Journal of pediatric and adolescent gynecology最新文献

Study objective: To summarize contraceptive information shared and sought by adolescents and young adults (AYAs) and caregivers on Reddit.

Methods: Posts were collected from 8 subreddits (June 2022-September 2024) using contraception-related keywords. Eligible posts were in English and authored by self-identifying AYAs (<26 years) or caregivers; comments from 10% of posts were included. We used hybrid inductive-deductive qualitative content analysis to characterize each post's primary purpose and to summarize common methods, side effects, medical and access questions, confusion/misconceptions, and sentiments.

Results: Of 607 posts, 297 met inclusion. Over half were authored by teens (<20 years, 59%), followed by young adults (32%) and caregivers (10%). The pill (47%) and intrauterine devices (25%) were most discussed. Common side effects included menstrual changes (36%) and mood/mental health (29%). Teens (n=174) frequently discussed condoms (23%) and emergency contraception (12%). Teens and young adults (n=268) shared sex/contraception education (13%) and opinions on contraceptive rights/behaviors (12%). They sought medical/behavioral advice (38%), contraceptive knowledge (15%), pregnancy scare advice (11%), and communication/access advice (9%). Caregivers (n=29) sought method recommendations (38%), shared moral/ethical concerns (35%), and sought knowledge (17%) or communication advice (10%). Overall (N=297), 15% contained misconceptions and 16% featured antihormonal sentiment. Few expressed positive emotions (10%) or trust (10%), while many conveyed negative emotions (60%) or mistrust (28%).

Conclusion: Reddit posts about contraception from AYAs and caregivers cover diverse topics, are often negative, and sometimes feature misconceptions that may influence decision-making. Clinicians should address online contraceptive information during counseling to better respond to patient concerns.

Purpose: Historically, the Human Papilloma Virus (HPV) vaccine has been the subject of vaccine hesitancy. In 2020, the introduction of a COVID-19 vaccine incited a new wave of vaccine hesitancy. We investigated whether introducing the COVID vaccine correlated with changes in HPV vaccine initiation compared to Tdap in a large New England health system.

Methods: Initial doses only of HPV as well as first recorded doses of the Tdap vaccine administered to individuals ages 9 to 18 between March 2019 and May 2023 were analyzed. Linear trends and per-day rates of each vaccine were assessed in three periods: prior to the pandemic (3/19-2/20); during the pandemic (3/20-5/21); and post-COVID vaccine (5/21-5/23), with a secondary analysis performed to account for seasonality. Daily vaccination rates were stratified by sex and population density (urban versus rural).

Results: Records from 15,696 patients who received 10,502 HPV initiation vaccines and 10,282 Tdap vaccines were analyzed. No difference was noted in HPV initiation rates during the pandemic (7.05 vs. 7.30, p=0.203), though a significant decrease was noted post-vaccine compared to pre-pandemic (7.05 vs. 6.63, p=0.011).This post-vaccine decrease was driven primarily by the male (3.68 vs. 3.43, p=0.035) and urban (3.48 vs. 2.73, p<0.001) populations. Tdap rates were unchanged during the pandemic (6.60 vs. 6.34, p=0.148), but increased post-vaccine (6.60 vs. 7.11, =0.003).

Discussion: HPV initiation rates declined following the introduction of the COVID vaccine in a large health system in New England, driven mostly by a decline among males and the urban population.

Study objective: To explore primary care providers' confidence delivering sexual and reproductive health (SRH) education and services to adolescents.

Methods: A cross-sectional survey measured United States based primary care providers' confidence delivering SRH care to adolescents. Confidence was measured on a 4-point Likert scale. Providers were asked to estimate the time burden of including sex education in appointments and to describe their perceived barriers to including SRH in routine care and to select their preferred education modalities to increase confidence. Median confidence scores were calculated. Mann-Whitney U-tests compared confidence by providers with a pediatric specialty to those without.

Results: Confidence levels were mixed. Provider confidence was highest discussing pregnancy or sexually transmitted infection prevention. Compared to those without a pediatric specialty, pediatric providers reported lower confidence in most areas, with the greatest differences reported in abortion-inclusive options counseling, pregnancy planning, and hand to genital sexual activity. Time was the most frequently cited barrier. The estimated time burden of including SRH in care varied widely, ranging from 5 to over 60 minutes. Preferred education modalities varied, but most providers preferred online education in one or more formats.

Conclusion: Providers report uneven confidence when delivering SRH to adolescents. Additional research and targeted training are needed to better understand this issue and increase confidence.

Study objectives: To assess the interest of transgender and nonbinary adolescents and young adults in fertility planning after an initial gender-affirming counseling appointment through completion of a fertility preservation procedure.

Methods: This is a retrospective cross-sectional study of patients aged 10-24 years seen for initial gender-related medical evaluations at the institution's Pediatric and Adolescent Gender Health Clinic between July 1, 2020 and August 31, 2023. The clinic uses a standardized interview template including questions about fertility goals. Data collected included referral to reproductive endocrinology and infertility (REI) services, REI appointment attendance, and completion of fertility preservation. Patient demographics and prior use of gender-affirming mental health or medical services were also assessed.

Results: Among 311 participants, 25 (8%) accepted an REI referral. Referral was positively associated with prior receipt of gender-affirming mental health or medical care. Of the 25 referred, 19 attended an REI appointment, and 8 ultimately underwent fertility preservation. All 8 were assigned male sex at birth and completed sperm cryopreservation. There was no association between previous gender-affirming care and completion of a fertility preservation procedure.

Conclusion: Although some transgender and nonbinary patients expressed interest in fertility preservation at their initial visit, only those assigned male sex at birth pursued preservation. This disparity likely reflects the relative simplicity and lower cost of sperm cryopreservation compared with oocyte preservation.

Study objective: To determine the prevalence and laterality of endometriosis in adolescents with obstructed Müllerian duct anomalies.

Methods: A retrospective cohort study of 42 adolescents with surgically confirmed obstructive Müllerian duct anomalies managed at a quaternary Paediatric and Adolescent Gynaecology Service between 2002 and 2025. All patients underwent laparoscopy or laparotomy during surgical correction of obstructed Müllerian duct anomalies and visual inspection for endometriosis. Lesion laterality and location were assessed relative to the side of the outlet obstruction. Demographic, clinical, and surgical data were collected from the medical records.

Results: Endometriosis was visually confirmed at surgery in 74% (31/42) of cases. Lesions occurred on the same side(s) as the outlet obstruction in 97% of affected cases (30/31), making the role of chance extremely unlikely.

Conclusion: Endometriosis is highly prevalent among adolescents with obstructed Müllerian duct anomalies, and lesions predominantly occurred on the side(s) of the obstruction. These findings strengthen the evidence supporting retrograde menstruation as a key driver for endometriosis pathogenesis in this cohort.