Journal of Pediatric and Adolescent Gynecology - Articles in Press

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

Vincenzo Puppo — 2012-02-02

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

Modifying Effect of Prenatal Care on the Association between Young Maternal Age and Adverse Birth Outcomes - Corrected Proof

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

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

Recurrent Vaginal Discharge in Children - Corrected Proof

Sharon McGreal, Paul Wood — 2012-01-24

Abstract: 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.

A Case of Vaginoplasty without Grafting - Corrected Proof

K.J. Pulman, S. Kives, M.A. Jamieson — 2012-01-20

Abstract: Background: Many techniques have been used to create a neovagina in patients with vaginal agenesis, and several surgical procedures involve the use of a graft. Grafting techniques are associated with intraoperative and postoperative morbidity and complications, at both the donor and the recipient site.Case: A 17-year-old patient with Mayer-Rokitansky-Kuster-Hauser syndrome complicated by unilateral pelvic kidney underwent successful vaginoplasty without the use of a graft, followed by insertion of a vaginal stent for 12 weeks. She had a functional, well-healed, and fully epithelialized neovagina by 6.5 months postoperatively.Conclusion: Patients undergoing surgical vaginoplasty may benefit from this simple surgical technique, thereby avoiding the morbidity associated with the alternative grafting techniques commonly used in practice.

The Connection between Young Women’s Body Esteem and Sexual Assertiveness - Corrected Proof

Beth A. Auslander, Jaqwiana Baker, Mary B. Short — 2012-01-20

Abstract: Study Objective: Healthy sexuality includes having positive feelings about one’s body and developing positive romantic relationships. Previous research predicts that women dissatisfied with their bodies may be less likely to enforce their rights of sexual autonomy (i.e., sexual assertiveness).Design: We assessed whether the body esteem of young women was related to their reports of sexual assertiveness. Young women from local colleges (N = 127) completed a questionnaire that included demographics, self reported weight and height, sexual history, along with body esteem and sexual assertiveness.Results: Overall, body esteem was related to sexual assertiveness regarding condom use when controlling for other variables. Women with less body esteem were less likely to insist that their partner use a condom. Individual components of body esteem did not independently predict insistence of condom use. Body esteem was not related to initiation of sex or refusal of unwanted sex.Discussion: The current study found relationships between body esteem and sexual assertiveness regarding STI prevention behaviors. Given these findings, implications for STI prevention programs are discussed.

Exercise and Sedentary Habits among Adolescents with PCOS - Corrected Proof

2012-01-20

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

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

2012-01-20

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

Human Papillomavirus Vaccine Policies Among American Indian Tribes in Washington State - Corrected Proof

Jessie Duvall, Dedra Buchwald — 2012-01-20

Abstract: Study Objective: American Indians experience high rates of cervical cancer, which is preventable by vaccination against human papillomavirus (HPV). We sought information on funding, barriers, education, and policies regarding HPV vaccination from clinics that serve tribal members in the Pacific Northwest.Design: We surveyed staff either by telephone or by using a mailed survey at 31 tribal and Indian Health Service clinics serving the 29 federally recognized American Indian tribes in Washington State. The survey included 11 items on policies and use of the HPV vaccine.Main Outcome Measures: Primary outcomes were funding options for HPV vaccine administration, barriers to vaccine delivery, potential gaps in education, and determination of tribal or clinic-specific policies.Results: Thirty-one clinics provided information; 28 administered the vaccine. Vaccination was supported by federal, private, and tribal sources. Barriers were reported by 89% of clinics, most commonly patients' lack of knowledge, distrust of the medical system, and lack of funding. Patient and provider information was widely available. Thirteen clinics had either tribal or internal clinic vaccination policies, or both.Conclusion: HPV vaccine is available, but complex policies on administration could result in tribal differences in vaccination rates.

