Journal of pediatric and adolescent gynecology最新文献

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, 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 (N= 141) 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 (MDAs).

Methods: A retrospective cohort study of 42 adolescents with surgically confirmed obstructive MDAs managed at a quaternary Paediatric and Adolescent Gynaecology Service between 2002 and 2025. All patients underwent laparoscopy or laparotomy during surgical correction of obstructed MDAs 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 MDAs, 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.

Background: Adolescents with polycystic ovary syndrome (PCOS) experience metabolic dysfunction, reproductive disturbance, and psychosocial burden. While combined hormonal contraceptives (CHC) are first-line pharmacologic treatment, concerns regarding side effects and long-term safety have spurred interest in nonhormonal alternatives. However, most evidence is derived from adult cohorts, leaving guidance specific to adolescents limited.

Study objectives: To systematically review the efficacy of nonhormonal pharmacotherapies including metformin, glucagon-like peptide-1 receptor agonists (GLP-1RAs), anti-androgens, and combination regimens in adolescents with PCOS.

Methods: We searched Medline, EMBASE, Cochrane Library, and CINAHL (1990-June 2025) for RCTs, cohort, and case-control studies enrolling PCOS teenagers aged 12-19 years. Two reviewers independently screened, extracted data, and assessed study quality. Outcomes included clinical signs (hirsutism, menstrual regularity), metabolic indices (BMI, insulin resistance, lipids), hormonal markers (testosterone, AMH), and patient-reported quality of life. This is the first systematic review on this topic.

Results: Nineteen studies (744 adolescents) met the inclusion criteria: Eleven on metformin monotherapy, seven on SPIOMET (spironolactone, pioglitazone and metformin), and one on flutamide + metformin. Metformin alone modestly reduced BMI (1-2 kg/m² reduction), improved HOMA-IR (25% reduction), and restored menses in up to 91% of participants. SPIOMET improved ovulatory function and halved Ferriman-Gallwey scores, decreased visceral and hepatic fat, normalised inflammatory markers (CRP, GDF15), and sustained benefits up to one-year post-treatment, without significant weight change. Flutamide plus metformin yielded substantial anti-androgenic and metabolic improvements compared to CHCs. No full-text trials of GLP-1 receptor agonist monotherapy in adolescents were identified.

Conclusion: Metformin appears to have some benefits for adolescents with PCOS, offering some metabolic and menstrual benefits based on a small number of observational studies and small RCTs. SPIOMET and flutamide & metformin show superior, multi-domain efficacy but should be studied in larger RCTs. Critical gaps include adolescent-specific GLP-1RA data and standardized outcome measures to guide optimal nonhormonal strategies.

Introduction: Although telehealth services for sexual and reproductive health are available to youth, there are inequities in telehealth use. This study explored access to telehealth technology, attitudes, intentions, barriers, and facilitators of telehealth among economically disadvantaged youth; and examined predictors of telehealth use.

Methods: A survey was administered to participants aged 18-24 years seeking an appointment at 9 urban publicly funded family planning and school-based clinics between May and August 2021. Constructs of interest included attitudes, intentions, barriers, and facilitators for telehealth. The outcome of interest was the type of appointment scheduled (telehealth or in-person). Data were analyzed for predictors of telehealth use.

Results: Participants (n = 347) were predominantly female (n = 307, 89%), Black race (52%), and non-Hispanic ethnicity (58%). A telehealth appointment was scheduled by 37% of participants. Overall, respondents had favorable attitudes towards telehealth. Concerns included the lack of in-person contact (39%), privacy (8%), and difficulty using technology (9%). Nearly all participants reported access to a device (99.6%) and the internet (99.2%), but 37% could not always trust their technology to work. Demographic factors, sexual risk perception, and quality of technology access did not statistically significantly predict telehealth use. However, respondents who scheduled telehealth visits had more positive attitudes towards telehealth (d = 0.50, P < .001) and were more likely to have prior experience with telehealth (OR 2.21 [1.3, 3.76], P = .003).

