Journal of Pediatric and Adolescent Gynecology

Urinary Tract, the Challenges of Diagnosis and Management of Interstitial Cystitis

Joseph S. Sanfilippo — 2012-06-01

In this issue of the Journal we have focused on a concerning and challenging clinical problem: interstitial cystitis (IC). This condition is frequently associated with distraught parents who have sought without success either the correct diagnosis, as this is not usually at the top of the Differential Diagnosis List, or specific treatment that will “make a difference.” One usually begins with the National Institute of Diabetes and Digestive and Kidney Diseases diagnostic criteria for IC. The problem is these criteria exclude anyone who is less than 18 years of age! Combine this problem with the sparsity of well designed studies in the literature and thus the stage is set! In this issue of the Journal of Pediatric and Adolescent Gynecology, we have called upon Drs. Yoost, Hertweck, and Loveless to enlighten us with the current diagnostic and management modus operandi. The literature attests that, on average, symptoms have been present for two years with a mean diagnosis time of five years! We as clinicians must be on the lookout for:

Diagnosis and Treatment of Interstitial Cystitis in Adolescents

J.L. Yoost, S.P. Hertweck, M. Loveless — 2011-05-25

Abstract: Interstitial cystitis (IC), or painful bladder syndrome, is characterized by irritative voiding symptoms and can be a challenging problem that affects children and adolescents. Diagnosis and management in children and adolescents is challenging because of strict diagnostic criteria and the paucity of investigations focusing on this age group, which often can lead to delayed or missed diagnosis. Clinical features suggestive of IC include bladder pain, urgency, frequency, nocturia, and pressure. Symptoms may wax and wane and often are exacerbated by menstruation, intercourse, dietary triggers, and stress. Diagnosis can be made by history, physical exam findings such as suprapubic tenderness, voiding diaries, and exclusion of other etiologies. Some diagnostic tests such as the potassium sensitivity test and cystoscopy are invasive and often impractical in younger patients. Treatment of IC consists of a multimodal approach that should be tailored to the individual needs of the patient. Therapies for younger patients include oral medication, intravesical therapy, cystoscopy with hydrodistention, and conservative measures such as dietary modification. This review of the literature focuses on diagnosing IC in younger patients and on what treatment modalities are appropriate and effective for this age group.

Exercise and Sedentary Habits Among Adolescents with PCOS

2012-01-20

Abstract: Study Objective: The purpose of this study was the recording of physical activity and sedentary habits of adolescents with polycystic ovarian syndrome (PCOS).Methods: We performed a structured interview to assess the level of physical activity and sedentary habits of girls with PCOS. We used a group of healthy adolescents as controls. All girls had their age, height, weight, hip and waist circumference measured and their BMI calculated.Results: 81 girls (35 with PCOS and 46 controls) participated in the study. Girls with PCOS engaged in physical activities less than controls. Even when they did, the frequency and intensity of exercise was less. Also, girls with PCOS were less likely to be aware of the positive effects of exercise on their health. Girls in both groups were sedentary in excess of the 4 hours per day limit, which has been linked with obesity.Conclusion: Healthy teenagers were involved in a sporting activity more often and more frequently than the PCOS group. Athletic and sedentary habits of adolescents with PCOS may interact with other factors leading to obesity.

Effect of Antiandrogen Treatment on Bone Density and Bone Geometry in Adolescents with Polycystic Ovary Syndrome

2012-01-20

Abstract: Study Objectives: To determine the impact of antiandrogen treatment on bone density and geometry.Design: Prospective cohort investigation.Setting: Academic research institute.Participants: 38 (age 14.96 ± 1.42 yr) subjects with PCOS.Interventions: Treated with metformin (n = 17) or metformin and antiandrogen (n = 21).Main Outcome Measure: Bone density and geometry parameters at baseline and after a mean duration of 1.92 ± 0.88 years using peripheral quantitative computed tomography of the forearm.Results: At baseline, z-scores for trabecular (0.53 ± 1.02) and cortical BMD (0.79 ± 1.55) as well as total (0.62 ± 1.07) and medullary cross sectional area (CSA) (0.79 ± 1.29) were elevated. Cortical CSA (−0.01 ± 1.10) and bone strength strain index (SSI) z-scores (−0.01 ± 1.10) were normal. Muscle CSA z-score (0.12 ± 1.70) was normal, but grip strength (−1.60 ± 1.15) was significantly reduced. There were no significant changes within and between the two treatment options in respect to bone density and bone geometry parameters. With antiandrogen treatment, free androgen index (FAI) was significantly lower and grip strength further decreased (P < .001).Conclusions: No significant changes in bone mineral density and geometry parameters took place in PCOS women irrespective of treatment followed over a time of almost two years. General muscle weakness expressed as low grip strength may influence further bone development in PCOS.