Using a Patient-Centered Approach to Develop a Fertility Preservation Brochure for Pediatric Oncology Patients: A Pilot Study - Corrected Proof

Devin Murphy, Kelly K. Sawczyn, Gwendolyn P. Quinn — 2012-01-06

Abstract: Study Objectives: Most pediatric education materials are designed for a parent audience. Social marketing techniques rely on the principles called the “4 P’s”: product, price, place, and promotion. The objective of this study was to test the design, readability, likelihood to read, and overall opinion of a pediatric fertility preservation brochure with patients, parents, and providers.Design: Qualitative face-to-face interviews.Setting: The Children’s Cancer Center in Tampa, FL, and All Children’s Hospital in St. Petersburg, FL.Participants: Male and female cancer patients and survivors aged 12-21 (N = 7), their parents (N = 11), and healthcare providers (N = 6).Interventions: Patients, survivors, parents, and healthcare providers were given two versions of gender concordant brochures on fertility preservation designed for both pediatric oncology patients and their parents.Outcome Measures: Design, readability, likelihood to read, and overall opinion from interviews in order to identify facilitators of involving patients in fertility preservation discussions.Results: Parents and teens differed on the design, readability, and likelihood to read, the highest discord being preferences for medical terminology used in the brochures. While parents remarked that much of the language was ‘too advanced,’ the majority of teens explained that they understood the terminology and preferred it remained on the brochure. Overall feedback from all three groups was utilized to revise the brochures into final versions to increase the likelihood of reading.Conclusion: Information about the development of the 4 P’s of social marketing highlights needs from the intended audience. Barriers to patient education in pediatrics can be ameliorated when using the social marketing approach.

Sexual Health Behavior Interventions for U.S. Latino Adolescents: A Systematic Review of the Literature - Corrected Proof

2011-12-30

Abstract: Study Objective: To identify sexual health behavior interventions targeting U.S. Latino adolescents.Design: A systematic literature review.Setting: Peer-reviewed articles published between 1993 and 2011, conducted in any type of setting.Participants: Male and female Latino adolescents ages 11–21 years.Interventions: Interventions promoting sexual abstinence, pregnancy prevention, sexually transmitted infection (STI) prevention, and/or HIV/AIDS prevention.Main Outcome Measures: Changes in knowledge, attitudes, engagement in risky sexual behaviors, rates of STIs, and/or pregnancy.Results: Sixty-eight articles were identified. Fifteen were included in this review that specifically addressed Latino adolescent sexual health behavior. Among the reviewed interventions, most aimed to prevent or reduce STI and HIV/AIDS incidence by focusing on behavior change at two levels of the social ecological model: individual and interpersonal. Major strengths of the articles included addressing the most critical issues of sexual health; using social ecological approaches; employing different strategies to deliver sexual health messages; and employing different intervention designs in diverse geographical locations with the largest population of Latino communities. Most of the interventions targeted female adolescents, stressing the need for additional interventions that target Latino adolescent males.Conclusions: Latino adolescent sexual health is a new research field with gaps that need to be addressed in reducing negative sexual health outcomes among this population. More research is needed to produce new or validate existing, age-specific, and culturally-sensitive sexual health interventions for Latino male and female adolescents. Further, this research should also be conducted in areas of the U.S. with the newest Latino migration (e.g., North Carolina).

The Clinical Presentation and Surgical Management of Adnexal Torsion in the Pediatric and Adolescent Population - Corrected Proof

