Journal of Pediatric and Adolescent Gynecology

Editor’s Workshop

Joseph S. Sanfilippo — 2012-02-01

In this issue of the Journal of Pediatric and Adolescent Gynecology we focus on the Juvenile Justice System as addressed in our Mini-Review, authored by Drs. Risk and Alderman. Specifically, girls charged with a juvenile offense are a special group of individuals that require clinicians to understand the unique problems associated with this population. Depression, severe neglect, sexual and physical abuse, and this occurs oftentimes while in the care of a government agency, is the background to the problem. New laws have been enacted that appear to “allow children to be housed in county jails outside the oversight, supervision or even inspection(s) by anyone experienced with the care of children”; the Florida Department of Justice has been front and center on this issue.

Issues in Gynecologic Care for Adolescent Girls in the Juvenile Justice System

Ruba Rizk, Elizabeth Alderman — 2011-03-21

It is estimated that 2.3 million adolescents pass through the juvenile justice system each year. In the year 2000, adolescent girls comprised 28% of these offenders, reflecting a dramatic 35% increase in the number of female delinquents from 1980. Recent data shows that on average 14,590 female juvenile offenders are housed in correctional facilities on any given day. These adolescent girls have significant health needs. They represent a medically underserved and hard-to-access population who are at high risk of medical, gynecologic, and emotional disorders. A large percentage of these troubled youth have been the victims of child abuse including sexual abuse and neglect. They have high rates of learning disabilities and substance abuse and engage in high-risk behaviors. With the majority of these juvenile offenders coming from backgrounds of considerable family, social, and psychological turmoil with limited access to medical care, incarceration has become a unique opportunity for health care providers to intervene. The striking numbers make health care provision and particularly gynecologic care and counseling critical in optimizing the futures of these incarcerated teens.

Adolescent Depressive Symptoms and Subsequent Pregnancy, Pregnancy Completion and Pregnancy Termination in Young Adulthood: Findings from the Victorian Adolescent Health Cohort Study

2011-11-17

Abstract: Study Objective: To examine relationships between depressive symptoms in adolescence (14-18 years of age) and becoming pregnant, completing a pregnancy (live birth) and terminating a pregnancy in young adulthood (21-24 years of age).Participants and Design: Data from 1000 females were drawn from a larger sample of 1943 young Australians participating in a longitudinal study of adolescent health and development, followed across 8 waves from adolescence (waves 1-6) to young adulthood (waves 7 and 8).Setting: Victoria, Australia.Main Outcome Measures: Pregnancy, pregnancy completion and pregnancy termination between 21-24 years of age.Results: We observed a twofold increase in the odds of becoming pregnant in those reporting persisting patterns of depressive symptoms during adolescence (2+ waves); however, after staged adjustment for adolescent antisocial behaviour, drug use and socioeconomic disadvantage, there was no evidence of association. Of particular note, and consistent with previous research, adolescent antisocial and drug use behavior were strongly associated with becoming pregnant and pregnancy termination in young adulthood.Conclusions: Adolescent antisocial and drug use behavior, not depressive symptoms, independently predict pregnancy outcomes in young adulthood.

The Incidence, Attitudes and Practices of the Removal of Pubic Hair as a Body Modification

2011-11-17

Abstract: Objective: To evaluate the incidence, attitudes, and practices of the removal of pubic hair as a body modification.Design: A voluntary, anonymous survey was conducted among adolescents and young women 12-20 years of age seen in gynecology clinics in Houston, Texas.Results: There were a total of 171 adolescent participants surveyed, of whom 70.4% of reported routinely shaving or waxing their pubic hair. More traditional body modification methods were evaluated, and 3.5% reported tattoos and 57.1% reported piercings. Sexually active participants were more likely to remove pubic hair routinely. The areas of the body where the participants felt there was “too much” hair included the genital area, upper lip, and abdomen. Of total respondents, 14.7% reported feeling “pressure” from friends or family to participate in body modification such as tattooing, piercing, or removal of pubic hair. The decision to participate in body modification was mostly influenced by friends and family.Conclusion: Based on this study, removal of pubic hair as a body modification is common. The results of this study demonstrated that removal of pubic hair was more common in sexually active participants compared to non-sexually active participants. Therefore, providers should additionally be aware that removal of pubic hair may be a warning sign of sexual behaviors or impending sexual activity.

