptoms beginning in adolescence. Despite increased awareness of adolescent endometriosis, there is a paucity of data regarding best practice for surgical and medical management to improve pain outcomes. This study aims to analyze pain outcomes at one year post index surgery in adolescent patients with surgically diagnosed endometriosis.</div></div><div><h3>Methods</h3><div>This was a single-site, IRB-approved (STUDY2514), retrospective cohort study reviewing the care of natal females (12-22 years old) with surgically diagnosed endometriosis from 2009 to 2021. Baseline characteristics (demographics and preoperative clinical characteristics) were gathered from chart review. Surgery was classified as diagnostic laparoscopy only, versus ablation and/or excisional biopsy based on the surgeon's operative report. Subset analysis of post-op hormonal management with an intrauterine device (IUD) or leuprolide was performed. Changes in pain status (defined as resolved, improved, same, or worse) were gathered from the subjective documentation within gynecology appointment notes one year post-op. Statistical analysis was performed using independent t-tests and Chi-Squared/Fisher's Exact tests. Statistical significance was defined as p&lt; 0.05.</div></div><div><h3>Results</h3><div>53 patients were identified in this study period. Mean age at time of index surgery was 15 (SD 1.7) years old, and the majority had stage 1 endometriosis. 66% of patients reported their pain was improved one year after their index surgery. There was no significant difference in pain outcome at one year based on whether a patient had a diagnostic surgery only compared to ablation and/or excisional biopsy of endometriosis lesions (p=0.43). There was no significant difference in pain based on the type of hormonal regimen implemented after the index surgery, including those who had an IUD (p=0.76) or received a post-operative course of leuprolide (p=0.7). There was no statistically significant difference in pain outcomes regarding patient demographics, including age (p=0.34) and BMI (p=0.36). Regarding pre-operative clinical characteristics, patients who reported worse pain had seen one additional specialist prior to diagnosis (p=0.005).</div></div><div><h3>Conclusions</h3><div>Over two thirds of patients who underwent surgical management of endometriosis reported their pain had improved one year following surgery. Patients who had worsening pain, had seen more specialists prior to their index surgery. There was no difference in pain outcomes based on the type of surgical or hormonal intervention, or other baseline patient characteristics.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 227-228"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520020","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":"14. Quantitative Sensory Testing in Females with Endometriosis and Chronic Pelvic Pain","authors":"Sinah Esther Kim ,&nbsp;Catherine Stamoulis ,&nbsp;Christine Sieberg ,&nbsp;Jenny Gallagher ,&nbsp;Beth Schwartz ,&nbsp;Stephen Scott ,&nbsp;Michele Hacker ,&nbsp;Amy DiVasta","doi":"10.1016/j.jpag.2025.01.027","DOIUrl":"10.1016/j.jpag.2025.01.027","url":null,"abstract":"<div><h3>Background</h3><div>Chronic pelvic/abdominal pain (CPP) due to endometriosis can be unresponsive to standard therapies due to excessive sensitivity to pain known as central sensitization. We studied whether quantitative sensory testing (QST), a psychophysical method examining how the somatosensory nervous system responds to stimuli, differed between females with endometriosis and pain-free individuals.</div></div><div><h3>Methods</h3><div>Females with laparoscopically-confirmed endometriosis and CPP despite hormonal medication use (pain ≥3/ 0-10 scale, ≥14 days/mo) were eligible, and underwent baseline QST for an IRB-approved, multi-site clinical trial. We measured pressure pain threshold (minimum pressure evoking pain) using an algometer, and wind-up temporal summation (perception of pain due to repetitive equally intense stimuli) using electronic Von Frey, in the lower abdomen and control areas (non-dominant third finger nailbed/deltoid). Age-matched data from 107 pain-free females were used as a reference sample. Unadjusted statistical comparisons were conducted using the Mann–Whitney U test. Statistical models with adjustments for age, race, and BMI were developed to examine statistical differences in pain outcomes. Data are reported as median (interquartile range).