The Utility of Ultrasound and Magnetic Resonance Imaging versus Surgery for the Characterization of Müllerian Anomalies in the Pediatric and Adolescent Population

X.M. Santos, R. Krishnamurthy, J.L. Bercaw-Pratt, J.E. Dietrich — 2012-02-23

Abstract: Study Objective: To evaluate the utility of transabdominal ultrasound and magnetic resonance imaging in the evaluation of American Society for Reproductive Medicine (ASRM)-classified müllerian anomalies compared to surgical findings in the pediatric and adolescent population.Design: Retrospective chart review.Setting: Tertiary academic center.Participants: Thirty-eight patients with müllerian anomalies seen in our pediatric and adolescent gynecology clinic were identified both on the basis of ICD-9 codes and having magnetic resonance imaging at Texas Children's Hospital between 2004 and 2009.Interventions: None.Main Outcomes Measure: Correlation among transabdominal ultrasound and magnetic resonance imaging findings with surgical findings.Results: Mean age was 12.2 (± 4.1) years. Twenty-eight patients underwent magnetic resonance imaging and required surgical intervention, and 88.5% demonstrated correlative consistency with surgical findings. Twenty-two patients underwent ultrasound, magnetic resonance imaging, and surgery, which revealed consistency among ultrasound and surgical findings (59.1%) and consistency among magnetic resonance imaging and surgical findings (90.9%). In ASRM diagnoses evaluated by magnetic resonance imaging, surgical findings correlated in 92% (Pearson 0.89). Overall, 55.2% of patients had a renal malformation.Conclusions: Magnetic resonance imaging is the gold standard imaging modality for müllerian anomalies and is an effective technique for noninvasive evaluation and accurate classification of the type of anomaly in the pediatric and adolescent population. Magnetic resonance imaging should be considered as an adjunct to transabdominal ultrasound to evaluate müllerian anomalies.

Modifying Effect of Prenatal Care on the Association Between Young Maternal Age and Adverse Birth Outcomes

C.L. Vieira, C.M. Coeli, R.S. Pinheiro, E.R. Brandão, K.R. Camargo, F.P. Aguiar — 2012-02-02

Abstract: Objectives: The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes.Methods: A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction.Results: Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes.Conclusion: Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines.

The Effect of Pelvic Size on Cesarean Delivery Rates: Using Adolescent Maternal Age as an Unbiased Proxy for Pelvic Size

Ola T. Malabarey, Jacques Balayla, Haim A. Abenhaim — 2012-06-01

Abstract: Objectives: Dystocia, the presence of abnormal labor, is the most common indication for cesarean delivery. Risk factors for dystocia include abnormalities of expulsatile forces during labor, fetal factors, and maternal pelvic size abnormalities. The objective of our study was to evaluate the effect of pelvic size on the risk of cesarean delivery rates using adolescent maternal age as an unbiased determinant of pelvic size.Methods: We conducted a population-based cohort study using the Center for Disease Control and Prevention’s Linked Birth-Infant Death and Fetal Death data on all births in the US between 1995 and 2004 for women aged 12 to 20. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations or chromosomal abnormalities. Maternal age and mode of delivery information was obtained from the birth records.Results: There were 6,188,704 births in our cohort of which 1,863 were to women aged 12; 12,903 to women aged 13; 68,890 to women aged 14, and the remainder to women aged 15 and above. Cesarean delivery rates were highest amongst women aged 12 at 19.59 % and declined to 13.92% amongst 15 year-olds, and 14.84 % amongst 20 year olds. This effect was more pronounced when the analysis was restricted to macrosomic fetuses (P<0.005).Conclusion: Cesarean delivery rates increase the younger the maternal age is suggesting that pelvic factors can play an important role in dystocia.

