Journal of pediatric and adolescent gynecology最新文献

Background: Levonorgestrel intrauterine devices (IUDs) provide effective contraception and medical benefits. They are safe for even severely medically complex patients. The CDC Medical Eligibility Criteria (MEC) states IUDs are category 4 for people with uterine cavity distortions, however there are previous case reports of their successful use in this population.

Cases: We present five cases of IUD use in uterine anomalies utilizing ultrasound or hysteroscopy for intra-cavitary placement confirmation. With up to 4.5 years of follow up, our expulsion rate is 40%. In those whose IUDs were expelled, the expulsion happened within 4 weeks of placement.

Conclusion: IUD use in uterine anomalies is possible and generally safe but expulsion is high. Early IUD expulsion within 4 weeks of placement could indicate undiagnosed uterine anomaly.

The objective of this document is to guide the screening, diagnosis, and management of Relative Energy Deficiency in Sport (REDs) in Adolescent/Young Adult (AYA) athletes to treat symptoms and reduce long-term sequelae with a focus on gynecologic aspects of the disorder. REDs is a more comprehensive term for the condition previously known as the Female Athlete Triad. An overview of the clinical presentation, evaluation, and management of the reproductive health aspects of REDs for female athletes is provided. For the purposes of this document, "female" refers to those designated female at birth, and "athlete" is defined as an individual who participates in regular physical activity. This document is intended for use by healthcare providers who care for female AYA athletes with REDs.

Study objective: Despite numerous accredited health organizations recommending the HPV (human papillomavirus) vaccine in adolescence, an estimated 26% of parents across the US are hesitant to vaccinate their children against HPV. We aim to describe HPV vaccine hesitancy (VH) among parents of children using a previously validated vaccine hesitancy scale (VHS) for the HPV vaccine and to reduce HPV VH among parents through direct HPV vaccine education.

Methods: Our study sampled parents of patients aged 9-18 years who attended an outpatient pediatric clinic. Two groups (parents of unvaccinated and vaccinated patients against HPV) completed an identical VHS HPV before and after watching an educational video. Survey responses were collected using a 4-point Likert scale, score ranged from 9 to 45. Pre- to post- intervention scores and vaccine uptake 12 months later were analyzed.

Results: The VH score decreased for both the unvaccinated and vaccinated groups, while likelihood to vaccinate increased in the unvaccinated group. In addition, 48.1% of the adolescents in the unvaccinated group expressed their willingness to receive the HPV vaccination.

Conclusion: Overall, education on the HPV vaccine increased likelihood to vaccinate while also decreasing VH among parents. The results from our study could encourage additional clinical sites to adapt similar strategies to increase HPV vaccination.

Objective: There is a relative lack of research on the association of mental health problems and menstrual-related concerns in adolescents. The objective of the current study was to compare anxiety, depression, quality of life, and perceived stress between adolescents with abnormal uterine bleeding (AUB) and control patients.

Study design: We performed a cross-sectional study in which participants were recruited from a tertiary training and research hospital. Adolescents aged 12-18 years with a first diagnosis of abnormal uterine bleeding and healthy controls evaluated in adolescent, pediatric endocrinology and general pediatrics departments were included in the study. The Revised Child Anxiety and Depression Scale (RCADS), the Pediatric Quality of Life Inventory (PedsQL) and the Perceived Stress Scale (PSS) were used to assess mood, quality of life and perceived stress.

Results: Fifty-six participants from the AUB group and fifty participants from the control group were included in the study. Except for social functioning scores which were lower in the AUB group versus controls (86.42∓14.03 vs. 92.4∓10.41, p<0.05), there was no significant differences in PedsQL scores between groups. There was a significant difference between the Perceived Stress Scale total scores of the AUB and control groups (32.07 ∓ 6.49; 28.98 ∓ 5.55, p<0.05), but no difference between the RCADS scores.

Conclusion: In our study, we found that abnormal uterine bleeding in adolescents was associated with reduced social functioning and increased perceived stress. Larger studies are needed to confirm our findings.

Purpose: To use modified Parenthood/Pregnancy Attitude, Timing and How important is pregnancy prevention (PATH) questions to assess parenting attitudes and reproductive desires in adolescents and young adults (AYAs).

