Journal of pediatric and adolescent gynecology最新文献

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.

Study objective: To evaluate the efficacy and safety of a prolonged 6-month induction regimen using ultrapotent topical corticosteroids and daily emollient in the treatment of pediatric vulvar lichen sclerosus (pVLS).

Methods: This retrospective observational study included 94 girls with clinical diagnosis of pVLS between 2021 and 2025. All patients underwent a standardized treatment protocol with clobetasol propionate 0.05% ointment applied daily for 30 days, every other day for 30 days, and twice weekly for 120 days, alongside daily application of a vitamin E-based emollient. Clinical evaluations and symptom assessments were conducted at baseline (T0), 3 months (T1), and 6 months (T2).

Results: Symptom remission was achieved in 83% of patients, with marked reductions in itching from 80% (T0) to 13% (T2), *P* < .001, and burning from 36% (T0) to 8% (T2), *P* < .001. Dysuria, dyschezia, and nocturnal awakenings resolved completely by the T1 follow-up. Significant improvements in clinical signs were observed in vulvar area. Improvements in perianal signs were more modest but statistically significant for fissures/erosions (P < .001) and hyperkeratosis/lichenification (P = .018). No significant changes were observed in anatomical alterations. Mild, self-limiting side effects were reported in 8% of patients at T1 and in only 1% at T2. No serious adverse events occurred.

Conclusion: A prolonged induction regimen with ultrapotent topical corticosteroids demonstrates high efficacy with a substantial symptom and sign resolution and favorable safety profile.

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.

Objective: Members of NASPAG provide reproductive health care to adolescent patients. This document aims to provide a comprehensive overview of the recommended counseling for any clinician caring for an adolescent patient with a positive pregnancy test, while addressing legal, ethical, and clinical considerations. The document will discuss strategies for guiding patients through the pregnancy testing process, as well as various issues to consider when ordering tests, disclosing results, and managing the situation if the test is positive. Due to variability between institutions and clinical scenarios, this review will not explicitly advise for or against universal pregnancy testing in medical settings.

Study objective: To compare intraoperative cyst rupture, peritonitis, and cyst recurrence after ovarian dermoid surgery via laparoscopy versus laparotomy in pediatric and adolescent patients.

Methods: A comprehensive systematic review and meta-analysis was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews. Five bibliographic databases (MEDLINE, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science) and 3 clinical trial registries were searched from inception to August 29, 2024. Eligible studies included quasi-randomized trials and prospective/retrospective cohort studies evaluating intraoperative cyst rupture, peritonitis, or cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery. Two authors independently performed title-abstract and full text screening and independently extracted data. Meta-analyses of cyst rupture and cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery were performed and presented in forest plots. Risk ratios for cyst rupture were pooled with a random-effects model, and for cyst recurrence were pooled with a fixed-effect model. Quality assessment was assessed using the Newcastle-Ottawa Scale.

Results: A total of 1021 studies were identified, with 6 studies included (2000-2022; Canada, United States, Poland). We included 481 (53.9%) patients who underwent laparoscopy, 353 (39.5%) who underwent laparotomy, and 59 (6.6%) who underwent laparoscopy converted to laparotomy. For meta-analysis, 5 studies were included for cyst rupture, and 4 studies were included for cyst recurrence. Random-effects meta-analysis demonstrated a significantly higher risk of cyst rupture with laparoscopy (RR = 2.47; 95% CI, 1.40-4.37). Fixed-effect meta-analysis found no significant difference in cyst recurrence between laparoscopy and laparotomy (RR = 0.92; 95% CI, 0.41-2.08). No cases of chemical peritonitis were observed.

Conclusion: For the surgical management of ovarian dermoid cysts in children, laparoscopy may carry a higher risk of intraoperative cyst rupture compared to laparotomy, however our work highlights that subsequent post-operative peritonitis was not clinically observed and recurrence rates remained similar.

Study objective: Concordance between contraceptive preferences and use is an indicator of person-centered contraceptive care. Adolescents and young adults (AYA) face barriers that may prevent them from fulfilling their contraceptive preferences. We sought to assess the prevalence and predictors of preference-concordant contraceptive use among AYA and examine its associated with person-centered contraceptive counseling (PCCC).

Design: We conducted a secondary analysis of a cross-sectional survey.

Setting: The survey was nationally representative of the United States and administered in 2022.

Participants: The sample included 516 participants, including adolescents (aged 15-17) and young adults (aged 18-24), who were assigned female at birth.

Main outcome measures: The primary exposure was receipt of PCCC at most recent contraceptive care visit. The main outcome was preference-concordant contraceptive use, measured among contraceptive users and nonusers.

Results: Fewer than 60% of AYA had preference-concordant contraceptive use or nonuse, and 19% were uncertain about their preferences. Adolescents were less likely than young adults to use a preferred method and more likely to be content nonusers or uncertain nonusers. Only 28% of participants received PCCC at their most recent visit. PCCC was associated with increased preference-concordant vs preference nonconcordant use (adjusted risk ratio: 1.45; 95% CI: 0.75, 2.82), though this was not statistically significant.

Conclusion: Many AYA are not fulfilling their contraceptive preferences, and uncertainty about method use is common, particularly among adolescents. Person-centered contraceptive counseling may support preference-concordant use, but broader structural, interpersonal, and informational barriers must also be addressed to promote equitable, preference-aligned contraceptive care and access.