Retrospective Review of Intrauterine Device in Adolescent and Young Women

2012-06-01

Abstract: Study Objective: To examine our experience with intrauterine device (IUD) use in adolescents and young women.Design: Retrospective descriptive study evaluating outcomes after IUD insertion for patients 21 years or less over an 8-year period.Setting: Three sites including a Pediatric and Adolescent gynecology private practice, a Title X clinic, and community based, grant funded clinic serving a high risk teen population.Participants: Females from menarche to age 21.Main Outcomes Measured: The probability of IUD retention, differences in IUD retention probabilities between two age groups, and risk factors for IUD removal, expulsion, and infection were evaluated.Results: 233 records showed 50% of the <18-year-old age group and 71.5% of the 18–21-year-old group had their IUD in place at 5 years. Age was found to be a significant factor for removal (P < 0.001), with under 18-year-olds at greater risk of removal/expulsion (hazard ratio (HR) = 2.85). Parity (RR = 5.6 for nulliparous vs multiparous patients, P < 0.001) and prior STI (RR = 5.5, P < 0.001) were significant risk factors for infection. Nulliparous patients were at higher risk of expulsion (P = 0.045), though age was not a statistically significant risk factor.Conclusions: The rate of continuation was lower in adolescents under 18 compared to18–21-year-olds, but was still higher than for other hormonal contraceptives. Despite this groups' high risk for STI the IUD did not increase the risk of infection and may offer some degree of protection. IUDs appear to be a safe option in young adolescents (<18 years old) and nulliparous women.

Depression During Pregnancy Among Young Couples: The Effect of Personal and Partner Experiences of Stressors and the Buffering Effects of Social Relationships

2012-06-01

Abstract: Study Objective: To assess the relationship between personal and romantic partner's experiences of stressful life events and depression during pregnancy, and the social moderators of this relationship, among 296 young couples with low incomes from urban areas.Participants and Setting: We recruited couples who were expecting a baby from four ob/gyn and ultrasound clinics in southern Connecticut; women were ages 14–21 and male partners were 14+.Design and Outcome Measures: We analyzed self-reports of stressful events in the previous six months, depression in the past week and current interpersonal social supports. To determine the influence of personal and partner experiences of stressful events on depression, we used multilevel dyadic models and incorporated interaction terms. We also used this model to determine whether social support, family functioning and relationship satisfaction moderated the association between stressful events and depression.Results: Experiences of stressful life events were common; 91.2% of couples had at least one member report an event. Money, employment problems, and moving were the most common events. Personal experiences of stressful life events had the strongest association with depression among men and women; although partner experiences of stressful life events were also significantly associated with depression among women. Social support, family functioning, and romantic relationship satisfaction significantly buffered the association between personal and partner stressful events and depression.Conclusion: Interventions that improve relationships, support systems, and family functioning may reduce the negative impact of stressors, experienced both personally and by a romantic partner, on the emotional well-being of young expectant parents.

Association Between Polycystic Ovarian Syndrome, Overweight, and Metabolic Syndrome in Adolescents

2012-06-01

Abstract: Purpose: Polycystic syndrome (PCOS) is associated with multiple metabolic abnormalities. Studies in the adolescent population are still limited and the results have been much different. The aim of this study was to investigate the association between PCOS, overweight, and metabolic syndrome in adolescents.Methods: 30 PCOS adolescents were randomly selected from a PCOS population with NIH 1990 criteria and 71 adolescents from the normal adolescents. Anthropometric, hormonal and metabolic parameters were evaluated in four sub-groups including obese and non-obese PCOS and obese and non-obese normal adolescents.Results: The prevalence of overweight and metabolic syndrome in adolescents with PCOS was 52% and 33.3% respectively vs 22.4% (P = 0.005) and 11.26% in control (normal) adolescents (P = 0.0001). Among all subjects, including obese and non-obese adolescents with or without PCOS, the prevalence of insulin resistance, hypercholesterolemia, central obesity, and metabolic syndrome was higher in obese PCOS with 61.5%, 46.2%, 53.8%, and 69.2%, respectively.Conclusions: Obesity and IR are important risk factors for metabolic syndrome in PCOS. Considering the long-term health risks, it is necessary to identify metabolic disorders in adolescents with PCOS as early as possible.