Substance Use and Mental Health Disparities among Sexual Minority Girls: Results from the Pittsburgh Girls Study

2011-11-04

Abstract: Purpose: To examine substance use and mental health disparities between sexual minority girls and heterosexual girls.Methods: Data from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms.Results: Compared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD, ODD, and CD symptoms.Conclusions: Sexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit.

Body Dissatisfaction on Top of Depressive Mood among Adolescents with Severe Dysmenorrhea

2012-02-01

Abstract: Objectives: This study aims to determine whether adolescent girls with severe dysmenorrhea (SD) have different psychological characteristics from their peers.Study design: Cross-sectional survey (SMASH 02).Settings: Nationally representative sample of adolescents attending post-mandatory education.Participants: N = 7548, of whom 3340 were females, aged 16-20 years.Intervention: Self-administered, anonymous survey consisted of 565 items on 4 main topics: sociodemographic determinants of health, health status, health behaviors, and health care use.Outcomes: Body image variables, mental health, and associated variables like sexual abuse and health perceptions. Bivariate analysis and binomial logistic regression controlling for explanatory variables were performed.Results: 12.4% (95% confidence interval [CI]: 11.0-14) declared SD. Compared to their peers, subjects with SD were more likely to report depressive symptoms (adjusted odds ratio [AOR]: 1.73; 95% CI: 1.38-2.15), have a higher gynecological age (AOR: 1.13; 95% CI: 1.05-1.20), and attend vocational school (AOR: 1.33; 95% CI: 1.00-1.76). Moreover, the proportion of those reporting dissatisfaction with their body appearance was higher (AOR: 1.50; 95% CI: 1.02-2.22).Conclusion: Patients with SD not only show a different profile from their peers in terms of their mental health academic track and gynecological age, but they are also more dissatisfied with their body appearance. Clinicians should pay particular attention to patients with SD and offer them a global evaluation, bearing in mind what factors can be associated with SD.

Bone Mineral Density, Fracture, and Vitamin D in Adolescents and Young Women Using Depot Medroxyprogesterone Acetate

Sarah A.B. Pitts, Henry A. Feldman, Amanda Dorale, Catherine M. Gordon — 2011-11-14

Abstract: Study Objective: To evaluate bone mineral density (BMD) in adolescents and young adults treated with depot medroxyprogesterone acetate (DMPA).Design, Setting, Participants: Eighty-three healthy subjects, 13-20 years old, who received at least 3 DMPA injections in an urban adolescent clinic and underwent dual energy x-ray absorptiometry (DXA) were evaluated by chart review.Main Outcome Measures: Anthropometric data, DMPA use, BMD of the spine and hip, fracture history, and vitamin D status were collected.Results: Subjects were a median age of 16.4 years old (range 13-20 years) when DMPA was initiated. The median number of DMPA injections was 5 (range 3-18) before the first DXA. At the spine and hip, respectively, BMD was normal (Z-score > −1.0 SD) for most subjects (79%, 86%). Subjects who received > 5 injections were more likely to have low spinal BMD (Z-score ≤ −2.0 SD) at first DXA (P = .018). In 15 subjects with repeat DXA measurements, after an additional median 6 injections, spinal BMD Z-score decreased by −0.33 ± 0.10 (mean ± SD, P = .004), as did absolute BMD at the hip (−0.019 ± 0.007 g/cm2, P = .014). History of fracture was not associated with initial or subsequent BMD measurements. Most (12/13, 92.3%) subjects with vitamin D measurements were deficient (25-hydroxy vitamin D < 20 ng/mL).Conclusions: Most subjects on DMPA had normal BMD at first DXA. Low spinal BMD was associated with longer DMPA use, and some BMD measurements declined with prolonged use. Fracture history is not an absolute contraindication to DMPA use in this population. Studies are needed to determine possible benefits of vitamin D supplementation in DMPA users.

