Journal of Pediatric and Adolescent Gynecology

Introduction for The Editor's Workshop

2010-02-01

Allow me to highlight our guest editor for this issue of the Journal of Pediatric and Adolescent Gynecology, Dr. Gina Sucato. Gina serves as Associate Editor for Pediatric Adolescent Medicine. She is in the Division of Adolescent Medicine at the University of Pittsburgh School of Medicine. Her undergraduate training was at Cornell, and she received her medical degree from the University of Pennsylvania. Dr. Sucato is also an MPH; she completed this degree at the University of Washington School of Public Health and Community Medicine. Her pediatric training was at the University of Washington, and her fellowship in adolescent medicine was at the University of Pittsburgh.

Hypertrophic Labia Minora

Jhansi Reddy, Marc R. Laufer — 2009-07-16

Increasing numbers of girls and young women are seeking medical attention due to concerns about the appearance of their external genitalia. One particular area of concern is hypertrophic labia minora, which remains a poorly defined clinical diagnosis. Once it was considered a variant of normal anatomy, but in recent times, increasing numbers of health care providers are being consulted for labioplasty. The symptoms, diagnosis and treatment of hypertrophic labia minora will be reviewed.

Characteristics of Adolescents Presenting to a Multidisciplinary Clinic for Polycystic Ovarian Syndrome

M. Tracy Bekx, Ellen C. Connor, David B. Allen — 2009-08-03

Abstract: Objective: To characterize patients referred to the adolescent polycystic ovarian syndrome (PCOS) clinic at the American Family Children's Hospital, University of Wisconsin, Madison, Wisconsin.Design: Chart review of patients seen in the first 33 months for details of initial presentation, age, body mass index (BMI), menstrual pattern, clinical and laboratory features of androgen excess, insulin resistance, and dyslipidemia.Setting: Multidisciplinary clinic for adolescents with PCOS at the American Family Children's Hospital, Madison, Wisconsin.Participants: Adolescent girls with PCOS.Results: Seventy patients (84% Caucasian) presented with an average age at referral of 16.2 years (range 11-22 y). Eighty four percent had a BMI > the 85th percentile and 70% had a BMI > 95th percentile. Menstrual pattern was quite varied, with some patients having primary amenorrhea, and over 50% experiencing hirsutism. There were 3 cases of type 2 diabetes, and over half of the patients had elevated fasting insulin levels and low HDL levels.Conclusion: Polycystic ovarian syndrome is a complex and heterogeneous disorder that requires multidisciplinary expertise. Knowing the unique features of the adolescent with PCOS and metabolic risks should permit earlier intervention with intensive counseling and medical therapy to address current health concerns and prevent future co-morbidities.

Gynecologic Issues of Adolescents with Down Syndrome, Autism, and Cerebral Palsy

Lori M. Burke, Claire Z. Kalpakjian, Yolanda R. Smith, Elisabeth H. Quint — 2009-07-30

Abstract: Study Objective: The gynecologic issues of adolescents with disabilities are understudied. The purpose of this study was to identify and compare the presenting complaints, treatments, and follow-up of adolescent girls with Down syndrome (DS), autism, and cerebral palsy (CP) presenting to a specialized gynecologic clinic for women with developmental disabilities.Setting: Outpatient gynecology clinic.Participants: Forty four adolescents (<21 y); 13 with DS, 14 with autism, and 17 with CP who presented to the clinic from 1999 to 2006.Interventions: None.Main Outcome Measures: A retrospective review of the electronic medical records to collect data on age at presentation to clinic, ethnicity, menstrual history, chief complaint, treatment, and follow-up.Results: Mean age at presentation to clinic was 15±3.5 years, and age of menarche was 12.5±2 years; age at menarche did not significantly differ between groups. The most frequent complaints were irregular bleeding (n=10) and mood/behavioral changes (n=6). Girls with autism were significantly (χ2=8.89, P=.012) more likely to present with behavioral issues than the other 2 groups. Initial management for the behavior issues in the autism group included nonsteroidal anti-inflammatory drugs (NSAID), oral contraceptives, and education.Conclusion: The most common gynecologic complaints of adolescent girls with DS, autism, and CP centered on menstruation and mood disorders. Patients with autism were more likely to present with behavioral issues related to the onset of periods.