Knowledge of Sexually Transmitted Infections Among Adolescents in the Houston Area Presenting for Reproductive Healthcare at Texas Children’s Hospital

2012-06-01

Abstract: Objective: Studies indicate a deficiency in knowledge of sexually transmitted infections (STIs) among adolescents, yet adolescents comprise 25% of the sexually active (SA) population and account for 48% of STIs acquired annually. This survey assesses knowledge of STIs among adolescent females. The goal of this study was to assess knowledge of STIs and how it relates to safe sex behaviors and educational access.Design: A confidential 10-question STI survey was administered to a convenience sample of female adolescents. Data analysis included descriptive statistics, chi-square analysis, and linear regression analysis.Setting: Texas Children’s Hospital Pediatric and Adolescent Gynecology Clinic.Interventions: None.Participants: Seventy-five female participants between the ages of 10–21 years.Main Outcome Measures: Age, sexual activity, educational access, preferred methods of risk reduction and questions answered correctly on the STI survey.Results: The mean age of participants was 14.9 ± 2.4 years; mean age of menarche was 10.9 ± 2.9 years. Based on survey responses, all adolescents demonstrated similar knowledge of specific STIs regardless of demographic factors. However, middle and late adolescent groups had increased awareness of STIs. SA participants (36%) were more likely to choose 2 or more methods of risk reduction compared to non-SA participants (P = 0.014). There was no correlation between educational access and preferred methods of risk reduction even though 92% of respondents reported receiving STI education from school, parents, or peers.Conclusions: Current efforts at STI education are not effective. Different approaches to STI education are necessary to increase knowledge and motivate adolescents to reduce high risk behaviors.

Gender Differences Among Low Income Women in Their Intent to Vaccinate Their Sons and Daughters Against Human Papillomavirus Infection

Abbey B. Berenson, Mahbubur Rahman — 2012-06-01

Abstract: Study Objective: The HPV vaccine was approved for use in males in 2009. The purpose of our study was to examine current intentions to vaccinate sons and daughters among low income women.Design: A survey was administered to 322 mothers with a son or daughter 9-26 years of age to examine gender differences in intent to vaccinate their children.Setting: Five public reproductive health clinics in southeast Texas, between August, 2010 and May, 2011.Participants: The study population consisted of 322 women with ≥1 child 9–26 years of age.Main Outcome Measures: Knowledge of HPV vaccine, intention to have son or daughter receive the HPV vaccine, and reasons for not vaccinating son or daughter.Results: Women with only a daughter were more willing than those with a son to vaccinate their child (71% vs 44%, P < 0.001). A similar scenario was observed for mothers of both daughters and sons (67% vs 39%, P < 0.001). Mothers of sons as compared to daughters were less likely to consider their child at risk of HPV (27% vs 12%, P = 0.028) while those with daughters were more concerned about side effects (54% vs 33%, P = 0.008).Conclusion: Educational interventions are needed to address the importance to mothers of vaccinating both their sons and daughters against HPV.

College Health

Susan D. Ernst, Robert D. Ernst — 2012-02-23

Misconceptions and stereotypes exist about the health behaviors of college students, both risky and protective. Having an understanding of student health behaviors helps clinicians to provide appropriate medical services and develop education, prevention, and wellness programs for the over 18 million college students in the United States. We intend to outline some of these behaviors and provide screening recommendations to assess the need for further education, intervention, or treatment for at-risk students.