Cervical Pap Screening Cytological Abnormalities among HIV-Infected Adolescents in the LEGACY Cohort

2011-11-17

Abstract: Objectives: To determine the prevalence of cervical Pap screening (CPAP-S), identify factors associated with CPAP-S, and explore risk factors for abnormal cervical cytology in female adolescents with perinatally and behaviorally acquired HIV infection.Design: Cross-sectional.Setting: LEGACY is a national observational cohort chart review study of 1478 HIV-infected persons (

The Use of Effective Contraception among Young Hispanic Women: The Role of Acculturation

Angelica M. Roncancio, Kristy K. Ward, Abbey B. Berenson — 2011-11-04

Abstract: Purpose: Culture may play an important role in contraceptive preference among young Hispanic women. We examined whether acculturation predicted the use of different contraceptives, grouped by level of efficacy in preventing pregnancy.Methods: 1017 sexually active Hispanic women between the ages of 16 and 24 (mean age 20.69 ± 2.42 years) responded to a self-administered questionnaire. Data were analyzed using multinomial logistic regression.Results: Women low in acculturation (OR 1.79, CI 1.06–3.02) and bicultural (OR 2.66, CI 1.52–4.64) were more likely than women high in acculturation to have used no method of contraception than long-acting reversible contraception (LARC). Bicultural women were more likely to have used condoms than LARC (OR 2.51, CI 1.40–4.49) compared to women high in acculturation. Finally, women in low in acculturation (OR 1.98, CI 1.11–3.50) and bicultural (OR 1.88, CI 1.01–3.51) were more likely to have used cyclic hormonal contraception than LARC compared to women high in acculturation.Conclusions: Educational efforts should focus on young Hispanic women who are bicultural and low in acculturation in order to increase their use of more effective contraceptive methods and reduce the number of unplanned pregnancies among this population.

Awareness and Knowledge of the Intrauterine Device in Adolescents

Maria Barrett, Reni Soon, Amy K. Whitaker, Sarah Takekawa, Bliss Kaneshiro — 2011-11-04

Abstract: Background: The purpose of this study was to explore intrauterine device (IUD) awareness and knowledge in a diverse, multiethnic population.Methods: We conducted a self-administered, anonymous survey addressing awareness of the IUD as a contraceptive method and knowledge about aspects of IUD use in a group of women aged 14 to 19 years. Demographic and medical information was obtained to compare awareness and knowledge between demographic groups. Chi-square, Fisher exact test, and t tests were used for analysis. Multiple logistic regression was utilized to confirm relationships.Results: Of the 106 respondents, 76.4% (81/106) were sexually active and 56.6% (60/106) reported a history of ever being pregnant. There were 21.1% (33/106) of respondents who had heard of the IUD as a contraceptive method. Of the subjects who had heard of the IUD, 39.4 % (13/33) were able to identify key features of the IUD. Although a history of pregnancy was predictive of having heard of the IUD, age, insurance status, education, and all other demographic factors were not associated with IUD awareness.Conclusion: Over 70% of the adolescents had not heard of the IUD and less than half of adolescents who had heard of the IUD were able to identify key features about this contraceptive method. The lack of knowledge of this effective and safe contraceptive option is concerning given that most participants were at high risk for unintended pregnancy.