2011-12-30

Abstract: Study Objective: To determine the history, clinical presentation, physical exam, and laboratory findings of ovarian and/or tubal torsion in the pediatric and adolescent population and to examine the surgical management of adnexal torsion.Design: Descriptive, retrospective chart review.Setting: Academic children’s hospital.Participants: Children and adolescents, aged 3–21 years, with the surgical diagnosis of ovarian and/or tubal torsion.Main Outcome Measures: Pain, physical exam, and laboratory characteristics and surgical outcomes.Results: Of the 82 cases, there was a higher rate of right-sided adnexal torsion (64%). The most commonly reported duration of pain was 24 hours. Most (91%) stated the pain has sudden onset and 69% qualified the pain as severe. Eighty-three percent complained of nausea and 67% had vomiting. There was a higher rate of tachycardia in younger patients (P = 0.003). On exam, 91% of subjects presented with tenderness, usually in the right lower quadrant (61%). A longer duration of pain was associated with a higher rate of oophorectomy and/or salpingectomy. There was no difference in the rates of the removal of adnexal structures between gynecologists and pediatric surgeons.Conclusions: Most pediatric or adolescent patients with adnexal torsion present with acute onset of severe, intermittent pain lasting for 24 hours. Nausea and vomiting, as well as abdominal tenderness were common. Our findings will facilitate the accurate diagnosis of adnexal torsion and may contribute to more expedient surgical management.

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

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

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

Can von Willebrand Disease Be Investigated on Combined Hormonal Contraceptives? - Corrected Proof

Tania Dumont, Lisa Allen, Sari Kives — 2011-12-30

Abstract: 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.

Intimate Partner Violence and Adolescent Mothers - Corrected Proof

Sonia F. Chalfin, Pamela Burke, Margaret Tonelli — 2011-12-30

A 20-year-old mother, ‘Tasha’ walked into our clinic with her 4-year-old daughter and 6-month-old son. The children looked healthy and well cared for; Tasha appeared more tired than usual and kept her head down. She had a head scarf over her hair, pulled over one half of her forehead.

Untangling a Web: An Unusual Case of Labial Necrosis in an Adolescent Female - Corrected Proof

Cameron Stock, Lily C. Wang, Nitsana A. Spigland — 2011-12-30

Abstract: Background: Hair tourniquets are commonly described in the pediatric literature. Prompt recognition of a hair tourniquet and treatment with complete removal of the hair by pediatricians, pediatric emergency room physicians, or gynecologists is essential to prevent ischemia and necrosis of affected tissue.Case: Herein we present the case of a 12-year-old female referred to the pediatric surgery clinic for labial pain and swelling. She was found to have a hair tourniquet of the labia minora caused by pubic hair. The patient was taken to the operating room for examination under anesthesia and removal of the hair. Her post-operative course was unremarkable and she was discharged home the following day. On follow-up visit to the clinic her labial edema had completely resolved and she was pain free.Summary and Conclusions: Unlike previous case reports that describe hair tourniquets as originating from hair on the head, our patient had a hair tourniquet caused by pubic hair. In adolescents where personal hygiene of the perineum is difficult, clinicians need to be aware of the possibility of a hair tourniquet forming from pubic hair.

Rett Syndrome and Menstruation - Corrected Proof

Amy Hamilton, Michael P. Marshal, Gina S. Sucato, Pamela J. Murray — 2011-12-30

Abstract: Objective: Describe the experience that girls with Rett syndrome have with menstruation including menstrual hygiene, dysmenorrhea, premenstrual syndrome (PMS), and attempts at treatment.Design: Anonymous web-based survey.Setting: Convenience sample recruited from Rett syndrome LISTSERV in July of 2009.Participants: Mothers of girls with Rett syndrome between the ages of 10–25 who have had at least one menses.Main Outcome Measures: Prevalence, frequency, and severity of dysmenorrhea and PMS; hygiene concerns; and treatments attempts and perceived effectiveness.Results: Dysmenorrhea and PMS are common problems among young women with Rett syndrome. Despite their frequency and severity they do not routinely limit activities. Multiple treatment attempts are common. Hormonal contraception is used mostly for menstrual cycle control with oral contraceptive pills the most commonly used method.Conclusions: Young women with Rett syndrome have standard symptoms of dysmenorrhea and PMS as well as autism spectrum specific PMS symptoms. Hormonal contraception is commonly used for menstrual management.