</div></div><div><h3>Results</h3><div>We enrolled n=85 females with endometriosis (age: 25.3 (13.4)y). Our pain-free cohort included n=107 females (age: 20 (30.0)y; Table 1). Females with endometriosis experienced median (IQR) 3(3) intensity pain, &gt;1 day/week, had lower median pain pressure thresholds (7.4 (8.1)) than the pain-free sample (16.0 (12.9); p&lt; 0.01 based on unadjusted comparisons), and higher median temporal summation of pain (2.0 (2.5) vs. 0.5 (1.0); p&lt; 0.01). These differences remained in adjusted analyses: lower pressure-pain thresholds (regression coefficient (β)=-0.28, 95% confidence interval (CI)= [-0.39, -0.18]) and higher temporal summation (β=1.69, 95% CI= [1.06, 2.31]). In females with endometriosis, median pressure pain threshold was lower on the abdomen compared with the finger (7.4 (8.1) vs. 17.1 (14.7), p&lt; 0.01). No site difference (abdomen vs. deltoid) in temporal summation was estimated (p=0.15).</div></div><div><h3>Conclusions</h3><div>Females with endometriosis had lower pressure-pain thresholds, indicating higher sensitivity to pain, and higher temporal summation measures, reflecting greater increase in pain perception from exposure to repetitive stimuli, compared with pain-free females. The pressure-pain threshold was lower at the lower abdomen vs. finger in those with endometriosis, but temporal summation was the same. Clinicians should consider treatments aimed at reducing central sensitization to pain in those with CPP due to endometriosis.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 228"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520021","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":"2. Availability and Accessibility of an Over-The-Counter Oral Contraceptive Pill in Retail Pharmacies in a Single Midwest US County: An Exploratory Study","authors":"Taylor Argo ,&nbsp;Tracey Wilkinson ,&nbsp;Julie Maslowsky ,&nbsp;Alana Otto","doi":"10.1016/j.jpag.2025.01.014","DOIUrl":"10.1016/j.jpag.2025.01.014","url":null,"abstract":"<div><h3>Background</h3><div>An over-the-counter (OTC) oral contraceptive pill (OCP) containing 75 μg of norgestrel became available without a prescription in US retail stores in March 2024. OTC access to an OCP has the potential to reduce barriers to contraceptive access and improve reproductive health equity, particularly for adolescents; however, removing the requirement for a prescription does not guarantee accessibility. The purpose of this study was to assess the availability and accessibility of the OTC OCP in pharmacies in a single midwest US county.</div></div><div><h3>Methods</h3><div>We used our state's licensing database to identify all licensed retail pharmacies in our county and visited these pharmacies between August and October 2024; we excluded pharmacies embedded in clinics and hospitals. We observed the availability, price, and accessibility of the OTC OCP (“the pill”), including availability for purchase of one- and three-month packs, price, and location (on the shelf with no security measures; behind the pharmacy counter; or in a locked security box that requires an employee to open at checkout). We present descriptive statistics of our findings.</div></div><div><h3>Results</h3><div>We visited a total of 44 retail pharmacies, including 16 standalone chain pharmacies, 14 independent local pharmacies, 12 mass merchandise retailers/supermarkets, and two wholesale clubs. The pill was available in 33 pharmacies (75% of those visited). Only three of 14 independent pharmacies (21%) carried the pill. Prices ranged from $18.97- $22.59 for one-month packs (manufacturer's suggested retail price [MSRP]: $19.99) and $47.99 - $55.99 for three-month packs (MSRP: $49.99). In 12 pharmacies (36%), the pill was available on the shelf with no security measures. In 13 pharmacies (39%), the pill was in locked security boxes. In 4 pharmacies (12%), some packs were available on the shelf, while others were in locked security boxes. Four pharmacies (12%) had the pill behind the pharmacy counter.</div></div><div><h3>Conclusions</h3><div>The OTC OCP was available at most pharmacies (75%) in our single US county at the time of data collection; however, few independent pharmacies stocked the product, and only 27% of all pharmacies had the product available without security measures. Prices in our county were generally similar to the MSRP. In more than half (63%) of pharmacies that stocked the pill, the OTC OCP was locked in security boxes or behind the pharmacy counter, requiring an individual to seek an employee to access the pill. Whether these measures affect adolescents' willingness to purchase the OTC OCP or contribute to stigma around contraception are important areas for future study.