Article Outline
Our counterpart in England held the BritSPAG annual meeting at the Royal College of Obstetricians and Gynecologists in London, January 24-25, 2011. The leadership of the organization includes:
Mr Paul Wood - Chair
Consultant Obstetrician & Gynaecologist,
Kettering General Hospital NHS, Northants
Dr Assunta Albanese - Treasurer
Consultant Paediatric Endocrinologist,
St George's Hospital, London
Dr Naomi Crouch - Secretary
Speciality Registrar
Obstetrics & Gynaecology
North West London NHS Hospitals Trust
The program was very well organized. The plethora of lectures addressed everyone in the audience, no matter where they are on the “PAG Spectrum.” Now for the PEARLS, just the PEARLS:
○Do you take a moment to ask your pediatric patient: “What do you call the vaginal area”?
○The best way to visualize the hymen is in the knee-chest position.
○The hymen takes on a “different appearance” depending on the patient’s position.
○Delayed puberty is manifested as amenorrhea at 14 years of age with no secondary sex characteristics or at 16 with secondary sex characteristics.
○15% of adolescents are ovulatory 1 year after menarche,75% at 5 years, and 95% at 12 years.
○What is “80 ml”? It equates with 3–6 pads/tampons per day
○Does your investigation of amenorrhea include: Dunnigan familial lipodystrophy, which presents with a “Cushing’s-like appearance,” but with thin lower extremities, all of which reflect inappropriate adipose distribution? Yes, it should be in your differential diagnosis.
○Amenorrhea should include galactosemia, an autosomal recessive disorder associated with defects in lactose transferase, which is “toxic to the ovaries.”
○Although it affects the GI tract, a lactose-free diet has little influence on the ovaries.
○Can you distinguish between “prolapsed urethra-cherry appearance” and urethrocele?
○What tumor markers do you look at with an ovarian mass in the pediatric patient? Is your work-up:
■Dysgerminoma: Alpha fetoprotein (AFP) negative, HCG negative, LDH elevated
■Embryonal carcinoma: AFP elevated, HCG negative
■Choriocarcinoma: AFP negative, HCG elevated
■Yolk sac-endodermal sinus tumor: AFP elevated, HCG negative
■Immature teratoma: AFP negative, HCG negative
○Don’t aspirate an adnexal mass with high probability of malignancy, because you may upstage it.
○Do you know the incidence of Turner syndrome? It’s 1:2000 female births, 50% of which are “mosaics.”
○AIS-First Hand. The program included a patient with androgen insensitivity syndrome telling what her life has been like. Her first-hand account of “learning the diagnosis” and what it all meant was eloquently conveyed. She was kind enough to share several book resources, including Teen Transition and Teenage Health Freak: The Secret Diary of Adrian Mole.
○The importance of AIS support groups cannot be stressed enough.
○Teen sexuality varies vastly from country to country. In the Fulani tribe, the male is bethrothed at circumcision, aged 7 on average, and his mate is an infant female. All appears to be in abeyance until sexual maturity is reached.
○What’s the legal age for marriage? Well, it varies country to country and may be as young as 13.
■Is marriage more common once the couple have 1 or 2 children as is the custom in some Scandinavian countries?
■Advise your teens that “I love you!” does NOT mean “OK for SEX!”
○What are the long-term outcomes with vaginal agenesis?
■More information continues to accrue regarding procedures such as the laparoscopic Vecchetti and outcomes data.
■Overall 98% “anatomic success” has been reported.
■Vaginal dilators remain “first line” therapy.
○How do you talk to “Generation Y 2010”? Do you advise parents to talk to their children about “Internet safety”?
○Cyberbullying—It’s a problem. It’s a BIG Problem! Be sure your patients and parents are aware.
○Are you familiar with female genital mutilation and its Types I–IV?
Well, the story continues “Across the Pond”! Kudos to the organizers for an excellent program.