An Adolescent Affliction: Nephrectomy and Persistent Severe Pains due to Misdiagnosed Non-communicating “Retroperitoneal” Uterine Horn

Ali M. El Saman, Ahmad M. Abo Elhassan, Reda M. Tawfik, Hazeem Saadeldeen — 2011-12-30

Abstract: Study Objective: To report the existence and management of retroperitoneal functioning uterine horn in a case with unicornuate uterus and to emphasis the significance of its misdiagnosis.Study Design: Case report.Setting: Assiut University, Woman’s Health Hospital.Participants: An adolescent female with progressive pains related to menstruation.Interventions: Extraperitoneal resection of the obstructed uterine horn.Main Outcome Measure: Operative time, complications and postoperative pains.Results: A patient aged 11 years presented with severe lower abdominal pains, history of correction of ectopia vesicae in infancy, and recent history of nephrectomy for ipsilateral obstructed pelvic kidney. MRI and transrectal ultrasonography showed a pelvic mass with thick wall. Laparoscopy showed unicornuate uterus with only the left horn was being visualized. Hysteroscopy showed normal vagina and cervical canal communicating with normal left hemi-cavity. Extraperitoneal approach via extending the incision of previous nephrectomy was done under laparoscopic monitoring. Excision of the horn was done totally extraperitoneal without puncturing its covering parietal peritoneum within 65 min. No operative or postoperative complications were reported. Menstrual pains showed dramatic improvement after the procedure.Conclusions: The present report is the first to describe the existence of a retroperitoneal functioning uterine horn with description of a successful extraperitoneal approach for its excision. Nephrectomy in the present case might be attributed to misdiagnosis of this problem.

Effect of Excess Estrogen on Breast and External Genitalia Development in Growth Hormone Deficiency

Susumu Hagisawa, Naoto Shimura, Osamu Arisaka — 2011-12-30

Abstract: Background: The progress of sexual maturation and development in cases with growth hormone (GH) and insulin-like growth factor-I (IGF-I) deficiency is not well documented in females.Case: We observed breast and genitalia development in a 2-year-old girl with GH deficiency following neonatal asphyxia; this girl later developed central precocious puberty. Markedly pigmented stimulated areolas and nipples without an apparent breast mound, and non-enlarged labia minora in the external genitalia were observed as features of sexual maturation in the patient. The hormonal condition was characterized by increased circulating estradiol levels and extremely low IGF-I levels.Summary and Conclusion: This case indicates that IGF-I is necessary for exerting the full effect of estrogen on the development of breasts and maturation of external genitalia.

Urinary Retention as the Presentation of Bartholin’s Duct Cyst in a Neonate

Muazez Cevik, Murat Savas, Murat Savas, Muharrem Guldur, Mehmet emin Boleken — 2012-06-01

Abstract: Patients with a vaginal mass (large Bartholin’s duct cyst) associated with a contralateral renal cyst and hydroureteronephrosis are unable to urinate. While occasionally seen in adults, Bartholin’s duct cyst is rare in neonates. The origins of Bartholin’s and Gartner’s cysts can be traced to the mesonephric duct. Given the rarity of these cysts, there is significant confusion regarding their diagnosis, management, and prognosis. Here, we present the first report of an interlabial mass as a Bartholin’s duct cyst in a neonate. The treatment of vaginal cysts is also discussed.

Successful Pregnancy and Delivery in a Patient with Bladder Exstrophy

2012-06-01

Abstract: Bladder exstrophy (BE) is a rare congenital anomaly. Owing to the advanced reconstructive surgical techniques and effective antibiotics, the incidence of urinary and systemic complications in patients with BE has decreased and the life expectancy has increased. However, this brings along social, sexual, and psychological problems; particularly, successful pregnancy and delivery is extremely rare in females with BE. We present a pregnancy of an 18-year-old female with BE, who has been followed at our university hospital since birth.

Adolescents, IUDs, PID, and Enterococcus: A Report of Two Cases

Terrill Bravender, Steven C. Matson — 2012-06-01

Abstract: Background: Intrauterine devices are being used more frequently in adolescents requiring long-term reversible contraception. This population of sexually active adolescents is also at risk for pelvic inflammatory disease (PID).Cases: We report two cases of PID in adolescents with IUDs in place, both of whom had symptom resolution with removal of their IUDs, and in whom both IUDs were culture positive for Enterococcus.Summary and Conclusion: Whether these results indicate vaginal contamination or a causative agent for PID is unclear, but one should consider alternative causes of PID in adolescents with IUDs, particularly in those with prolonged symptoms.