Cultural Practices Relating to Menarche and Menstruation among Adolescent Girls in Taiwan—Qualitative Investigation

H.-L. Liu, K.-H. Chen, N.-H. Peng — 2011-11-04

Abstract: Study Objective: The aim of this study was to qualitatively record the cultural attitudes and practices associated with menarche and menstruation in Taiwanese girls, particularly with respect to coping mechanisms.Participants: Forty-eight adolescent girls participated.Intervention: Adolescent girls were individually interviewed to investigate the effects of their cultural practices, coping mechanisms, and physiological symptoms during menarche and menstruation.Main Outcome Measure(s): The qualitative investigation revealed mixed reactions to menstruation, such as eating chocolate, using sanitary napkins, and feeling irritable or embarrassed. Cluster construction suggested that adolescents were prepared for menarche but required emotional support; in addition, the new generation employed the Internet to learn how to cope.Results: A phenomenological approach showed that menarche and menstrual attitudes among Taiwanese adolescents were comprised in 4 dimensions: self-perception, information, and cultural practices with regard to menarche; physiological symptoms and psychological reactions during menstruation; coping mechanisms during menarche and menstruation; and methods for coping and cultural practices for menstruation. Cultural beliefs and the Internet have changed cross-cultural contacts.Conclusions: Educators and health professionals should seek to understand this generation of girls, who perceive the world as more flexible and available and have more creativity and new eating behaviors and hobbies.

Prevalence and Correlates of Recent Vaginal Douching among African American Adolescent Females

R.J. DiClemente, A.M. Young, J.L. Painter, G.M. Wingood, E. Rose, J.M. Sales — 2011-11-04

Abstract: Study Objective: To describe the prevalence and correlates of vaginal douching among urban African American adolescents and to examine the association between douching and sexually transmitted infection (STI) status.Design: Demographic, psychosocial, and behavioral data were collected through cross-sectional, self-administered surveys. Self-collected vaginal swabs were assayed using nucleic acid amplification tests for trichomoniasis, chlamydia, and gonorrhea.Setting: Sexual health clinic in a large metropolitan area of the southeastern United States.Participants: African American females (N = 701), ages 14–20, participating in a human immunodeficiency virus prevention intervention.Main Outcome Measure: The outcome of interest was the association between vaginal douching (lifetime, past 90 days, and past 7 days) with demographic characteristics (eg, age, education, and socioeconomic status), physical and mental health status, STI status, sexual behavior (eg, number of vaginal sexual partners, age of sex partners, consistent condom use in the past 90 days, sex while self/partner was high on drugs or alcohol), and psychosocial characteristics (eg, sexual adventurism, social support, peer norms, sexual satisfaction, self-efficacy for sex refusal, self-esteem, relationship power, risk avoidance).Results: Forty-three percent reported ever douching, and 29% reported douching in the past 90 days. In bivariate analyses, recent douching was associated with demographic, behavioral, and psychosocial variables, but not current STI status. In multivariate analyses, recent douching was associated with age (odds ratio [AOR] = 1.13, confidence interval [CI] = 1.02–1.25), lower socioeconomic status (AOR = 1.25, CI = 1.05–1.47), and having sex with much older partners (AOR = 1.87, CI = 1.22–2.86).Conclusion: Increased age, lower socioeconomic status, and older partners may be salient risk factors for douching behavior among African American young women.

Vaginal Agenesis, the Hymen, and Associated Anomalies

N. Kimberley, J.M. Hutson, B.R. Southwell, S.R. Grover — 2011-11-04

Abstract: Study Objectives: Review anomalies in patients with vaginal agenesis. In particular, to clarify the impact of an absent hymen on the presence of other anomalies; on the success of creating a vagina with dilators; and on sexual function outcomes.Design: Retrospective medical record review; questionnaire on sexual function.Setting: Gynecology service at a children’s hospital and the practice of 1 gynecologist.Participants: All patients with vaginal agenesis were identified from the databases, as well as the subgroup in which hymenal status was known.Outcome Measures: Data regarding hymen, renal, skeletal, cardiac, and other anomalies; for women who had a neovagina, the technique used to create a functional vagina.Results: Of 69 females (age range 2–70 years), renal tract anomalies (43.3%), vertebral anomalies (29%), cardiac anomalies (14.5%), and syndromes including Klippel-Feil (7%) and MURCS association (7%) were identified. Where hymenal status was known (n = 47), 31 were normal, and 16 had an absent hymen. Where the hymen was absent, renal agenesis was increased (odds ratio = 13.5, P < .001). There was no association between other anomalies and an absent hymen, or between the various anomalies. For women without a hymen, the likelihood of failing dilation therapy was increased (odds ratio = 21.7; P < .01].Conclusion: An absent hymen makes renal agenesis more likely and increases the likelihood that dilator techniques will fail. This condition appears to be associated with reports of long-term problems with poor lubrication that are potentially related to the absence of the peri-hymenal Bartholin’s glands.