Depressive Symptoms and Birth Outcomes among Pregnant Teenagers

2009-08-17

Abstract: Study Objective: Few studies have examined the effects of maternal depressive symptoms among adolescent women. The purpose of this study was to investigate the impact of depressive symptoms on birth outcomes of infants born to adolescent mothers.Design: The medical records of pregnant adolescent patients were examined. Information about maternal depressive symptoms and birth outcomes was collected.Setting: Data were collected at Washington Hospital Center, a nonprofit, community-based hospital that serves residents throughout the Washington, DC area.Participants: Participants were 294 African-American and Latina adolescent mothers. Mean age was 16.2 years (standard deviation [SD] 1.4). Based on self-reports of depressive symptoms, adolescents were categorized by the following: no reported symptoms, depressive symptoms without SI/SA (suicidal ideation or attempt), and depressive symptoms with SI/SA.Main Outcome Measures: Infant birth weight and gestational age at delivery.Results: Over one-quarter of pregnant adolescents in this study reported symptoms of depression. Adolescents reporting depressive symptoms with SI/SA delivered babies that weighed 239.5 grams (98.3% confidence interval [CI] 3.9 to 475.1) less than babies born to mothers reporting depressive symptoms without SI/SA. There was no association between reported symptoms and gestational age.Conclusions: Results suggest that compared to nonpregnant teens and adults, pregnant teens may have an increased risk for depression. Additionally, pregnant adolescents with suicidal ideation are at greater risk for delivering infants of lower birth weight compared with teens reporting depressive symptoms without SI/SA and teens reporting no symptoms. This study supports the need for early screening and treatment of depression for young pregnant women.

Bone Accretion in Adolescents Using the Combined Estrogen and Progestin Transdermal Contraceptive Method Ortho Evra: A Pilot Study

2009-08-03

Abstract: Objective: To date, there are no data regarding the effect of the transdermal combined estrogen and progestin contraceptive Ortho Evra on bone mineral content (BMC) and bone mineral density (BMD). We examined the effects of transdermally delivered ethinyl estradiol and norelgestromin on whole body (WB) BMC and BMD of the hip and lumbar spine (LS) of adolescent girls.Methods: In a matched case-control study, girls (n = 5) who applied Ortho Evra for days 1-21 followed by days 22-28 free of medication for 13 cycles (about 12 months) were compared with 5 age- and ethnicity-matched control girls. Evaluations of calcium intake; bone-protective physical activity; bone densitometry (DXA, QDR 4500A, Hologic); bone formation markers serum osteocalcin (OC) and bone-specific alkaline phosphatase (BAP); bone resorption marker urinary N-telopeptide (uNTX); insulin growth factor-1 (IGF-1); and sex hormone binding globulin (SHBG) were carried out at initiation, 6 months, and 12 months. Changes from baseline were compared using mixed models, adjusting for follow-up comparisons using the Holm Test (sequential Bonferroni).Results: There were no significant differences (SD) between groups at baseline in age, gynecologic age, WBBMC, hip BMD, and LSBMD. Girls on Ortho Evra did not change significantly in WBBMC (12-month mean increase 0.2% ± 0.8%), whereas controls did (3.9% ± 1.8%, P ≤ .001, adjusted P = .002), with SD between the 2 groups (P = .007, adjusted P = .036). Adolescents on Ortho Evra did not change significantly in hip BMD (12-month mean increase 0.5% ± 0.6%), whereas controls did (2.7% ± 0.6%, P ≤ .001, adjusted P = .004), with SD between the 2 groups (P = .024) prior to adjustment for multiple comparisons, but no SD after adjustment (P = .096). Similarly, although the increase in LSBMD within the control group after 12 months (mean increase 2.8% ± 1.0%) was statistically significant (P = .009, adjusted P = .044), the change within the treatment group (12-month mean increase 0.8% ± 0.8%) was not. However, percent LSBMD changes after 12 months did not significantly differ between the 2 groups before or after adjustment for multiple comparisons. Calcium intake and bone-protective physical activity did not significantly predict BMC and BMD changes of study participants. There was a significantly greater increase in SHBG levels in the treatment group after 6 months (P = .003, adjusted P = .013) and 12 months (P ≤ .001, adjusted P ≤ .001) than in controls. Changes in levels of OC, BAP, uNTX, and IGF-1 were not significantly different between the 2 groups.Conclusions: Ortho Evra use attenuates bone mass acquisition in young women who are still undergoing skeletal maturation. This attenuation may be attributed in part to increased SHBG levels, which reduce the concentrations of free estradiol and free testosterone that are available to interact with receptors on the bone. Clinical implications remain to be determined in studies with a larger number of adolescents.