Discussion: Telehealth use for SRH services was influenced by attitudes and prior experience but not by access. Hence, it is important to address negative attitudes towards telehealth to enhance use.

Study objective: Pelvic inflammatory disease (PID) is a common reason for hospitalization among female adolescents and young adults (AYA). This study's objective was to compare inpatient characteristics, outcomes, and trends between AYAs and adults hospitalized with PID in the United States.

Methods: This retrospective cohort study used National Inpatient Sample data from 2016 to 2021 to identify patients with a PID diagnosis, stratified into AYA (ages 12-21) and adult (ages 22-50) cohorts. Demographics, comorbidities, complications, length of stay, costs, and discharge disposition were analyzed using t-tests for continuous variables and Chi square tests for categorical variables.

Results: Among 287,365 PID hospitalizations, 9.5% (n = 27,280) occurred in AYAs, rising from 8.3% to 10.3% over the study period. AYAs were more likely than adults to be Black (31.3% vs 26.9%), Hispanic (19.8% vs 17.3%), insured by Medicaid (54.3% vs 31.8%), and live in the Northeast (17.1% vs 15.8%) and Midwest (22.3% vs 19.6%) (all P < .001). Despite having fewer comorbidities, AYAs had significantly higher rates of serious complications like sepsis (11.8% vs 10.4%, P = .001). AYAs also had shorter hospitalizations (3.7 vs 3.9 days, P = .016), lower costs ($42,994 vs $55,238, P < .001), and more routine discharges (93.5% vs 90.5%, P < 001).

Conclusions: AYAs hospitalized with PID experienced more severe disease, suggesting delayed diagnosis and treatment. Stable AYA admissions, despite a declining rate in adults, may reflect barriers to care and disruptions in reproductive healthcare services-particularly during the COVID-19 pandemic. Improved screening, early intervention, and adolescent-centered sexual health services are needed to reduce disease severity and unnecessary hospitalizations.

Background: The purpose of this study was to (1) evaluate adolescent and young adult (AYA) delivery outcomes from 2015 to 2022 and (2) compare patient and delivery characteristics between the pre-pandemic period and during the pandemic.

Methods: A retrospective cohort study was performed using the Texas Inpatient Public Use Data File from 2015 to 2022. Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to summarize the data. Chi-squared or Fisher exact tests were used for association studies between categorical variables. Analysis of variance with Bonferroni adjustment for least squares means or t tests were used for continuous response variables.

Results: The study sample consisted of 105,458 deliveries. Overall, AYA deliveries decreased by approximately 50% from the pre-pandemic period (46,112) to during the pandemic (32,913). Deliveries before the pandemic were more likely to be among AYA mothers who were non-Hispanic and Black. During the pandemic, deliveries were more likely to be among AYA mothers who were Hispanic and White (P < .0001). The percentage of AYA deliveries in mothers who were obese was significantly lower during the pandemic (3.6%) than before the pandemic (4.17%; P < .0001). Finally, the percentage of AYA mothers with tobacco dependence was significantly higher during the pandemic (3.6%) than before the pandemic (1.9%; P < .0001). With regard to pregnancy complications, there was a significant decrease in the prevalence of liver disorders during pregnancy (P < .0001) and a significant increase in asthma during pregnancy (P < .0001), postpartum hemorrhage (P < .0001), and third-/fourth-degree perineal laceration (P = .002) when comparing pre- and during the pandemic numbers. The incidence of cesarean and operative vaginal (with forceps or vacuum) deliveries and the length of stay were significantly lower during the pandemic when compared with pre-pandemic values (P < .0001).

Conclusions: Overall, AYA deliveries decreased from the pre-pandemic period to during the pandemic, likely due to social behavior changes. AYA demographic characteristics, mode of delivery, and pregnancy complications also varied significantly, highlighting the need to study these trends further for potential health care disruptions in the future.