Long Acting Reversible Contraception in Postpartum Adolescents: Early Initiation of Etonogestrel Implant is Superior to IUDs in the Outpatient Setting

K. Tocce, J. Sheeder, J. Python, S.B. Teal — 2011-11-04

Abstract: Study Objective: To evaluate the outpatient initiation of postpartum long-acting reversible contraception (LARC).Design: Prospective cohort study of pregnant adolescents’ prenatal contraceptive intentions and successful postpartum initiation of LARC.Setting: Urban, university hospital-affiliated, adolescent outpatient clinic.Participants: Adolescents attending an integrated prenatal and postpartum maternity clinic.Interventions: Data were collected via the electronic medical record and telephone interview.Main Outcome Measures: Contraceptive intentions during the third trimester, contraceptive methods used postpartum, timing of LARC initiation, timing of resumption of intercourse.Results: 116 patients were enrolled; 75% intended LARC use postpartum. Of 38 implant-intenders, 14 received it within 14 days postpartum. All reported abstinence pre-placement. Mean time to insertion was 18±13 days. Of 37 IUD-intenders, only two received one by 8 weeks postpartum. By 14 weeks postpartum, 43% received one. Over half reported intercourse prior to insertion; the only method of contraception used was condoms. Mean time to insertion was 70±11 days. Resumption of intercourse prior to initiation of the intended LARC method was significantly higher in IUD recipients compared to those who intended and received the implant (RR 8.8; CI 1.3–57.5).Conclusion: In postpartum teens attending a clinic that prioritizes contraceptive use, the implant is far more likely to be received prior to resumption of sexual activity than the IUD. This may be due to more and earlier opportunities for placement, or waning commitment with time since delivery. Post-placental IUDs may be needed to equal the success of the implant in this patient population. Short-acting, reliable contraceptive methods should be implemented for postpartum adolescents preferring to wait for IUD insertion.

The Role of Examination under Anesthesia (EUA) and Vaginoscopy in Pediatric and Adolescent Gynecology: A Retrospective Review

Rola S. Nakhal, Dan Wood, Sarah M. Creighton — 2011-11-04

Abstract: Background: Examination under anesthesia (EUA) with diagnostic vaginoscopy is an invaluable method in the lower genital tract assessment of pediatric and adolescent females. The literature on this topic remains scarce.Methods: This is a retrospective medical notes review of all patients who underwent EUA with or without vaginoscopy over the past 5 years at a pediatric and adolescent gynecology unit specializing in disorders of sex development (DSD).Results: From 2005 to 2010, 83 patients underwent 92 procedures. All procedures were performed under general anesthesia, and a 3-mm pediatric cystoscope was used for vaginoscopy. Of the 92 cases, 33 (36%) were EUA alone and 59 (64%) consisted of a combined EUA and vaginoscopy. The mean age was 13.3 ± 3.7 years. The most common indications included assessment for reconstructive surgery (33.7%), vaginal stenosis (21.7%), vaginal discharge (19.6%), vaginal bleeding (16.3%), and pelvic pain (8.7%). Most (61%) of those presenting for assessment for reconstructive surgery had a DSD and history of surgical correction in early childhood. In 88 cases (96%), the evaluation was satisfactory and a diagnosis was reached or normality confirmed. Four cases (4%) required further investigation. No significant intraoperative or postoperative complications were encountered. Of the 92 cases, 15 (16%) required a further minor procedure, which was performed at the time of the EUA/vaginoscopy. Another 33 (36%) required further major surgery, which was performed at a later date.Conclusion: EUA/vaginoscopy is a safe and highly useful method in the assessment of the lower genital tract in pediatric and adolescent patients.