Evaluation of an HIV/STD Sexual Risk-Reduction Intervention for Pregnant African American Adolescents Attending a Prenatal Clinic in an Urban Public Hospital: Preliminary Evidence of Efficacy

R.J. DiClemente, G.M. Wingood, E. Rose, J.M. Sales, R.A. Crosby — 2009-07-30

Abstract: Study Objective: To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents.Design: A randomized controlled trial. Participants completed baseline and follow-up assessments.Setting: An urban public hospital in the Southeastern U.S.Participants: Pregnant African-American adolescents (N=170), 14–20 years of age, attending a prenatal clinic.Intervention: Intervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition.Main Outcome Measures: Consistent condom use.Results: Intervention participants reported greater condom use at last intercourse (adjusted odds ratio=3.9, P=0.05) and consistent condom use (AOR=7.9, P=0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex.Conclusions: Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.

Discussions of Vaginal Douching with Family Members

Mary B. Short, William R. Black, Katie Flynn — 2009-07-30

Abstract: Purpose: This study examined women's personal douching history and the information they were given by others.Methods: Participants in the study (N=199; mean age=28.92) completed a 48-question survey on douching practices and attitudes.Results: Fifty-seven percent of participants had douched and 39% currently douche. The majority of women reported douching after menstruation, before or after sex, or as needed. Reasons for douching included maintaining cleanliness, feeling good and fresh, eliminating vaginal odor, and removing menstrual blood. Most women (69%) had at least one discussion about douching, with 49% having a discussion with their mother and 22% with a health care provider (HCP). Of the women who currently do not douche, 47% stopped after a HCP instructed them to quit; whereas, 100% of women whose HCP encouraged douching went on to douche. Furthermore, 66% of women planned to discuss douching with a younger girl, with 57% encouraging or being neutral and 43% discouraging it. Women who have previously douched were more likely to discuss and encourage douching than women who had never douched. Also, women who have received a discussion about douching or were encouraged to douche were more likely to douche than women who had not received a discussion or were discouraged.Conclusions: Results from this study suggest that younger generations may be taught about or encouraged to douche by their mothers. By giving women accurate information and discouraging douching, women may be less likely to douche or encourage douching in their daughters.