Transition from Pediatric to Adult Care for Adolescents and Young Adults with a Disorder of Sex Development - Corrected Proof

Stephanie E. Hullmann, Laura J. Chalmers, Amy B. Wisniewski — 2011-12-30

Abstract: Over the past twenty years, there has been an increasing awareness of the transition to adult-oriented health care in adolescents and young adults with a chronic illness. While general guidelines for health care transition have been established, some have called for illness-specific guidelines which are tailored to the needs of specific illness populations. The current paper sought to outline illness-specific guidelines for health care transition in adolescents and young adults with disorders of sex development based upon the recent American Academy of Pediatrics guidelines. We also suggest indicators of successful transition for adolescents and young adults with disorders of sex development as well as areas for future research.

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

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

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

Use of Norethindrone Acetate Alone for Postoperative Suppression of Endometriosis Symptoms - Corrected Proof

D.J. Kaser, S.A. Missmer, K.F. Berry, M.R. Laufer — 2011-12-12

Abstract: Study Objective: To evaluate the efficacy and tolerability of norethindrone acetate (NA) as single-agent hormonal therapy for suppression of endometriosis symptoms in adolescents and young adults.Design: Retrospective study.Setting: Two academic medical centers.Participants: A keyword search using the query ‘NA’ was applied to the electronic medical records of all women treated by one gynecologist (M.R.L.) from 1992 to 2010. IRB-approved chart review was then conducted on the index records.Interventions: Continuous treatment with NA (5–15 mg daily).Main Outcome Measures: Postoperative bleeding and pain scores; adverse effects.Results: One hundred and ninety-four patients with surgically diagnosed endometriosis initiated NA postoperatively during the study period. Median patient age was 18.9 years. 92.2% of patients had stage 1 or 2 disease, and distribution was similar among those excluded. Median pain scores decreased from 5 at NA initiation to 0 at follow-up (P = .0001) and bleeding scores from 2 to 0, respectively (P = .001) for all stages of endometriosis. Post-NA bleeding scores were improved regardless of prior hormonal regimen, and post-NA pain scores improved in all patients except for those previously prescribed GnRH-agonist plus add-back. Most patients (55.2%) did not report any side effects. The most common adverse effect was weight gain (16.1%), with a mean increase in BMI of 1.2 ± 1.6 kg/m2 at 12 months.Conclusion: NA alone is a well-tolerated, effective option to manage pain and bleeding for all stages of endometriosis. Among those on prior hormonal therapy, symptoms improved after NA initiation.

Evidence-Based Treatment and Prevention of External Genital Warts in Female Pediatric and Adolescent Patients - Corrected Proof

L. Thornsberry, J.C. English — 2011-12-12

Abstract: External anogenital warts, or condylomata acuminata, are caused by the proliferation of squamous epithelial cells secondary to human papillomavirus infection. In sexually active adults and adolescents, anogenital warts are a common sexually transmitted disease, but in children they may be a sign of sexual abuse. There are several treatment options available for anogenital warts, but no treatment has been proven to be the most efficacious, and recurrence after clinical clearance is common. Evidence-based treatment of genital warts is challenging because of the lack of controlled trials comparing treatments, especially in pediatric and adolescent populations. This paper discusses various treatment modalities such as physical destruction, cytotoxic agents, and immunomodulating therapies. Many variables influence the selection of a treatment, such as the size, quantity, and location of the warts; and the patient and provider preference, and its availability and cost. All treatments can cause local side effects, and patient tolerability must also be factored into treatment selection. Many treatments have similar clearance and recurrence rates, and none of the treatments completely eliminates the virus. With the numerous challenges surrounding the treatment of anogenital warts, the primary prevention of HPV infection through vaccination is a key component in decreasing the incidence of the disease.