Urogenital Symptoms in Premenarchal Girls: Parents' and Girls' Perceptions and Associations with Irritants

Cynthia DeLago, Martin A. Finkel, Esther Deblinger — 2011-11-04

Abstract: Objectives: Premenarchal girls commonly seek care for urogenital symptoms, yet little is published about parents' and girls' perceived causes of symptoms or associations with irritant exposures. We sought to describe urogenital symptoms, perceived causes, and associations between symptoms and genital irritant exposures.Design: Descriptive study. Parents/girls interviewed; medical records reviewed.Participants: Five- to 12-year-old well, premenarchal girls and their parents.Setting: One urban and 1 suburban pediatric practice.Outcome Measures: Prevalence of histories of urogenital symptoms and perceived causes; association between symptoms and exposure to genital irritants in a well population.Results: Of 191 parent/girl dyads, 33% of parents and 48% of girls reported girls' histories of urogenital symptoms not attributed to urinary tract infections or trauma. Perceived causes: poor hygiene (29% of parents vs 14% of girls); soap products (20% of parents and girls); none identified (24% of parents vs 53% of girls). Analysis of symptoms versus irritant exposures demonstrated these associations: dysuria and genital soreness with poor genital hygiene, tight garments, or exposure to soap products; genital pruritus with poor hygiene (all P < .05). No symptoms were associated with nylon underwear, tights, or bike or horseback riding. Vaginal discharge was not associated with any irritants.Conclusion: Almost half the girls had histories of urogenital symptoms. Poor hygiene and soap exposure were perceived causes of most symptoms. When no cause for urogenital symptoms is identified, treatment should be focused on hygiene, soap exposure, and tight-fitting clothes, not on bike or horseback riding or wearing nylon underwear or tights. Vaginal discharge warrants further evaluation.

Adolescent Caesarean Delivery in the US Military Health Care System

David A. Klein, Ginny Gildengorin, Peter Mosher, William P. Adelman — 2011-11-17

Abstract: Objectives: Determine cesarean delivery (CD) rates and associated demographics among military dependent teenagers.Methods: United States military health care claims records of live births from 2003-2006 to 13- through 19-year-old dependent children were analyzed using logistic regression.Results: The CD rate rose from 17% in 2003 to 20% in 2006. Rates were significantly higher for ages 18 and 19, for African American sponsors' children, and those who gave birth in a civilian facility. Rates did not differ significantly by sponsor's military rank.Conclusions: Teenagers in the military health care system have increasing rates of CD. Independent demographic risk factors for teenage CD include age > 17 years, sponsor's race African American, and delivery at a civilian facility.

Minocycline-Induced Hyperpigmentation

Soo Jung Kim, Joseph C. English — 2011-09-26

A 16-year-old Caucasian female presented for evaluation of irregular menstrual periods. She also complained of a persistent bruise on her right thigh present for 2 years. Her mother is concerned that the 2 problems are related. The patient’s medical history is significant for acne vulagris for which she has been on long-term oral antibiotic therapy prescribed by her primary care physician. On physical exam, an irregular bluish, non-blanchable patch was seen on the right lateral thigh (). A referral to a dermatologist was ordered.

When Parents Do Not Want Their Daughters on Birth Control Pills: Tips for Navigating a Difficult Clinical Situation

Lisa K. Perriera, Marjorie Greenfield — 2011-11-04

“The Pill” just celebrated its 50th birthday. When looking back at this monumental discovery, how many clinicians have wished its creators had named it something other than “the birth control pill”? Imagine if it had been called “the menstrual cycle regulation pill,” “the menstrual cramp avoidance pill,” or “the anti-acne pill.” If the name had been separated from its contraceptive effects, our job of helping adolescents with menstrual maladies would be much easier. We could tell patients and their parents that this medication will safely cure dysmenorrhea, improve acne, and regulate cycles, and incidentally, prevent ovulation.