Vitamin D Insufficiency Is Prevalent among Pregnant African American Adolescents

2009-07-30

Abstract: Study Objective: Recent attention has focused on vitamin D insufficiency but few data exist on vitamin D status among pregnant minority youth.Design: A screening study was undertaken in adolescents having prenatal blood samples drawn for other routine tests obtained during the second trimester (18±1.8 week gestation, n=44) or third trimester of pregnancy (28.4±2.1 week gestation, n=36). Serum 25- hydroxyvitamin D (25(OH)D) was measured and significant determinants of vitamin D insufficiency in this cohort were identified.Setting: Urban prenatal clinic.Participants: Eighty pregnant African American adolescents (≤ 18 y of age).Main Outcome Measure(s): Vitamin D status, STDs, hemoglobin, season, birth weightResults: Serum 25(OH)D in this group averaged 21.6±8 ng/mL (age 16.5±1.1 y, n=80), and did not significantly differ between the second (20.95±8.2 ng/mL, n=44) and third trimester cohorts (22.5±7.9 ng/mL, n=36). Vitamin D insufficiency (< 20 ng/mL) was evident in 46.25% and vitamin D deficiency (<15 ng/mL) was evident in 21.25% of those studied. Significant predictors of suboptimal vitamin D status included sampling during the winter months (P=0.004), lower hemoglobin concentration (P=0.019), and higher second trimester leptin levels (P=0.018). Inverse associations between 25(OH)D and bacterial vaginosis were evident when controlled for season of sampling (P=0.02, n=80).Conclusions: Vitamin D insufficiency was prevalent among urban pregnant minority adolescents. Further studies are needed to address the impact of this finding on maternal and neonatal calcium homeostasis and bone health.

Bilateral Ovarian Serous Borderline Tumor with a Giant Non-invasive Peritoneal Implant in a Four-Year-Old Girl

2009-10-19

Abstract: Epithelial ovarian tumors are uncommon before 20 years of age and rarely occur before puberty. The vast majority of these tumors are benign, and few cases of malignant and borderline tumors are described.We report a case of a 4-year-old premenarchal girl, previously healthy, who presented with two abdominal masses. Laboratory analysis of blood showed elevation of the serum level of the CA-125. Ultrasonographic examination disclosed bilateral cystic ovarian masses. Laparoscopic exploration revealed bilateral ovarian multicystic masses with retro-uterine peritoneal implant. Bilateral salpingo-oophorectomy with implant resection was performed. Histologic findings were consistent with a serous borderline tumors of both ovaries and the peritoneal implant was of the non-invasive type. There is no evidence of recurrence at 3-year follow-up.To our knowledge, there are only four cases of ovarian borderline tumors in premenarchal girls reported in the English literature: three of the mucinous type and only one of the serous type.

Cultured Bilayered Skin Allograft for Vaginal Construction

Albert Altchek, Andrew Hanflik, Liane Deligdisch, Harold Brem — 2009-09-04

Abstract: Objective: This is the first report of live human cultured bilayered skin allograft (taken from another person) (LHCBSA) to line a dissected space to create a vagina.Case: A 19-year-old with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome) of vaginal and uterine agenesis had a space dissected and lined with LHCBSA. Although the lining devitalized within 2 weeks, there was a rapid ingrowth of vaginal mucosal cells from the vaginal dimple with an excellent long-term result.Conclusion: This is the first report that LHCBSA is able to stimulate vaginal mucosal cell growth for a neovagina. It is possible that it might stimulate other surface tissue lining to cover adjacent raw areas such as bladder or esophagus.

Abiotrophia/Granulicatella Tubo-ovarian Abscess in an Adolescent Virginal Female

William G. Gensheimer, Sireesha Y. Reddy, Marcy Mulconry, Christine Greves — 2009-08-17

Abstract: Tubo-ovarian abscess (TOA) is a common acute complication of pelvic inflammatory disease (PID). It can also develop as a complication of pelvic or abdominal surgery, malignancy, and intra-abdominal processes such as appendicitis. In premenopausal women, PID is the most common cause of tubo-ovarian abscess. We report a case of tubo-ovarian abscess in a virginal adolescent female with no past surgical history and no known history of appendicitis, inflammatory bowel disease, or cancer. Cultures of the tubo-ovarian abscess drainage grew Abiotrophia/Granulicatella species. This case supports including TOA in the broad differential diagnosis for abdominal pain with fever in adolescent females regardless of sexual history.