Implications and contributions: This study highlights a significant decline in AYA deliveries during the pandemic, along with notable shifts in maternal demographic characteristics, health conditions, and delivery outcomes. These findings provide critical insights into how global crises affect maternal health, contributing valuable knowledge to the literature on health care disruptions and informing future public health strategies.

Background: Retained foreign bodies can be the source of prolonged vaginal bleeding or abnormal discharge in pediatric patients.

Case: A 17-year-old with history of childhood sexual abuse presented with a six-year course of progressive, foul-smelling vaginal discharge. Despite multiple provider visits, a pelvic exam had never been completed until referral to specialized care. An exam under anesthesia demonstrated significant adherence of the object and imaging failed to clarify the planes of invasion. Therefore, a multidisciplinary surgical team was convened for further evaluation. Laparoscopy was utilized to confirm no pelvic invasion, and the 8 cm object was removed vaginally.

Conclusion: Long-retained vaginal foreign bodies can be significantly morbid. The value of trauma-informed care, the need for early exams, and a multidisciplinary approach are invaluable for patients presenting with these symptoms.

Background: Patients with obstructive Müllerian anomalies (OMAs) experience significant pain secondary to hematometrocolpos and often require menstrual suppression to achieve symptomatic pain control and to optimize timing before surgical intervention. Currently, there are limited data on menstrual suppression for these patients. We aimed to describe our institution's experience with the success of different menstrual suppression options for this population.

Methods: A retrospective cohort study of patients diagnosed with and treated for an OMA from 2012 to 2024 was performed at a tertiary care center. Exclusion criteria included imperforate hymens, those with surgical intervention at outside institutions, and patients lost to follow-up. Demographic characteristics, type of OMA, total time of menstrual suppression, and methods used were collected. The primary outcome was successful pain management of at least 3 months, with unsuccessful management defined as changes in therapy or proceeding with surgical management due to pain.

Results: Forty-two patients were included. The mean age was 15.7 years, and patients had a variety of OMAs. Of the patients, 57.1% (24/42) began menstrual suppression before surgical intervention. Most patients on suppression (66.7%, 16/24) began taking a combined oral contraceptive (COC) pill: 45.8% (11/24) took a 30-mcg ethinyl estradiol (EE) pill, and 20.8% (5/24) took a 20-mcg EE pill. Almost half (41.6%, 10/24) of those on menstrual suppression did not have adequate pain control with their initial method. Of the patients, 87.5% (21/24) ultimately achieved successful pain management using a variety of methods, including 30-mcg EE COCs (9/21), 20-mcg EE COCs (2/21), gonadotropin release hormone (GnRH) agonist depot leuprolide (3/21), progestin-only pills (4/21), and 1 patient each using the medroxyprogesterone acetate injection and the combined estrogen-progestin patch.

Conclusion: Most patients who began menstrual suppression in this cohort took COC pills. Many patients reported effective suppression with COC pills containing 30 mcg of EE. Almost half of the patients reported poor pain control with the initial menstrual suppression method.

Background: Complete androgen insensitivity syndrome (CAIS) is a disorder of sex development characterized by a female phenotype in 46,XY individuals. Given the increased risk of testicular tumors, prophylactic bilateral orchiectomy is offered to patients with CAIS. While CAIS has traditionally been associated with infertility, recent evidence demonstrating the presence of germ cells in the testes of affected individuals raises the possibility of fertility preservation at the time of gonadectomy.

Case: We present a case of gonadal tissue cryopreservation (GTC) following orchiectomy in a 16-year-old patient with CAIS. Half of each testis was sent for GTC, and the remaining tissue for histopathological examination, which revealed no definitive germ cells.

Summary and conclusion: This case report discusses tumor risk, fertility potential and ethical considerations surrounding GTC in CAIS.