Journal of pediatric and adolescent gynecology最新文献

Objective: To achieve consensus on a standardized definition and diagnostic criteria of primary dysmenorrhea.

Methods: A modified Delphi procedure was conducted from January to October 2024. Consensus on a question was predefined as a rate of agreement of 70% or higher. Participants were experts defined by their clinical experience in managing patients with primary dysmenorrhea, publishing on the topic, or membership in international pediatric and/or adolescent gynecology associations.

Results: Twenty of 41 invited experts participated. Three rounds were required to achieve consensus, with response rates for each round of 85%, 82%, and 86%, respectively. Experts defined primary dysmenorrhea as dysmenorrhea in absence of any pelvic pathology. Primary dysmenorrhea may not start at menarche. Onset of symptoms may be before or during menstrual blood loss. The diagnosis of primary dysmenorrhea requires the absence or low clinical suspicion of the following conditions: sexually transmitted infection, pelvic inflammatory disease, congenital uterine anomaly, endometriosis, adenomyosis, and fibroids. A pelvic examination is not required for diagnosis. Consensus was reached on using ultrasound examination (transabdominal ultrasound in non-sexually active patients or transvaginal ultrasound in sexually active patients) as the preferred initial diagnostic instrument, with magnetic resonance imaging if results are inconclusive. No minimum duration of dysmenorrhea is required. Severity assessment using a verbal multidimensional scoring system (VMSS) of grade 2 or higher is part of the diagnostic criteria for primary dysmenorrhea. Systemic symptoms are not considered to be necessary for diagnosis.

Conclusion: Consensus was achieved regarding the definition and diagnostic criteria for primary dysmenorrhea.

Study objective: This study evaluated changes in symptoms of depression, anxiety, and stress among adolescents using the etonogestrel subdermal implant. It analyzed psychometric score variations and the proportion of participants with values above normative thresholds to assess the method's safety with respect to mood symptoms.

Study design: Prospective cohort study involving female adolescents aged 12-19 years who chose the etonogestrel subdermal implant for contraception. Participants completed the Depression, Anxiety, and Stress Scale for Adolescents (EDAE-A) at baseline, and at 3 and 6 months postinsertion. We performed statistical analyses using the Friedman test, chi-square tests, and relative risk estimates. Subgroup analyses were conducted for participants with elevated baseline scores. Significance was set at P ≤ .05.

Results: Of the 97 participants enrolled, 66 completed all follow-up stages. The median age was 17 years. Baseline EDAE-A scores indicated mild symptoms of depression and anxiety and normal stress levels. Approximately 50% of participants scored above normative thresholds across all time points, but scores remained stable over 6 months, with no statistically significant changes in any domain. Among adolescents with elevated baseline symptoms, we observed a trend toward reduced depressive symptoms (P = .06). Prior hormonal contraceptive use did not significantly influence scores.

Conclusion: Use of the etonogestrel implant was not associated with significant changes in depression, anxiety, or stress symptoms among adolescents over 6 months. The findings support the psychological safety of the method and suggest that mood symptoms are more common in this population and are more likely related to developmental factors than to contraceptive use.

Study objective: To determine the prevalence of anxiety and depression in women with Mayer-Rokitansky-Kϋster-Hauser (MRKH) syndrome in Malaysia.

Methodology: This was a cross-sectional study conducted on women with MRKH living in Malaysia. The study collected the sociodemographic and medical profiles of participants. Two translated and validated questionnaires were used: Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), to determine the prevalence of anxiety and depression, respectively.

Results: A total of 77 women participated in this study. The participants had a mean age of 29.1 ± 8.3 years, and the mean age at MRKH syndrome diagnosis was 20.5 ± 5.0 years. Based on GAD-7 outcomes, up to 29 women (37.7%) experienced anxiety. Following assessment of depression prevalence using the PHQ-9, 25 participants (32.5%) were classified into the depressed group. There was no statistically significant difference in participants' attributes on the basis of the examination of sociodemographic and clinical characteristics between the 2 groups. Further analysis identified that participants with MRKH in the B40 income bracket (

Conclusion: More than a third of women with MRKH syndrome in Malaysia experienced depression and anxiety, which needs to be addressed.