Mullerian Adenosarcoma of the Uterine Cervix in an Adolescent Girl

S. Buyukkurt, A.B. Guzel, D. Gumurdulu, M.A. Vardar, H. Zeren, M. Sucu — 2009-07-30

Abstract: Background: Cervical adenosarcoma is a rare gynecological tumor which is prone to recur locally. A case of cervical adenosarcoma in a 14-year-old girl treated in order to preserve fertility.Case: A 14-year-old girl presented with a pedunculated mass protruding from the vagina. Simple excision was performed. Histological evaluation revealed adenosarcoma. Her clinical course has been uneventful for fifteen months.Summary and Conclusion: Adenosarcoma is a low malignant potential tumor of the female genital tract. A simple excision may be an option for young women who need to preserve their fertility. It is mandatory to monitor regularly the cervical base of the lesion for the purpose of the high potential of the local recurrence.

Venous Thrombosis and Congenital Absence of Inferior Vena Cava in a Patient with Menorrhagia and Pelvic Pain

J.L. Nichols, S.C. Gonzalez, P.J. Bellino, E.J. Bieber — 2009-07-30

Abstract: Background: Agenesis of the inferior vena cava (IVC) is an uncommon congenital vascular malformation. We report a case in a teenage female recently started on oral contraception.Case: Because of menorrhagia, the patient had begun an oral contraceptive pill (OCP) 1½ months prior to presentation. She initially presented with pelvic and lower back pain, and imaging showed a pelvic deep venous thrombosis (DVT) and an interrupted IVC. Anticoagulation was started, the OCP was discontinued, and a discussion occurred regarding the treatment options for her menorrhagia following her recent diagnosis.Summary and Conclusion: The case presented shows the rare occurrence of the congenital absence of an IVC with pelvic thrombosis in a young female with a history of menorrhagia and new onset of pelvic pain. The evaluation of this case report leads to a comprehensive review in the treatment choice for menorrhagia with the preceding history of a thrombotic event.

Vaginal Stones in a 5-Year-Old Girl: A Novel Approach of Removal

Judith W. Jaspers, Simone M. Kuppens, Andre A. van Zundert, Michel J. de Wildt — 2009-07-30

Abstract: Background: Primary vaginal stones in children are extremely rare and removal can be difficult. We describe a procedure for safe extraction of vaginal stones.Case: A 5-year-old, wheelchair-bound girl was referred to the urologic department with recurrent febrile urinary tract infection. Diagnostics of the kidneys showed no abnormalities. The bladder appeared to contain two stones. On urethro-cystoscopy no stones were seen. Vaginoscopy identified vaginal stones. After 4 weeks of estrogen treatment, a second procedure via vaginal introduction of a nephroscope in combination with an ultrasonic device, effectively disintegrated the stones.Summary and Conclusion: We recommend the use of a nephroscope in visualizing the vagina and cervix and facilitating instrumentation in prepubertal girls.

Recurrent Bilateral Serous Cystadenomas in a Premenarchal Girl: A Case Report and Literature Review

S.E. Barton, K.C. Kurek, M.R. Laufer — 2009-07-30

Abstract: Background: Ovarian serous cystadenomas are rare in children. No case of recurrence after surgical resection in a premenarchal girl has been published.Case: An 8-year-old presented with abdominal pain and ultrasound showed bilateral ovarian cystic masses with normal clinical and laboratory exam. Cystectomies were performed revealing serous cystadenomas. Ten months later, her pain returned and ultrasound showed new cysts. Persistence of cysts and symptoms required repeat surgery with the same pathology.Summary and conclusion: Premenarchal girls with ovarian cystic masses require surgical intervention in cases of persistent symptoms, uncertain diagnosis, or concern for ovarian torsion. With reassuring imaging and tumor markers, conservation of the ovary can be achieved with cystectomy alone. Ultrasound follow-up is recommended after surgical resection until bimanual exam can be performed.