Methods: Between November 2020 and January 2022, we recruited participants 13-22 years old via a convenience sample from an Adolescent Medicine outpatient clinic at an urban children's hospital to participate in a cross-sectional survey. The survey was self-administered on a tablet and was adapted from the original PATH questions.

Results: 300 adolescents completed the survey. Median age 17 years, 87.3% identified their assigned sex at birth as female, 43.0% identified as Black, and 55.3% had public insurance. 61.3% reported ever being sexually active. 62.7% reported a desire for future children, 70.2% listed a time frame or specific age when they would like children. Those who had ever had sexual activity were more likely to desire future children. Most participants (68.5%) reported pregnancy prevention was very important or important.

Conclusions: To our knowledge, this is the first study assessing parenting attitudes and reproductive desires of AYA patients assigned sex female at birth and assigned sex male at birth in a clinical setting. Most AYAs reported they were sexually active, had a desire for future children, had a certain time frame in mind for having children, and would want to prevent pregnancy until that time. Assessing AYA's parenting attitudes and reproductive desires supports the use of shared decision making and the provision of reproductive health counseling aligned with patients' preferences and priorities.

Background: Neovaginal ileitis is an understudied complication of intestinal vaginoplasty for which no evidence-based treatments exist. Mesalamine has been successfully reported to treat neovaginal colitis and has mixed evidence of efficacy in treating ileal inflammatory syndromes.

Case: We report a 29-year-old female with a history of ileal neovaginoplasty at two years of age for cloacal variant and treatment-refractory neovaginal ileitis with pain and bleeding whose symptoms resolved with treatment with topical mesalamine.

Conclusion: Mesalamine may be a viable treatment for neovaginal ileitis. More data is needed on neovaginal ileitis incidence and treatment, in addition to broader quality of life outcomes after intestinal vaginoplasty.

Background: Norethindrone acetate (NETA) is commonly used in adolescent patients for management of heavy menstrual bleeding, menstrual suppression, and endometriosis. Clinical guidelines do not address specific dosing strategies, clinical indications, contraindications, or monitoring. We sought to survey current prescribers of NETA to assess practice patterns of use among adolescent patients.

Methods: An anonymous cross-sectional survey was sent via email list-serv to members of the North American Society for Pediatric and Adolescent Gynecology Providers (NASPAG). Participants were asked about their own demographics, patterns of use and monitoring of NETA.

Results: Seventy-one providers participated in the survey including 46 gynecologists and 22 adolescent medicine trained clinicians. The most common indications for use were menstrual suppression and treatment of endometriosis. Most providers (n=51) used NETA in patients with estrogen contraindications, with over half limiting the maximum dose used (n=24). While 14%(n=9) of providers surveyed had concerns about effects on bone mineral density with prolonged NETA use, only 1 participant routinely obtained dual-energy X-ray absorptiometry (DEXA) scans. 43% of participants using NETA felt there were no absolute contraindications (n=27); others cited liver disease (n=15), active or prior venous thromboembolism (n=7), and inherited thrombophilia or increased clotting risk (n=3) as strict contraindications.

Conclusions: NETA is commonly prescribed for adolescents by study participants. Despite widespread use, practice patterns vary regarding eligibility, monitoring, and perceived risks. This likely reflects limited data and highlights the need for further investigations of NETA use. Our study was limited by low response rate that may not be reflective of general clinical practice.

Study objective: The aim of this paper is to review our understanding of the vaginal microbiome (VM), the internal and external factors that influence its composition, and how it relates to adult and adolescent reproductive health.

Methods: A literature review was conducted in March 2024 using Web of Science, PubMed, Embase, and Google Scholar.

Results: The majority of studies focused on the VM in healthy adult women and demonstrated that the VM changes across the menstrual cycle, with the greatest species diversity during menses. In most women, the VM is dominated by lactobacilli, however, Black and Hispanic women are more likely to demonstrate a polymicrobial profile. The VM is also affected by lifestyle factors (e.g., diet, alcohol, smoking, sexual activity, vaginal hygiene) and contraception, whereas the role of endogenous reproductive hormones in shaping the VM is unclear. The VM of adolescents begins to resemble that of adults in mid- to late puberty.

Conclusion: The VM is a complex and dynamic microbial community that has the potential to serve as an important clinical biomarker of adult as well as adolescent reproductive health, possibly aiding in the diagnosis of such conditions as polycystic ovarian syndrome. However, additional studies are needed in healthy adolescent girls.