Study objective: Between 10 and 25% of adolescents in the United States experience menstrual inequity, or insufficient access to menstrual products or education. The emergency department (ED), which often serves as a safety net for adolescent health access, has been identified as a strategic venue for public health interventions. The Child Opportunity Index (COI) is a validated, multidimensional neighborhood measure of structural opportunity that can impact child health and development. Therefore, the purpose of this project was to measure the prevalence of menstrual inequity in a pediatric ED and examine associations with the COI.

Methods: This cross-sectional study analyzed electronic survey data from adolescents 13-21 years old who visited a pediatric ED from January 2024 to February 2025. Participants were included if they had started menstruation and responded to validated questions that assessed menstrual inequity. Home addresses were geocoded into census tracts and linked to COI version 3.0. The prevalence of menstrual inequity was calculated, and logistic regression was used to measure associations between menstrual inequity and COI.

Results: One-third reported experiencing menstrual inequity during the past 12 months. Patients living in areas with low neighborhood opportunity had higher odds of experiencing menstrual inequity than those in high-opportunity areas.

Conclusion: Menstrual inequity is common among adolescent pediatric ED patients, particularly among those from low-resourced neighborhoods. Future work should explore increasing advocacy efforts at the institutional level through menstrual product drives and distribution, as well as larger, national-level efforts to influence policy changes.

Study objective: To assess knowledge and perceptions of abortion and emergency contraception (EC) among adolescents and young adults (AYA) in a state with protected abortion access following the Dobbs v. Jackson Women's Health Organization decision.

Methods: We conducted a cross-sectional survey of patients aged 14-24 presenting to a Title X-supported sexual health clinic in Colorado between April 2023 and January 2024. A 50-item anonymous survey measured knowledge of abortion and EC laws, beliefs about abortion myths, and sociodemographic characteristics. Knowledge scores were categorized as high (≥50% correct) or low (<50% correct).

Results: Among 244 respondents, most were female (94.2%) and aged 18 or older (85%). While 83.3% were familiar with the Dobbs decision, 64.6% were unaware of any changes to abortion laws in Colorado. Less than half (45%) demonstrated high knowledge of abortion laws. Gaps were particularly notable regarding parental consent and gestational limits. In contrast, 76% demonstrated high EC knowledge, though 58.8% either believed EC could end an early pregnancy or were unsure. High abortion knowledge was associated with higher education, prior pregnancy, and awareness of Dobbs. Belief in abortion myths was more common among those with lower knowledge.

Conclusion: Despite living in a state with legal abortion protections, many AYA remain unclear about abortion laws and hold common misconceptions, which may delay care. EC knowledge was higher, but misunderstandings persist. Targeted efforts are needed to improve reproductive health literacy among youth and ensure access to accurate, state-specific information.

Study objective: Published information on the sexual health and well-being of individuals with complete androgen insensitivity syndrome (CAIS) remains limited. In this study, we aimed to evaluate the vaginal lengths, sexual well-being and body image findings of a relatively large, young cohort of individuals with CAIS, with the goal of guiding clinical practice toward more accurate and individualized patient-centered counseling.

Methods: In this interim analysis of a prospective IRB-approved AIS Natural History Study funded by the National Institutes of Health (NIH), we collected demographic information and vaginal length measurements from 23 individuals with CAIS between 2021 and 2025. Participants over 18 were invited to complete the PROMIS Sexual Function and Satisfaction (PROMIS SexFS) questionnaire and the Body Image Scale (BIS) questionnaire.

Results: The cohort (n = 23) ranged in age from 14 to 65 (median = 19). Fourteen participants (61%) identified as heterosexual, 7 (30%) had undergone complete gonadectomy, and 1 had undergone vaginoplasty. Three participants reported practicing serial vaginal dilations. Vaginal length measurements (n = 14) ranged from 25 to 90mm (median = 60mm). Of those who completed the PROMIS SexFS (n = 11), mean t-scores were within one standard deviation of normalized U.S. female population ranges. Of those who completed the BIS (n = 15), the average mean-item score was 0.9 on a Likert scale from 0 "not at all" to 3 "very much".

Conclusion: Aside from one outlier, vaginal lengths in our cohort did not differ significantly from those reported in the general population, and most participants reported a positive body image and the ability to engage in fulfilling sexual activity.

