Pediatric Annals最新文献

Detransition refers to stopping, shifting, or reversing an initial gender transition. It often involves changes in self-identity and decisional regret with prior transition-related medical or surgical treatments. There are currently no formal care guidelines available to assist clinicians in discussing detransition with patients and their families or for supporting young people navigating the process. The aim of this article is to examine contemporary detransition research published between 2020 and 2025 to enhance evidence-informed care for adolescents and young adults who are transgender and gender diverse, as well as individuals who opt to detransition. Detransition often occurs in the context of health concerns or complications with treatments, transgender discrimination, complex mental health challenges and neurodivergence, and identity shifts. Recommendations for care and support for patients contemplating or engaging in a detransition process are discussed.

Youth who are transgender and gender diverse (TGD), particularly those who are persons of color, experience significant health disparities driven by intersecting systems of oppression. These include elevated rates of depression, suicidal ideation, substance use, violence, and limited access to gender-affirming care. Minority stress theory and intersectionality help explain how structural stigma, racism, and transphobia interact to intensify poor health outcomes. Youth who are persons of color and TGD often face racism within LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) spaces, transphobia within their racial or ethnic communities, and discrimination in health care settings. Despite these challenges, many individuals demonstrate resilience through family support, affirming school environments, and strong community connections. Providers have a critical role in reducing disparities by addressing personal biases, creating inclusive care environments, advocating for equitable access, and supporting research that centers the TGD experiences of persons of color. Centering intersectionality in clinical care and policy is essential to improving health outcomes and affirming the dignity of all youth who are TGD.

Vulvovaginitis is a common complaint with a variety of etiologies in the pediatric and adolescent population. Health care providers who see these patients should be familiar with the common etiologies, evaluations, and treatments for these conditions. In this review, we will discuss the common presenting symptoms for vulvovaginitis and how the anatomy and physiology of pediatric and adolescent patients contribute to its development. We will discuss how the evaluation process differs depending on age and risk factors for infectious and noninfectious causes of vulvovaginitis.

Puberty marks the development of secondary sexual characteristics and reproductive capacity, with normal onset ranging from age 8 to 13 years in female children. Precocious puberty (ie, the onset of secondary sexual characteristics before age 8 years in female children) can result from central or peripheral mechanisms, requiring tailored diagnostic and therapeutic approaches. Delayed puberty (ie, the absence of sexual development beyond expected age ranges) often stems from primary or secondary hypogonadism. Amenorrhea (ie, the absence of menses) can be primary or secondary, with causes ranging from genetic abnormalities to hormonal imbalances. This review explores the epidemiology, causes, clinical assessments, and management strategies for precocious and delayed puberty, as well as primary and secondary amenorrhea, emphasizing the importance of individualized care to optimize growth, development, and psychosocial outcomes.

Routine growth monitoring includes plotting children on World Health Organization or Centers for Disease Control and Prevention charts that have primarily been developed on typical, healthy populations. However, it is advisable to plot children with known genetic conditions on specialized growth curves (SGCs) when they are available. In this review, we highlight the most common genetic conditions for which SGCs are available, clinical reasons to use SGCs based on specific rare diseases, and how these SGCs can be found. In addition, we raise awareness of the limitations of SGCs and future directions to improve rare disease growth curve accessibility and ease of use into general pediatric practice.

Abnormal uterine bleeding (AUB), a common gynecologic concern in adolescents, often leads to significant physical and emotional distress. This article provides a comprehensive overview of AUB in adolescence, including classification, common causes, diagnosis, and management. The physiology of the hypothalamic-pituitary-ovarian axis is reviewed, highlighting its role in menstrual regulation and the immaturity-related anovulation that commonly contributes to AUB in the first 2 to 3 years after menarche. The International Federation of Gynecology and Obstetrics PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified) classification system is discussed, with emphasis on the nonstructural causes most relevant to adolescents, such as coagulopathies, ovulatory dysfunction, and iatrogenic factors. Anovulatory conditions, including hypogonadotropic hypogonadism and polycystic ovary syndrome, are reviewed in detail, as is heavy menstrual bleeding. Lastly, we review the psychosocial implications of AUB and opportunities for education and advocacy.

Based on extensive evidence, gender-affirming care (GAC) is endorsed by numerous medical societies as the gold standard for supporting youth who are transgender and gender diverse (TGD). Unfortunately, there remain barriers to accessing GAC and an ongoing risk of gender identity-based mistreatment for youth who are TGD accessing all forms of health care. Gynecologic care is commonly accessed by youth who are TGD as part of medical gender affirmation, with needs ranging from hormone management, menstrual suppression, contraception counseling, and surgical consultation. It is imperative that clinicians understand the unique clinical concerns with which youth who are TGD may present. Additionally, as access to medical and surgical care faces legal threats, it is important that gynecologists, pediatricians, and others who may provide care to youth who are TGD understand the core competencies of GAC and how to create welcoming and inclusive clinical spaces to uphold patient dignity and optimize psychosocial outcomes.