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 220"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520096","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":"25. Correlation of serum inhibin B and radiographic hemorrhagic cyst: A case for conservative management","authors":"Jennifer Silk,&nbsp;Sarah Hill,&nbsp;Laura Stafman,&nbsp;Blair Lacy","doi":"10.1016/j.jpag.2025.01.058","DOIUrl":"10.1016/j.jpag.2025.01.058","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian neoplasms occur 2.6 per 100,000 in the child and adolescent population and are usually benign in nature. The incidence of pediatric ovarian malignancy is poorly understood, as it is exceedingly rare, though when present, adnexal masses are diagnosed as gynecologic malignancy 3-8% of the time. Tumors markers like inhibins can be used to differentiate between benign and malignant lesions. Inhibin B is generally thought to be elevated in granulosa cell malignancies and can be a cause of primary or secondary amenorrhea. No literature, however, has demonstrated an association with an elevation of inhibin B with benign pathologies as discussed in this case.</div></div><div><h3>Case</h3><div>A 12-year-old female presented to pediatric gynecology with a left adnexal mass incidentally noted on renal ultrasound while undergoing evaluation for pediatric hypertension. Menarche occurred at age 11 with regular monthly cycles. An abdominal ultrasound and CTAP were notable for a 5.3 × 4.9 × 4.2cm thin walled cyst in left ovary concerning for hemorrhagic cyst. Labs demonstrated normal estradiol, testosterone, aldosterone, bHCG, inhibin A, and AFP. Inhibin B was elevated to 464. Given patient age and reassuring findings on ultrasound, it was ultimately decided to trend serum inhibins, mass size with ultrasound, and consult pediatric surgery given possible gynecologic malignancy. Repeat imaging 4 weeks later showed a stable hemorrhagic cyst and down trending inhibin B at 180. At 8 weeks from onset, imaging demonstrated interval resolution hemorrhagic cyst and inhibin B at 118. Given the improvements, repeat imaging and inhibin was obtained five months later with no evidence of recurrence of hemorrhagic cyst and normalized inhibin B at 35.</div></div><div><h3>Comments</h3><div>Limited data exists regarding conservative treatment of adnexal masses that are benign in nature in the setting of elevated tumor markers in pediatric and adolescent patients. In this case, a benign appearing lesion was associated with elevations of inhibin B, which raised concern for gynecologic malignancy. In absence of high-risk ultrasonographic features or symptoms of hyperestrogenism that one would expect in juvenile granulosa cell tumor, the clinical picture was consistent with benign pathology. Thus, inhibin was trended to normal range and correlated with simultaneous resolution of the cyst. An unnecessary surgical procedure was avoided in this asymptomatic patient. Further studies need to be collected to validate the use of trending inhibin B in the setting of benign adnexal pathologies like hemorrhagic cysts.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 242"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519939","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":"27. Diagnosis of Imperforate Hymen: A Case Study for Quality Improvement","authors":"Avanthi Ajjarapu,&nbsp;Jennifer Dietrich","doi":"10.1016/j.jpag.2025.01.060","DOIUrl":"10.1016/j.jpag.2025.01.060","url":null,"abstract":"<div><h3>Background</h3><div>Imperforate hymen, transverse vaginal septum, vaginal agenesis, and lower vaginal atresia are four common forms of vaginal outlet obstruction. Early differentiation between these anatomic variants is crucial to determine a correct diagnosis and ensure appropriate surgical timing to avoid unnecessary surgical revision or complication. Distinguishing between these variants relies initially on physical exam. When characteristic components are absent, it is critical to obtain imaging to distinguish between other obstructive vaginal anomalies as the presence of hematocolpos or hematometra may occur with many types of obstructive mullerian anomalies. A pelvic ultrasound may be ordered initially as it is more readily available but may not yield enough detailed information. In this circumstance, further imaging should be obtained prior to surgical intervention with Pelvic MRI; the gold standard imaging modality for reproductive tract anomalies. This case reminds the provider of the steps to take for the correct diagnosis as well as recommendations for specialist referral when the presentation is not that of a bulging membrane with blue hue at the introitus.