Journal of Pediatric and Adolescent Gynecology RSS feed: Articles in Press. Journal of Pediatric and Adolescent Gynecology includes all aspects of clinical and basic science research in pediatric and adolescent gynecology, as well as molecular biology research as applied to the field. The Journal draws in expertise from a variety of disciplines including pediatrics, obstetrics and gynecology, reproduction and gynecology, reproductive and pediatric endocrinology, genetics, and molecular biology. The Journal of Pediatric and Adolescent Gynecology features original studies, review articles, book and literature reviews, letters to the editor, and communications in brief. It is an essential resource for the libraries of OB/GYN specialists, as well as pediatricians and primary care physicians. http://www.jpagonline.org//inpress?rss=yesElsevier Inc.en © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved. Journal of Pediatric and Adolescent Gynecology1083-31882012-05-11 © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jpagonline.org/article/PIIS1083318812000836/abstract?rss=yesAbstract: Objective: Epithelial ovarian neoplasms are extremely uncommon in children. Ovarian mucinous cystadenoma is benign and an extremely rare presentation in the premenarchal period. Here, we present a case of giant mucinous cystadenoma of the left ovary in a 13-year-old girl and a review of the supporting literature.Case report: The patient in the present case was admitted with a history of increasing abdominal distension and pain for approximately 3 months and a history of an ovarian mass for 3 years. An adnexal mass measuring 40 x 30 x 20 cm was detected by abdominal ultrasonography and computed tomography. The tumour markers CEA, CA 19-9, and CA 125 were high, although alpha fetoprotein and human chorionic antigen were within normal ranges. The patient underwent surgery. The smooth-surfaced mass filled the abdomen. A frozen biopsy was performed and the results indicated a benign mucinous cystadenoma. We performed a unilateral oophorectomy with tumour removal.Conclusion: The ovarian mass was revealed by abdominal distension and a diagnosis was established by frozen biopsy. Complete and careful surgical resection provides satisfactory results; however, careful follow-up is required.An extra large ovarian mucinous cystadenoma in a premenarchal girl and a review of the literature - Accepted ManuscriptMuazez Cevik10.1016/j.jpag.2012.04.007Journal of Pediatric and Adolescent Gynecology (2012)2012-05-11Journal of Pediatric and Adolescent Gynecology2012-05-11http://www.jpagonline.org/article/PIIS1083318812000848/abstract?rss=yesAbstract: Study Objective: The objective was to quantify cis and trans fatty acids in maternal plasma and infant cord plasma from adolescent mothers.Design: In 80 adolescent healthy mothers, we sampled maternal blood postpartum and umbilical cord blood at birth. Trans fatty acids (tFA), linoleic (18:2), and arachidonic (20:4, AA) acids of the n-6 family, and alpha-linolenic (18:3), eicosapentaenoic (20:5, EPA) and docosahexaenoic (22:6, DHA) acids of the n-3 family were analyzed by gas-liquid chromatography. Results were expressed as a percentage of total fatty acids.Results: Linoleic fatty acid was present in greater proportions in the maternal plasma than in that of the umbilical cord, whereas AA was present in greater proportions in the total lipids of the blood of the umbilical cord. DHA was the LC-PUFA of the n-3 family predominant in both the maternal and umbilical-cord plasma. The tFAs in the maternal plasma had a negative correlation with oleic acid and linoleic acid. Linolenic acid had a positive correlation with the cephalic perimeter upon birth. A tendency for a negative correlation between trans isomers and gestational age at birth (p = 0.05) was observed.Conclusions: LC-PUFAs that are important to growth and development of the fetus were found in greater quantities in the cord blood of the newborns of adolescents than in the maternal blood, indicating a priority of transfer of AA and DHA fatty acids to the fetus. Despite the lower levels of tFAs found in the maternal blood, we verified potential risk for premature birth.Status of cis and trans Fatty Acids in Brazilian Adolescent Mothers and their Newborns - Accepted ManuscriptF.S. Santos, C.R.M. Chaves, R.S.S. Costa, O.R.C. Oliveira, M.G. Santana, F.D. Conceição, F.L.C. Sardinha, G.V. Veiga, M.G. Tavares do Carmo10.1016/j.jpag.2012.05.001Journal of Pediatric and Adolescent Gynecology (2012)2012-05-10Journal of Pediatric and Adolescent Gynecology2012-05-10http://www.jpagonline.org/article/PIIS1083318812000800/abstract?rss=yesAbstract: Study Objective: To explore the perceptions of perimenarchal females and their mothers regarding tampons and tampon use.Design: Descriptive study; convenience sample surveySetting: Diverse pediatric practice settingParticipants: 139 females 11-18 years of age and 129 of their mothers/female guardiansIntervention: SurveyMain outcome measures: frequencies, chi square associationsResults: Most adolescents (38-55%) respond “don't know” to various attitude and knowledge items pertaining to tampon use. Adolescent-mother pairs report similar perceptions about tampon use for adolescents. Mothers and adolescents who have “ever tried” tampons (including 68% and 56% of respondents, respectively) have more favorable attitudes about tampons than those who have not tried tampons. Adolescent females list their mothers as the primary source of tampon information; 70% of adolescents and 66% of mothers report that no doctor has spoken to them about tampon use for the daughter.Conclusions: There is a vast educational deficit among both adolescent females and their mothers regarding the use of tampons among youth. Adolescents and their mothers note that few providers have educated 11-18 year old females or their parents about tampons. Providers have the opportunity to impact adolescent health choices and quality of life associated with tampon use.Perceptions Among Adolescent Girls and Their Mothers Regarding Tampon Use - Accepted ManuscriptAmy B. Middleman, Jamie Varughese10.1016/j.jpag.2012.04.004Journal of Pediatric and Adolescent Gynecology (2012)2012-05-09Journal of Pediatric and Adolescent Gynecology2012-05-09http://www.jpagonline.org/article/PIIS1083318812000824/abstract?rss=yesHigh Level of Agreement Between Clinician-collected and Self-collected Samples for HPV Detection Among South African Adolescents - Accepted ManuscriptDavid H. Adler, Anthony Almudevar, Glenda E. Gray, Bruce Allan, Anna-Lise Williamson10.1016/j.jpag.2012.04.006Journal of Pediatric and Adolescent Gynecology (2012)2012-05-09Journal of Pediatric and Adolescent Gynecology2012-05-09http://www.jpagonline.org/article/PIIS1083318812000484/abstract?rss=yesAbstract: Study Objective: The current study presents findings from a qualitative examination of free text comments from a national survey of U.S. physicians on human papillomavirus vaccine recommendation beliefs and practices. Qualitative analyses of free text physician responses may offer a more complete and physician-driven description of influences on human papillomavirus vaccine recommendation.Design and Participants: In 2009, a survey assessing physicians' knowledge, attitudes, and human papillomavirus vaccination practices was conducted among a national sample of U.S. physicians practicing Family Medicine, Pediatrics, or Obstetrics/Gynecology (response rate 67.8%). Qualitative comments were analyzed using a Grounded Theory approach.Results: Of 1008 completed surveys, 112 participants provided comments, which were organized into three primary HPV vaccine-related themes: (a) comments about cost of the vaccine, (b) comments about institutional policies and procedures, and (c) physicians' personal views and one secondary theme related to survey methodology: the parent study's use of an upfront cash incentive. Many comments pertained to issues that were queried in the closed-end survey items; however, some comments provided insight into understudied areas (e.g., physician attitudes regarding survey methodology).Conclusion: Physician respondents used the free text space to reemphasize issues that were most important to them and to offer insight about aspects of the vaccine and the survey process.A National Survey about Human Papillomavirus Vaccination: What We Didn't Ask, But Physicians Wanted Us to Know - Corrected ProofGwendolyn P. Quinn, Devin Murphy, Teri L. Malo, Juliette Christie, Susan T. Vadaparampil10.1016/j.jpag.2012.02.007Journal of Pediatric and Adolescent Gynecology (2012)2012-04-20Journal of Pediatric and Adolescent Gynecology2012-04-20ORIGINAL STUDYhttp://www.jpagonline.org/article/PIIS1083318811005365/abstract?rss=yesIt is the rare adolescent who does not complain of fatigue at some point during the teen years. For most, their schedules and lifestyles lead to sleep deficits on a regular basis, with the occurrence of minor viral illnesses often exacerbating the situation. By and large, adolescents continue to function in their daily activities despite whatever fatigue they are experiencing. When the complaint of fatigue is raised by the patient or parent in the physician’s office, it implies there may be something out of the ordinary about the