Urinary Tract Infection as a Single Presenting Sign of Multiple Vaginal Foreign Bodies: Case Report and Review of the Literature

Endre Z. Neulander, Alex Tiktinsky, Igor Romanowsky, Jacob Kaneti — 2009-07-30

Abstract: Background: Vaginal foreign bodies in children usually present with foul-smelling discharge and/or vaginal bleeding. Rarely, these basic clinical diagnostic signs are not present.Case: We report on a 5½-year-old girl with recurrent lower urinary tract infection as the sole presentation of multiple vaginal foreign bodies. Ultrasound of the lower urinary tract was inconclusive, and cystography indicated for recurrent urinary tract infections was declined by the patient in an outpatient setting. Cystography under general anesthesia raised the suspicion of foreign vaginal objects, and the definitive diagnosis was made by vaginoscopy. The relevant literature covering this subject is reviewed.Conclusion: High level of suspicion and strict basic diagnostic protocol are the most important steps for a timely diagnosis of this condition.

Endometriosis in a Patient with Mayer-Rokitansky-Küster-Hauser Syndrome and Complete Uterine Agenesis: Evidence to Support the Theory of Coelomic Metaplasia

Evelyn Y. Mok-Lin, Adam Wolfberg, Heidi Hollinquist, Marc R. Laufer — 2009-07-09

Abstract: Background: There are many hypotheses regarding the pathogenesis of endometriosis. Most theories, including retrograde menstruation, require the existence of a uterine structure and endometrial tissue. We report endometriosis with the absence of a uterus. This finding supports the theory of coelomic metaplasia.Case: A 20-year-old with Mayer-Rokitansky-Küster-Hauser syndrome presented with increasing pelvic pain and underwent laparoscopy. Uterine, cervical, vaginal, and tubal agenesis was confirmed. Stage I endometriosis was visualized in the posterior cul-de-sac and destroyed. She received medical therapy for 5 years until she represented with pain and underwent another laparoscopy, at which endometriosis was again identified and destroyed.Summary and Conclusion: This case of endometriosis in a patient with complete uterine agenesis supports the theory of coelomic metaplasia.

Augmentation Vaginoplasty of Colonic Neovagina Stricture Using Oral Mucosa Graft

Meghan B. Oakes, Stacy Beck, Yolanda R. Smith, Elisabeth H. Quint, John M. Park — 2009-07-09

Abstract: Background: Vaginal reconstruction is performed for a variety of congenital and acquired anomalies, and several techniques have been described. Conventional neovaginal reconstructions typically involve skin grafts or vascularized intestinal segments. Oral mucosa has been used successfully in urethral reconstruction, and several long-term studies have demonstrated its surgical versatility and durability.Case Report: Here we present the successful use of an oral mucosal graft in the surgical treatment of a strictured, colonic neovagina in a 19-year-old, 46XX female with cloacal exstrophy.Conclusion: Though the literature contains reports of oral mucosal grafts in primary gynecologic surgeries, this is the first report describing the use of buccal mucosa for a secondary, neovagina reconstruction. Based on the outcome of our case, we conclude that oral mucosa is a promising graft material suitable for vaginal reconstructions.Synopsis: We report a novel use of oral mucosa free graft to augment a long, strictured segment of previously reconstructed colonic neovagina in a young woman with cloacal exstrophy.