</div></div><div><h3>Case</h3><div>A 13 yo female presented to an outside emergency room with severe, cyclic abdominopelvic pain. A pelvic ultrasound suggested hematometra. She was taken to the operating room due to pelvic exam findings concerning for no vaginal patency. A vaginal dimple was present without blue hue or bulging noted. Intraoperatively, an incision did not reveal release of menstrual contents. The surgery was aborted due to findings inconsistent with imperforate hymen. MRI Pelvis was ordered later and a diagnosis of cervicovaginal agenesis with hematometra was made. Menstrual suppression was then initiated with GnRh antagonist orally. A few years later, the patient was referred to Pediatric and Adolescent Gynecology.</div></div><div><h3>Comments</h3><div>For complex reproductive tract anomalies, pelvic MRI should be ordered following pelvic US as MRI best correlates with the type of anomaly. Avoid going to the operating room if the classic presentation of imperforate hymen is not visualized and confirmed to minimize complications. Optimize pain management to allow time to obtain adequate MRI Pelvis with contrast for optimal delineation of hymenal versus other vaginal and mullerian variants. This includes assessing distance from introitus to defect. Refer to a specialist with expertise in managing obstructive reproductive tract anomalies, when an anomaly other imperforate hymen is suspected.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 243"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519941","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":"8. Geospatial Distribution of Mullerian Anomalies in the State of Texas between 2012-2024: A Retrospective Cohort Study","authors":"Avanthi Ajjarapu ,&nbsp;Jennifer Dietrich ,&nbsp;Michael Jochum","doi":"10.1016/j.jpag.2025.01.020","DOIUrl":"10.1016/j.jpag.2025.01.020","url":null,"abstract":"<div><h3>Background</h3><div>Etiology of Mullerian anomalies (MA) has long been considered multifactorial, but the specific contributing factors remain unclear. Some genes have been correlated to certain MA, but no genes explain all anomaly types. The role of environmental pollutants (EP), specifically possible endocrine disruptors, has been considered, but not explored to date. We aimed to understand distribution of patients with any MA to assess proximity to EP.</div></div><div><h3>Methods</h3><div>An IRB approved retrospective cohort study was conducted among Pediatric and Adolescent Gynecology patients (</div></div><div><h3>Results</h3><div>526 patients met inclusion/exclusion criteria following initial population analysis with Epic SlicerDicer. A majority of patients identified as White (78%), and non-Hispanic and/or Latino (57%) (Table 1). 34.6% of the cohort was comprised of complex mullerian anomalies. Geographic coordinates by census tract code and anomaly type were plotted on a Texas State map, visually demonstrating MA distribution. Best Fit modeling of study cohort by optimal silhouette width revealed 43 distinct geographic clusters (Figure 1). Among zipcodes with the highest MA prevalence, one was noted in close proximity to a superfund site which is a high hazard EPA classification. Clusters 3 and 4 were of interest due to higher rates of OHVIRA and MRKH. Among waste sites within a 10-mile radius to each cluster, top chemicals emitted included known endocrine disruptors.</div></div><div><h3>Conclusions</h3><div>This is the first study of its kind to assess geospatial distribution of mullerian anomalies and proximity to environmental pollutants. We hope that this data provides the groundwork to further elucidate impact of environmental factors on MA.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 224"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520007","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":"3. Cardiovascular Risk in Females with Endometriosis","authors":"Madeline Smith ,&nbsp;Margaret Bolan ,&nbsp;Catherine Stamoulis ,&nbsp;Shannon Lyon ,&nbsp;Amy DiVasta","doi":"10.1016/j.jpag.2025.01.015","DOIUrl":"10.1016/j.jpag.2025.01.015","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with endometriosis are at higher risk of cardiovascular (CV) disease, hypertension, high cholesterol, and atherosclerosis. While CV disease is rare in young people, surrogate markers such as the pulse wave velocity (PWV), a measure of arterial stiffness, can predict future CV dysfunction. We sought to determine if females with endometriosis had elevated PWV values, and thus increased CV risk, compared with healthy control subjects. We also investigated whether additional predictors of future CV risk correlated with PWV measurements.