degree of fatigue being experienced by that adolescent, and the complaint becomes worthy of attention. It can be the symptom of an underlying medical condition, a psychological or psychiatric difficulty, or a specific sleep disorder. This review provides a framework for evaluating the complaint of fatigue in adolescents and offers approaches to management. This communication is based on the author’s personal experience in the clinical management of fatigue in adolescents and draws from the growing literature on the subject. Two particularly useful recent references on this topic are the December 2010 edition of Adolescent Medicine: State of the Art Reviews on Sleep and Sleep Disorders in Adolescents and the June 2011 edition of Pediatric Clinics of North America, which provides a Pediatric Sleep Medicine Update.Fatigue in Adolescents - Corrected ProofMartin Fisher10.1016/j.jpag.2011.12.067Journal of Pediatric and Adolescent Gynecology (2012)2012-04-05Journal of Pediatric and Adolescent Gynecology2012-04-05MINI-REVIEWhttp://www.jpagonline.org/article/PIIS1083318811005353/abstract?rss=yesAbstract: Background: 46,XY, or Swyer syndrome, is a complete gonadal dysgenesis. Patients usually presents with primary amenorrhea with underdeveloped secondary sex characteristics. Phenotypes of these patients are female. In this report, a Swyer syndrome case is reported with novel clinical features that are classified as connective tissue disorders. This case and the 2 other previously reported Swyer syndrome cases with ascendant aortic aneurysm and diaphragmatic hernia are suggest that the Y chromosome has an important role in the structure of connective tissue.Case: Here we report a case of a 17-year-old with clinical features of 46,XY complete gonadal dysgenesis including external female genitalia, hypoplastic uterus, hypergonadotrophic hypogonadism, incomplete secondary sex characterics, primary amenorrhea, and normal male karyotype. In addition, she had mild mental retardation, severe rotoscoliosis, pectus excavatus, spina bifida occulta, hip dislocation, and long, slender extremities. She had a rudimentary uterus and streak gonads; after giving her cyclic estrogen and progesterone pills, she was able to menstruate.Summary and Conclusion: In this report, a Swyer syndrome case was discussed regarding clinical features, especially those are not characteristic for Swyer syndrome after a review of the literature.A Complete Gonadal Dysgenesis Case with Mental Retardation, Congenital Hip Dislocation, Severe Vertebra Rotoscoliosis, Pectus Excavatus, and Spina Bifida Occulta - Corrected ProofCem Dane, Aysegul Karaca, Ender Karaca, Banu Dane10.1016/j.jpag.2011.12.066Journal of Pediatric and Adolescent Gynecology (2012)2012-02-23Journal of Pediatric and Adolescent Gynecology2012-02-23MINI-REVIEWhttp://www.jpagonline.org/article/PIIS1083318811005341/abstract?rss=yesAbstract: Background: Childhood vaginal discharge remains a frequent reason for referral from primary to secondary care. The Paediatric and Adolescent Gynaecology (PAG) service at Kettering General Hospital was established in 1993 and provides a specialized service that meets the needs of children with gynaecological conditions.Aim: To investigate recurrent vaginal discharge noting symptomatology, defining pathogens, common and rarer causes, exploring management regimes, and any changes in practice over time.Method: Retrospective review spanning 15 years identifying prepubertal children attending the outpatient PAG clinic with recurrent vaginal discharge. We reviewed the medical notes individually.Results: 110 patients were identified; 85% were referred from primary care. The age distribution was bimodal at four and eight years. Thirty-five percent of our patients were discharged after the initial consultation. The commonest cause of discharge was vulvovaginitis (82%). Other important causes included suspected sexual abuse (5%), foreign body (3%), labial adhesions (3%), vaginal agenesis (2%). 