Hypoplastic Uterus and Clitoris Enlargement in Swyer Syndrome

Valérie Hétu, Evelyne Caron, Diane Francoeur — 2009-07-30

Abstract: Background: Swyer syndrome is associated with absent testicular differentiation in a 46XY phenotypic female.Case: A 17-year-old female presented with primary amenorrhea and 46XY karyotype. Breast and pubic hair development were Tanner 2, and clitoral enlargement was noted. Magnetic resonance imaging revealed a hypoplastic uterus and 2 “normal ovaries.” Serum follicle-stimulating hormone and luteinizing hormone were elevated. Testosterone and androstenedione were in the female range. Dehydroepiandrosterone sulfate was slightly elevated. Laparoscopic bilateral gonadectomy was performed. Pathology reports showed bilateral microscopic benign hilar cell tumors.Summary and Conclusion: The diagnosis was a real puzzle for the clinicians because of the association of clitoral hypertrophy without hirsutism, female internal genitalia, and a 46XY karyotype. Clitoral enlargement can be explained by transient androgen secretion by the hilar cells found in the resected gonads.

Premenarchal Ovarian Torsion and Elevated CA-125

Jenifer D. McCarthy, Kimberly M. Erickson, Yolanda R. Smith, Elisabeth H. Quint — 2009-07-09

Abstract: Background: Ovarian tumors are the most common gynecologic malignancy occurring in childhood, with germ cell tumors being most frequent. This contrasts with adults where epithelial tumors account for most ovarian neoplasms. Tumor markers are an integral part of the work-up and may guide management.Case: A 6-year-old girl with a persistent adnexal mass was found to have a highly elevated CA-125. Other tumor markers were normal. Laparoscopy revealed an enlarged, adherent ovary. A minilaparotomy revealed an ovary filled with necrotic material. This necrotic material was excised and the ovary was spared. The pathology was consistent with necrosis. Follow-up ultrasonography and CA-125 were normal.Summary and Conclusions: This case demonstrates for the first time the association of an elevated CA-125 and ovarian torsion in a pediatric patient. This benign finding allowed attempting a conservative ovary-sparing approach during the surgery even in the presence of a highly elevated CA-125. However, in general, for children CA-125 is of limited utility, as it will not affect the indication for surgical exploration of persistent masses and elevations in CA-125 may discourage ovarian conservation.

The STD/Alcohol Connection

Angela Nicoletti — 2010-02-01

It is well known that teens and young adults have the highest rates of sexually transmitted diseases (STDs), particularly gonorrhea and chlamydia. One might logically assume that this group would also be more frequently screened for STDs; however, this appears not to be the case. A study by the Centers for Disease Control (CDC) Division of STD Prevention in 2005, using data from the National Ambulatory Medical Care Survey, found that young women were not screened at 84.0% of 1.2 million asymptomatic preventive visits and were not tested for chlamydia at 78.3% of 0.6 million visits where they presented with signs or symptoms of chlamydia.

Introduction: HPV Vaccination: Time to End the Debate

Sari Kives — 2009-09-07

The HPV vaccine has now been available in the USA and Canada since 2006 and has received a significant amount of negative publicity from parents, social commentators and religious leaders. Many articles have been written about concerns around the vaccine's long-term safety and efficacy, its potential impact on our daughters' sexual behavior and the promotion of premarital sex and its potential contradiction to the abstinence-only programs in many states. As a result, it has been a tough sell for many parents who have reservations about whether to have their daughters vaccinated. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) have, however, endorsed the Gardasil vaccine for protection against cervical cancer for all girls at age 11 or 12. The objective of this program is to deliver protection before or not long after their “sexual debut” to the expected 40% of girls that would become infected with HPV within two years of becoming sexually active. Now that the vaccine has been available for 3 years and the evidence in favor of the vaccine has been so compelling, is the debate finally over? I have asked Dr. Mark Harris Yudin, an infectious disease specialist in gynecology, to provide an opinion on this controversial subject.

HPV Vaccination: Time to End the Debate

Mark H. Yudin — 2009-09-09

Why is there such extensive debate surrounding vaccination for human papillomavirus (HPV)? Ever since the vaccine was approved, detractors have used various arguments to make the point that we as a society should not be so quick to accept this important vaccine, and that we as health care professionals should not be so quick to advocate its use for our patients. Concerns expressed have included apprehension regarding vaccine safety and long-term efficacy, and the argument that vaccinating adolescents against a sexually transmitted infection is tantamount to encouraging them to become sexually active. In fact, HPV vaccines are extremely safe and effective, and represent one of the most promising and exciting health care milestones of our time.