Differences in Stimulated Androgen Levels in Black and White Obese Adolescent Females

Tamara S. Hannon, Silva A. Arslanian — 2011-11-17

Abstract: Study Objective: Little is known about racial differences in androgen levels among obese children. The objective of this pilot study was to compare basal and stimulated androgen levels in a cross-sectional sample of obese black and white pubertal females.Study Design, Setting, and Participants: This was cross-sectional study of obese (body mass index ≥ 95th percentile) but otherwise healthy female adolescents (10 black and 12 white; age range 8.8-13.9 y) who underwent adrenocorticotropic hormone stimulation testing at an academic medical center as part of a protocol for the study of obesity-related conditions.Main Outcome Measures: Basal and stimulated androgen levels.Results: White and black participants were similar with regard to pubertal stage, body mass index, percentage body fat, and fasting glucose and insulin levels. Black girls had lower stimulated levels of 17-hydroxyprogesterone, and the differences between basal and stimulated levels of 17-hydroxyprogesterone and androstenedione were lower in black girls. Body mass index was negatively correlated with stimulated cortisol in blacks only (r = -0.69, P = .03).Conclusion: There appear to be race-related differences in stimulated androgen levels in obese adolescent females. These differences deserve further study, as measurements of androgen levels are commonly used in clinical practice and research.

Congenital Paraurethral Cysts in two Newborn Girls: Differential Diagnosis, Management Strategies, and Spontaneous Resolution

Vahe Badalyan, Swathi Burgula, Richard H. Schwartz — 2011-11-17

Abstract: Background: At least five types of interlabial masses of different etiologies may present in a female neonate. The more serious type of interlabial mass must be differentiated from the benign and self-resolving paraurethral or hymenal cyst. Clues include appearance and color of the mass and the location of the mass in relation to the urethral meatus and the vaginal opening. Clinicians should be able to distinguish lesions that require aggressive intervention, i.e. surgery, from those that self-resolve and merely require observation.Case: Two unrelated newborn girls each had a protruding faint-yellow-colored spherical interlabial cyst. The cyst was located anterior to the vaginal orifice and partially obscured the urethral meatus. Neither girl had any voiding problems. No other congenital anomalies were detected. Both cysts resolved rapidly and completely without surgical intervention.Summary and Conclusion: Paraurethral cysts of the newborn and hymenal cysts rarely cause urinary obstruction or spotting, and are self-resolving. When positively identified, no evaluation of upper urinary tract is required and neither aspiration of cyst contents or marsupialization procedure is necessary.

Ovarian Endometrioma in an 11-Year-Old Girl before Menarche: A Case Study with Literature Review

M. Gogacz, M. Sarzyński, R. Napierała, J. Sierocińska-Sawa, A. Semczuk — 2011-11-04

Abstract: Background: To date, a limited number of endometriosis cases occurring before or around the time of menarche have been documented.Case: An 11-year-old adolescent underwent an emergency operation for left ovarian endometrioma. Her menarche occurred spontaneously 6 months after surgery.Results and Conclusions: We discuss the above mentioned case and consider data published in the literature. Endometrioma should be considered even in premenarcheal girls with ovarian cysts, regardless of their size.

Diagnosis and Management of Precocious Puberty in Atypical Presentations of McCune-Albright Syndrome: A Case Series Review

2011-11-04

Abstract: Background: McCune-Albright syndrome is a rare syndrome, classically defined as the triad of precocious puberty, fibrous dysplasia of bone, and café au lait lesions. Partial or atypical presentations of McCune-Albright syndrome, with only one or two of the classic symptoms, have been described in the literature and remain particularly challenging due to lack of diagnostic phenotype. In these patients, the utility of analysis of mutations in the gene of the α subunit of the stimulatory G-protein is limited and so the diagnosis is often based on clinical judgment. Three atypical cases of suspected McCune-Albright syndrome with gonadotropin-independent precocious puberty are presented.Cases: Case #1: A 5-year-old female presented with painlesss vaginal bleeding and was found to have café au lait lesions. She was diagnosed with gonadotropin independent precocious puberty with eventual progression to gonadotropin dependent precocious puberty which was successfully treated with both letrozole and gonadotropin-releasing hormone agonist therapy. Case #2: A 3-year-old female presented with painless vaginal bleeding and was found to have café au lait lesions. She was diagnosed with gonadotropin independent precocious puberty and was successfully treated with letrozole. Case #3: A 5-year-old female presented with fibrous dysplasia and was found to have evidence of uterine and ovarian enlargement on ultrasound. She was diagnosed with gonadotropin-independent precocious puberty and was successfully treated with letrozole.Summary and Conclusion: Although different in presentation, all three atypical cases of suspected McCune-Albright syndrome with gonadotropin-independent precocious puberty were successfully treated with aromatase inhibitors. This small case series shows the utility and efficacy of aromatase inhibitors in the setting of atypical cases of suspected MAS with gonadotropin-independent precocious puberty.