Mullerian Agenesis with Vaginal Vault Prolapse Following Mechanically Created Neovagina

Eve Burns, Masood Naim, Shawky Z.A. Badawy — 2012-06-01

Abstract: A 21-year-old with mullerian agenesis, presented with vaginal mass. Previously, she developed a neovagina by the use of vaginal dilators. Examination revealed vaginal vault prolapse. She was surgically treated with vaginal vault suspension using a mesh.

46,XY Karyotype in a Female Phenotype Fetus: A Challenging Diagnosis

2012-06-01

Abstract: Background: The growing use of prenatal investigations allows an early detection of several inborn disorders, including disorders of sexual development. The management of these conditions is an arising problem.Case: 46,XY karyotype and female phenotype were detected in a fetus; 5α-reductase and androgen receptor gene analysis on chorionic villi revealed no relevant mutation. The newborn was assigned to female sex. The diagnosis of 17β-hydroxysteroid dehydrogenase-3 β-OL deficiency was reached at four months of age, by means of a low testosterone/Δ 4-androstenedione ratio after HCG test and HSD17B3 gene analysis.Summary and Conclusion: A 46,XY fetus with female external genitalia suggests different conditions, some very rare. Specific genetic investigations should be performed prenatally when possible. A complete evaluation is mandatory after delivery to reach a correct diagnosis.

The definition of “have sex” must be unique. Re: Mehta CM, et al: “Sex isn’t something you do with someone you don’t care about”: young women’s definitions of sex. J Pediatr Adolesc Gynecol. 2011; 24:266-71.

Vincenzo Puppo — 2012-02-02

To the Editor, Mehta et al wrote: “Using semi-structured interviews, young women were asked to define sex” and “Young women’s definitions of sex varied.”

Editorial Board

2012-06-01

Journal of Pediatric and Adolescent Gynecology

Urinary Tract, the Challenges of Diagnosis and Management of Interstitial Cystitis

Diagnosis and Treatment of Interstitial Cystitis in Adolescents

Exercise and Sedentary Habits Among Adolescents with PCOS

Effect of Antiandrogen Treatment on Bone Density and Bone Geometry in Adolescents with Polycystic Ovary Syndrome

The Utility of Ultrasound and Magnetic Resonance Imaging versus Surgery for the Characterization of Müllerian Anomalies in the Pediatric and Adolescent Population

Modifying Effect of Prenatal Care on the Association Between Young Maternal Age and Adverse Birth Outcomes

The Effect of Pelvic Size on Cesarean Delivery Rates: Using Adolescent Maternal Age as an Unbiased Proxy for Pelvic Size

Retrospective Review of Intrauterine Device in Adolescent and Young Women

Depression During Pregnancy Among Young Couples: The Effect of Personal and Partner Experiences of Stressors and the Buffering Effects of Social Relationships

Association Between Polycystic Ovarian Syndrome, Overweight, and Metabolic Syndrome in Adolescents

Knowledge of Sexually Transmitted Infections Among Adolescents in the Houston Area Presenting for Reproductive Healthcare at Texas Children’s Hospital

Gender Differences Among Low Income Women in Their Intent to Vaccinate Their Sons and Daughters Against Human Papillomavirus Infection

College Health

An Adolescent Affliction: Nephrectomy and Persistent Severe Pains due to Misdiagnosed Non-communicating “Retroperitoneal” Uterine Horn

Effect of Excess Estrogen on Breast and External Genitalia Development in Growth Hormone Deficiency

Urinary Retention as the Presentation of Bartholin’s Duct Cyst in a Neonate

Successful Pregnancy and Delivery in a Patient with Bladder Exstrophy

Adolescents, IUDs, PID, and Enterococcus: A Report of Two Cases

Mullerian Agenesis with Vaginal Vault Prolapse Following Mechanically Created Neovagina

46,XY Karyotype in a Female Phenotype Fetus: A Challenging Diagnosis

The definition of “have sex” must be unique. Re: Mehta CM, et al: “Sex isn’t something you do with someone you don’t care about”: young women’s definitions of sex. J Pediatr Adolesc Gynecol. 2011; 24:266-71.

Editorial Board

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