Assessment of Pregnancy Outcomes with Uterine Leiomyomas Larger Than 10 cm; Antepartum and Postpartum Complications

Volkan Turan, Mete Ergenoglu, Ozgür Yeniel, Murat Ulukuş — 2009-10-30

Dear Editor, We have found that the increased number of premature deliveries and cesarean deliveries, as well as the increase in postpartum bleeding and infections such as endometritis, may be caused by large uterine myomas. Sonograms in patients with fibroids were reviewed between 2007 and 2009 in the Department of Obstetrics and Gynecology at Ege University to determine the number of fibroids, their sizes, their locations, and relationship with the placenta. Cesarean ratio, preterm loss of pregnancy, and the incidence of postpartum complications were also evaluated.

The Johns Hopkins Manual of Gynecology and Obstetrics

Carolyn Foley, Brinda N. Kalro — 2009-07-10

This compact manual offers a thorough and comprehensive, yet concise reference of clinical topics in obstetrics and gynecology. Written by residents in obstetrics and gynecology at The Johns Hopkins University in an outline format modeled after the popular Washington Manual of Medical of Medical Therapeutics, this text is a useful clinically-oriented resource for residents and medical students on their obstetrics and gynecology rotation and will also be valuable for residents and clinicians in family, emergency, and internal medicine.

Comprehensive Gynecology

Jennifer Salati, Suketu Mansuria — 2009-07-30

The most recent edition of Comprehensive Gynecology is a thorough and comprehensive reference of topics in gynecology, ranging from the basic science and anatomy of the female reproductive system to the evidence-based clinical management of gynecologic disorders. Originally published in 1987, the 5th edition has been updated to reflect the advancement in knowledge and understanding of issues in gynecology that has occurred since the release of the 4th edition in 2001. Four new editors and 23 contributing co-authors have assembled to provide the field with an updated and revised text that continues to serve as a valuable educational tool for physicians and students.

Obstetric and Gynecologic Dermatology

Angela S. Casey — 2009-07-30

Obstetric and Gynecologic Dermatology serves as a useful reference for providers in primary care and OBGYN. This book comprehensively covers many of the classic dermatologic conditions seen in the female patient, with a focus on dermatoses of pregnancy. The clinical photos are excellent, and the discussions are concise and straightforward. One subject that the book is lacking is a chapter dedicated to the general description for dermatologic conditions in terms of color, morphology, and distribution. Such information is usually extremely helpful to non-dermatologists in terms of following descriptive terminology in the text as well as aiding in the accuracy of documentation of clinical findings.

Brook's Clinical Pediatric Endocrinology

Wafa R. Alromaih — 2009-07-09

This is the fifth edition of this textbook of pediatric endocrinology, which contains 25 chapters. It opens with a basic science section summarizing the mechanisms of hormone action, genomics, proteomics, and the development of bioinformatics, in which biology and information technology converge (table 2.2) written by Westwood and Kopp Chapters 1 and 2 respectively.

Essential Adolescent Medicine

Pamela J. Taylor, Kimberly K. McClanahan — 2010-02-01

This text was written as a practical guide for residents, mid-level providers, and physicians who treat adolescent patients. The first section of Essential Adolescent Medicine begins with a thorough review of growth and development, legal and ethical issues, cultural diversity, transitioning to adulthood for the disabled, and end-of-life issues. Part II encompasses a review of key organ systems of the body during adolescence. Part III entails a full discussion of gynecology and sexuality. Part IV delves into eating disorders; Part V is an overview of sports medicine; and Part VI is a discussion of mental health issues including substance abuse, disruptive behavior disorders, mood disorders, anxiety disorders, ADHD, and schizophrenia.

Editorial Board