</div></div><div><h3>Methods</h3><div>At the baseline visit of a multi-site, randomized clinical trial, n=70 females with laparoscopically-confirmed endometriosis and persistent pelvic pain provided health history and anthropometric measures. Blood samples were obtained for measurement of inflammatory markers (hs-CRP, ESR), lipid profiles (HDL, LDL), and hormonal concentrations (estradiol). PWV was collected by using two pressure probes placed at the carotid artery and femoral artery. The time it takes the pressure wave to go from the upstream probe to the downstream probe provides the Pulse Transit Time. PWV is calculated by dividing the distance traveled by the transit time. Previously obtained normative data from n=1455 from healthy controls were used as reference. Generalized linear regression models with adjustments for age, endometriosis stage and BMI were developed to test the associations of interest. We had local IRB approval.</div></div><div><h3>Results</h3><div>Of the n=70 participants, n=63 (median (interquartile (IQR)) age 25.3 (13.2) y, range 16.1–39.2y)) had PWV scans adequate for analysis. All were using hormonal therapy: 10 (15.9%) combined-hormonal contraception, 27 (42.9%) oral progestin, 31(49.2%) LNG IUD, and 11 (17.5%) other. Participants were excluded for other CV disease risk (n=2 high cholesterol, n=1 hypertension). Demographic and clinical characteristics are summarized in Table 1. About 30% of participants had stage I endometriosis. Median (IQR) PWV was 5.1 (1.2) m/s, lower than normative values for this age range (median=6.1-6.4 m/s for ages &lt; 30 – 39). Respective associations between PWV and hs-CRP, ESR, HDL, and estradiol were nonsignificant (p&gt; 0.15). LDL was positively associated with PWV (regression coefficient (β)=0.02, 95% CI=[0.01, 0.03], p&lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Females with endometriosis had lower PWV measurements compared to age-matched control subjects. LDL was positively associated with PWV; other CV risk markers were not. In this sample, young females with endometriosis did not demonstrate early signs of increased CV risk as measured by PWV. Future studies should investigate the impact of duration of disease and use of hormonal treatment on these findings.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 220-221"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520111","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":"4. Effect of GLP-2 Coated Vaginal Expansion Sleeves (VES) in a Rat Model","authors":"Joshua Colvin,&nbsp;Rachel Cline,&nbsp;Hannah Meyer,&nbsp;Donald Sorrells,&nbsp;Jonathan Alexander,&nbsp;Mila Shah-Bruce","doi":"10.1016/j.jpag.2025.01.016","DOIUrl":"10.1016/j.jpag.2025.01.016","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal atresia is the congenital absence of the vaginal canal. Current treatments include at-home dilation therapy and surgical vaginoplasty. In our previous studies we have created a novel vaginal expansion sleeve (VES) that progressively elongated and retained vaginal expansion with only minor procedural intervention. This study aims to further explore the effect of the VES device on vaginal lengthening utilizing Glucagon-like peptide 2 (GLP-2). GLP-2 is known to promote intestinal tissue proliferation however the research exploring GLP-2′s role in non-intestinal tissues including female reproductive tissue is sparse.</div></div><div><h3>Methods</h3><div>The VES is a cylindrical, spring-like device with resin caps. Each VES was cut to 1.3x the current vaginal canal length, coated with 50µg GLP-2 via cross-linking with polyvinyl alcohol, inserted into the vaginal canals of 4 Sprague Dawley rats, and anchored with nonabsorbable sutures. Each week, the sleeves were removed and replaced with a serially longer VES over three weeks measuring 1.3x the current length of the vaginal canal. Rats were monitored for another 2 weeks to assess for any decrease in vaginal length. Vaginal lengths were measured prior to initial VES insertion and weekly during the 5-week trial.</div></div><div><h3>Results</h3><div>Serial deployment of GLP-2 coated VES devices resulting in an increase in vaginal length from 26.25 ± 0.96 mm to 35.5 ± 3.11 mm (p&lt; 0.001, week 5). Histologically, diffuse vaginal wall thinning with preservation of the epithelial, mucosal, and muscular layers was seen. Mild to moderate inflammation was also noted as evidenced by intraepithelial and and subepithelial lymphoid infiltrate.</div></div><div><h3>Conclusions</h3><div>The serial implantation of GLP-2 VES resulted in significant and retained expansion of the rat vagina comparable to the previous non-GLP-2 VES with both rounds of devices producing an average vaginal length of 35.5 mm with retained tissue architecture. The GLP-2 VES suggests a minimally invasive alternative for vaginal atresia treatment.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 221"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520112","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}