46XY Girls: The Importance of Careful Newborn Examination - Corrected Proof

T. Sharp, N. Fraser, M.U. Shenoy, T. Randell, L. Denvir, A.R. Williams — 2011-11-30

Abstract: Study Objective: To understand the timing and factors affecting diagnosis of phenotypically female 46XY children.Design, Setting, and Participants: We studied all phenotypically female 46XY children who attended our multidisciplinary disorders of sexual differentiation (DSD) clinic in Nottingham England in a 3-year period since its inception. Case notes from a prospectively maintained database were reviewed and data were analyzed on the age at presentation, family history, findings on genital examination, and underlying endocrine abnormality.Results: Eleven children were studied, all of whom were being raised as girls. The median age of presentation was 18 months (range birth-15 years). Although the newborn examination detected the possibility of DSD in only 3 cases; 10 of 11 children had at least one significant abnormality in their external genitalia at presentation.Conclusion: Careful neonatal genital examination can identify children with DSD. However, not all children with these conditions are identified early. Early diagnosis, when possible, is important, as it has the potential to make the management of this difficult condition more straightforward.

Exogenous Pubertal Induction by Oral versus Transdermal Estrogen Therapy - Corrected Proof

Lisa Kenigsberg, Sadana Balachandar, Kris Prasad, Bina Shah — 2011-11-24

Abstract: 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.

Pregnancies in Young Adolescent Mothers: A Population-Based Study on 37 Million Births - Corrected Proof

2011-11-17

Abstract: Objectives: Pregnancy in young adolescents is often understudied. The objective of our study was to evaluate the effect of young maternal age on adverse obstetrical and neonatal outcomes.Methods: We conducted a population-based cohort study using the Center for Disease Control and Prevention’s Linked Birth-Infant Death and Fetal Death data on all births in the US between 1995 and 2004. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations or chromosomal abnormalities. Maternal age was obtained from the birth certificate and relative risks estimating its effect on obstetrical and neonatal outcomes were computed using unconditional logistic regression analysis.Results: 37,504,230 births met study criteria of which 300,627 were in women aged <15 years with decreasing rates from 11/1,000 to 6/1,000 over a 10-year period. As compared to women 15 years and older, women <15 were more likely to be black and Hispanic, less likely to have adequate prenatal care, and more likely to not have had any prenatal care. In adjusted analysis, births to women <15 were more likely to be IUGR, born under 28, 32, and 37 weeks’ gestation and to result in stillbirths and infant deaths. Prenatal care was protective against infant deaths in women < 15 years of age.Conclusion: Although public health initiatives have been successful in decreasing rates of young adolescent pregnancies, these remain high risk pregnancies that may benefit from centers capable of ensuring adequate prenatal care.

Adolescent Intimate Heterosexual Relationships: Measurement Issues - Corrected Proof

2011-11-17

Abstract: 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.

Bloody Nipple Discharge in Infancy: A Case Report and Recommendations for Management - Corrected Proof

Z. Pleša Premilovac, V. Tokić — 2011-09-26

Abstract: 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.

Fertility Preservation in Prepubertal Girls Prior to Chemotherapy and Radiotherapy—Review of the Literature - Corrected Proof

B. Lawrenz, R. Rothmund, E. Neunhoeffer, S. Huebner, M. Henes — 2011-08-29

Abstract: 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.

Management of Vaginal Agenesis - Corrected Proof

Rola S. Nakhal, Sarah M. Creighton — 2011-08-29

Abstract: 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.

Teenage Sexuality in Different Cultures - Corrected Proof

Paul L. Wood — 2011-06-30

This 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.

Human Papillomavirus in Infants: Transmission, Prevalence, and Persistence - Corrected Proof

Delese E. LaCour, Connie Trimble — 2011-05-25

Human Papillomavirus (HPV) is very common in reproductive age women. It has been demonstrated that this infection can be transmitted from mother to infant. Evidence of HPV infection can be seen in infant and toddlers. A review of the literate was undertaken to examine the manner in which HPV can be transmitted, the rate at which transmission occurs, and if HPV can persist. The manifestations of HPV were also reviewed. It is not clear what effect the quadravalent HPV vaccine, given to mothers will have on HPV infections in infants.

Diagnosis and Treatment of Interstitial Cystitis in Adolescents - Corrected Proof

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

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