Diagnostic Imaging: Pediatrics

Andrea Sanfilippo, Stefano Bartoletti — 2011-11-04

Pediatrics is a unique and challenging field in which the practitioner must understand the problems that affect children and be able to recognize them from normal variants. Diagnostic Imaging: Pediatrics offers a comprehensive and complete look at pediatric pathology and the imaging associated with it. This book is suited for both radiologists and non-radiologists who deal with a pediatric population. Although the book focuses on imaging findings, clinical issues are addressed with each topic. The authors keep the reader (including Pediatric Adolescents Gynecologists) in mind, which results in an efficient, yet thorough review. The book can serve many purposes, including as a day-to-day reference, study guide, or a teaching aide.

Editorial Board

2012-02-01

Journal of Pediatric and Adolescent Gynecology

Editor’s Workshop

Issues in Gynecologic Care for Adolescent Girls in the Juvenile Justice System

Adolescent Depressive Symptoms and Subsequent Pregnancy, Pregnancy Completion and Pregnancy Termination in Young Adulthood: Findings from the Victorian Adolescent Health Cohort Study

The Incidence, Attitudes and Practices of the Removal of Pubic Hair as a Body Modification

Substance Use and Mental Health Disparities among Sexual Minority Girls: Results from the Pittsburgh Girls Study

Body Dissatisfaction on Top of Depressive Mood among Adolescents with Severe Dysmenorrhea

Bone Mineral Density, Fracture, and Vitamin D in Adolescents and Young Women Using Depot Medroxyprogesterone Acetate

Cervical Pap Screening Cytological Abnormalities among HIV-Infected Adolescents in the LEGACY Cohort

The Use of Effective Contraception among Young Hispanic Women: The Role of Acculturation

Awareness and Knowledge of the Intrauterine Device in Adolescents

Cultural Practices Relating to Menarche and Menstruation among Adolescent Girls in Taiwan—Qualitative Investigation

Prevalence and Correlates of Recent Vaginal Douching among African American Adolescent Females

Vaginal Agenesis, the Hymen, and Associated Anomalies

Long Acting Reversible Contraception in Postpartum Adolescents: Early Initiation of Etonogestrel Implant is Superior to IUDs in the Outpatient Setting

The Role of Examination under Anesthesia (EUA) and Vaginoscopy in Pediatric and Adolescent Gynecology: A Retrospective Review

Urogenital Symptoms in Premenarchal Girls: Parents' and Girls' Perceptions and Associations with Irritants

Adolescent Caesarean Delivery in the US Military Health Care System

Minocycline-Induced Hyperpigmentation

When Parents Do Not Want Their Daughters on Birth Control Pills: Tips for Navigating a Difficult Clinical Situation

Differences in Stimulated Androgen Levels in Black and White Obese Adolescent Females

Congenital Paraurethral Cysts in two Newborn Girls: Differential Diagnosis, Management Strategies, and Spontaneous Resolution

Ovarian Endometrioma in an 11-Year-Old Girl before Menarche: A Case Study with Literature Review

Diagnosis and Management of Precocious Puberty in Atypical Presentations of McCune-Albright Syndrome: A Case Series Review

Diagnostic Imaging: Pediatrics

Editorial Board

Table of Contents