35% of patients were admitted for vaginoscopy.Conclusion: Vaginal discharge is the most common gynecological symptom in prepubertal girls and can cause repeated clinical episodes. Vulvovaginitis is the most common cause and often responds to simple hygiene measures. Awareness of the less common causes of vaginal discharge is essential.Recurrent Vaginal Discharge in Children - Corrected ProofSharon McGreal, Paul Wood10.1016/j.jpag.2011.12.065Journal of Pediatric and Adolescent Gynecology (2012)2012-01-24Journal of Pediatric and Adolescent Gynecology2012-01-24ORIGINAL STUDYhttp://www.jpagonline.org/article/PIIS1083318811004207/abstract?rss=yesAbstract: Study Objective: To review the medical literature and determine whether testing for von Willebrand disease can be performed in adolescents using combined hormonal contraceptives (CHC).Design: Literature review where Embase and Medline were searched using the key words “von Willebrand factor,” “von Willebrand disease,” “contraceptive agents,” and “menorrhagia.” Articles were included in the review if they were controlled trials comparing a current form of CHC versus a control group and testing for von Willebrand factor was performed and reported.Main Outcome Measures: Impact of combined hormonal contraceptives on von Willebrand factor antigen. Secondary outcomes included effects on Factor VIII and von Willebrand factor activity known as the Ristocetin cofactor.Results: Seven articles met inclusion criteria. All seven assessed VWF Ag with CHC use; six of the seven demonstrated no change and one, Gevers Leuven, demonstrated a significant decrease after CHC use. Three studies measured Factor VIII and showed no significant change with use. One study by Kadir assessed the Ristocetin cofactor and also failed to demonstrate change on CHC.Conclusion: From the literature it appears that adolescents, assessed for menorrhagia and already on combined hormonal contraceptives, can be tested for von Willebrand disease if this diagnosis is suspected by the physician. By allowing adolescents to remain on combined hormonal contraceptives during testing, one avoids the risk of recurrent and severe menorrhagia which could result in admission and transfusion.Can von Willebrand Disease Be Investigated on Combined Hormonal Contraceptives? - Corrected ProofTania Dumont, Lisa Allen, Sari Kives10.1016/j.jpag.2011.10.010Journal of Pediatric and Adolescent Gynecology (2011)2011-12-30Journal of Pediatric and Adolescent Gynecology2011-12-30MINI-REVIEWhttp://www.jpagonline.org/article/PIIS1083318811003846/abstract?rss=yesAbstract: Hypogonadal adolescent girls need estrogen therapy for the induction of puberty. For years, oral conjugated estrogens have been used for this purpose, starting at a very low dose, with gradual increments over time, to allow for the maturation of the reproductive organs, in order to mimic physiologic conditions. Several concerns, mainly due to first pass through the liver, are manifest with oral estrogen therapy. With the advent of transdermal estrogens and its improved efficacy profile as well as reduced side effects, it seems reasonable to consider it for pubertal induction. The primary objective of this study was to compare and contrast oral versus transdermal estrogen with regard to metabolism and physiology and to review current available data on transdermal estrogens with respect to exogenous pubertal induction.Exogenous Pubertal Induction by Oral versus Transdermal Estrogen Therapy - Corrected ProofLisa Kenigsberg, Sadana Balachandar, Kris Prasad, Bina Shah10.1016/j.jpag.2011.09.012Journal of Pediatric and Adolescent Gynecology (2011)2011-11-24Journal of Pediatric and Adolescent Gynecology2011-11-24MINI-REVIEWhttp://www.jpagonline.org/article/PIIS1083318811003822/abstract?rss=yesAbstract: During adolescence, individuals develop increased ability to have emotionally and physically intimate relationships. The type of intimate relationship will make a difference as to whether the adolescent engages in protective behaviors or avoids risky behaviors. However, in reviewing the literature on the association of relationship type and sexual risk and protective behaviors, four methodological challenges were noted. These challenges limit our understanding of the impact of relationship type. These four challenges are: (a) inconsistent definitional frameworks; (b) lack of adolescent voices; (c) lack of consideration of gender; and (d) poor differentiation between individual and relationship risk. These issues direct the course of future work in this area and are necessary to advance the field of adolescent sexual health, particularly with regard to the development and testing of appropriate interventions designed to reduce untoward outcomes of adolescent sexuality.Adolescent Intimate Heterosexual Relationships: Measurement Issues - Corrected ProofMary B. Short, Marina Catallozzi, Carmen Radecki Breitkopf, Beth A. Auslander, Susan L. Rosenthal10.1016/j.jpag.2011.09.010Journal of Pediatric and Adolescent Gynecology (2011)2011-11-17Journal of Pediatric and Adolescent Gynecology2011-11-17MINI-REVIEWhttp://www.jpagonline.org/article/PIIS1083318811003068/abstract?rss=yesAbstract: We report a 5-month-old male infant with benign unilateral bloody nipple discharge, and we present a brief review of 