Study objective: To compare norethindrone acetate (NA) and combined oral contraceptives (COC) in managing adolescents with acute abnormal uterine bleeding (AUB).

Methods: We recruited adolescents and young adults (AYA) aged 10-21 years, with a diagnosis of AUB or other specified irregular menses from January 2022 to March 2023, who were first treated at our emergency department (ED) and then enrolled at our adolescent medicine clinic. We distributed questionnaires, focusing on days until bleeding cessation with treatment, hospitalizations related to bleeding, patient satisfaction, and side effects. Data were grouped as NA or COC and compared. A P < .05 was considered statistically significant.

Results: Of fifteen patients, seven were treated with NA and eight patients were treated with COC. The average length of stay (LOS) in the hospital was 2.3 days (SD = 0.6) in the NA group and 2.4 days (SD = 0.9) in COC group. The time to bleeding cessation was 2.6 days in both groups. Most patients who took NA (86%) experienced no side effects compared to the COC group (25%) (P = .041).

Conclusions: In our small sample, NA appeared to be as efficacious as COC. We found no difference in the time to bleeding cessation and length of hospital stay. Those treated with NA had fewer side effects than those treated with COC. We hope this pilot study will promote further inquiries as to whether NA may be the better choice for acute AUB in young women.

Study objective: The goal of this study was to describe the age ranges in which common genital, gonadal, and reproductive variations in sex characteristic (VSC)-related procedures are done and evaluate the variability in 30-day postoperative complications based on age range to address ongoing uncertainties about optimal surgery age for VSCs.

Methods: This was a retrospective cohort study utilizing data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2012 to 2021. Included cases had a postoperative diagnosis associated with a VSC condition. Descriptive analyses were used. Fisher's exact test was used to test differences in complication risk.

Results: Our final analysis included 48,227 cases. Most cases were performed on individuals under the age of 3. When comparing the risk of any short-term, surgical complication by age category for each procedure, only three had significant age differences: ureter/bladder procedures had a higher risk of complications when performed in individuals under 11, and urethral/hypospadias surgeries and scrotoplasties had higher complication rates when performed in those 11 or older. In NSQIP-P, over 5 times as many vaginoplasties and clitoroplasties were performed under the age of 3 as over the age of 11. There were no differences across age groups for any assessed type of complication in either vaginoplasties or clitoroplasties.

Conclusion: There were few variations seen in NSQIP-P-assessed complications by age at the time of surgeries performed for VSCs, including in vaginoplasties and clitoroplasties. Many later surgeries do not appear to result in significantly worse intraoperative and 30-day postoperative outcomes.

Aim: The experience of dysmenorrhea can vary significantly between immigrant and non-immigrant adolescents. This study aims to compare the dysmenorrhea self-care practices among immigrant and non-immigrant adolescents.

Method: This study had a comparative cross-sectional design that was done in 2025. The population consisted of 209 immigrant and non-immigrant adolescent girls in 7th and 8th grade in Konya, Türkiye. Data were collected using the Adolescent Dysmenorrhea Self-Care Scale and a demographic form. Data was analyzed using independent samples t-tests, one-way ANOVA, and Pearson correlation coefficients. A p-value of less than 0.05 was considered as a statistically significant level.

Results: The mean age of participants was 13.71 years, and the average age at menarche was 11.84 years. Reported pain severity averaged 4.76 (maximum possible score: 10). The total dysmenorrhea self-care score averaged 87.85 (maximum possible score: 200), with significantly lower scores observed among immigrant adolescents (p < .001). Immigrants also reported a later age at menarche (p = .002) and lower scores in several dysmenorrhea self-care subdimensions. A moderate positive correlation was observed between pain severity and dysmenorrhea self-care (r = 0.394, p < .001), and a weak positive correlation was found between years lived in Türkiye and dysmenorrhea self-care (r= 0.181, p < .001).

Conclusion: Immigrant adolescents had lower dysmenorrhea self-care scores, later menarche, and relied more on traditional methods than Turkish peers, who practiced evidence-based care. Family and culture influenced self-care, while higher pain increased engagement. Culturally sensitive school and community education is vital to enhance menstrual health literacy and equitable self-care practices.