20 previously described cases of bloody nipple discharge in infancy. On the basis of our case and previous reports, we offer recommendations for the management of the bloody nipple discharge in the first year of life: (1) diagnosis should be based on noninvasive diagnostic procedures, in the absence of dubious ultrasound or cytological diagnostic findings; (2) the condition resolves spontaneously, and surgical intervention should be avoided; (3) manipulation of the nipple can prolong the bleeding; (4) antibiotics should be given only in the presence of clear clinical and cytological signs of infection; and (5) parent reassurance is an important part of infantile bloody nipple discharge management.Bloody Nipple Discharge in Infancy: A Case Report and Recommendations for Management - Corrected ProofZ. Pleša Premilovac, V. Tokić10.1016/j.jpag.2011.07.013Journal of Pediatric and Adolescent Gynecology (2011)2011-09-26Journal of Pediatric and Adolescent Gynecology2011-09-26ORIGINAL STUDYhttp://www.jpagonline.org/article/PIIS1083318811002403/abstract?rss=yesAbstract: Significant improvement in the survival rates of children with pediatric cancers has been achieved over the last 25 years, so the number of long-term survivors is increasing and their subsequent quality of life is of increasing importance. One of the most serious side effects of chemotherapy or radiotherapy is damage to the ovarian function, which can lead to loss of fertility. The degree of this damage depends on the substances used, the dose of radiotherapy reaching the ovaries, and the age of the girl at the time of treatment. Up to now, the only established method of fertility preservation has been cryoconservation of fertilized egg cells or embryos, but this is not possible in prepubertal girls because of their sexual immaturity.Removal of ovarian tissue and subsequent cryoconservation with the option of later orthotopic retransplantation is therefore an option to these girls. This method can lead to pregnancy and birth in adult women. Up to now there are no studies about the retransplantation of ovarian tissue which was removed before puberty.Displacement of the ovaries away from the radiation field before radiation to the pelvic area can be considered; however, the data is controversial.One problem in the use of fertility preservation methods in these very young patients is that they undergo procedures which, because of their age, they mostly do not understand and the parents must make a decision based on the assumed later wishes of their daughter.Fertility Preservation in Prepubertal Girls Prior to Chemotherapy and Radiotherapy—Review of the Literature - Corrected ProofB. Lawrenz, R. Rothmund, E. Neunhoeffer, S. Huebner, M. Henes10.1016/j.jpag.2011.05.009Journal of Pediatric and Adolescent Gynecology (2011)2011-08-29Journal of Pediatric and Adolescent Gynecology2011-08-29MINI-REVIEWhttp://www.jpagonline.org/article/PIIS1083318811002798/abstract?rss=yesAbstract: Rokitansky syndrome and complete androgen insensitivity syndrome are the most common causes of vaginal agenesis. Treatment should be deferred until adolescence to allow informed consent and compliance. The best treatment for vaginal agenesis remains controversial although vaginal dilation therapy is still widely considered the first line treatment because success rates are high and associated risks are low. A variety of surgical options are also available, each with enthusiastic proponents. Long-term outcome studies on most surgical techniques, however, are still lacking and until recently most studies have reported on success rate in terms of anatomical success only, without including sexual function. Moreover, the medical literature lacks prospective comparative outcome studies, meaning that current choice of surgical procedure relies greatly on the surgeon’s preference and experience.Management of Vaginal Agenesis - Corrected ProofRola S. Nakhal, Sarah M. Creighton10.1016/j.jpag.2011.06.003Journal of Pediatric and Adolescent Gynecology (2011)2011-08-29Journal of Pediatric and Adolescent Gynecology2011-08-29MINI-REVIEWhttp://www.jpagonline.org/article/PIIS1083318811002312/abstract?rss=yesThis paper has been compiled in order to highlight historical and contemporary issues surrounding adolescent sexuality in the context of cultural heritage with the aim of improving understanding and awareness among clinicians caring for young adults.Teenage Sexuality in Different Cultures - Corrected ProofPaul L. Wood10.1016/j.jpag.2011.05.003Journal of Pediatric and Adolescent Gynecology (2011)2011-06-30Journal of Pediatric and Adolescent Gynecology2011-06-30MINI-REVIEW