From the Editor
Early Puberty in Girls—What Do We Know in 2022?I remember 1997. Early puberty was THE topic of discussion among pediatric and adolescent gynecologists, adolescent medicine physicians, and pediatric endocrinologists. That year, Marcia Herman-Giddens published the landmark study entitled “Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network.” The study included the findings that at age 8, 48.3% of African American girls and 14.7% of white girls had at least 1 sign of pubertal development, earlier than was suggested in standard pediatric textbooks.
Using the Menstrual Cycle as a Vital Sign: What We Still Want to Know about Adolescent Menstrual CyclesI remember the place and the conversation. Dr. Larry Nelson and I were attending an interdisciplinary women's health education retreat in Chantilly, Virginia, in 2000 and chatted over lunch.1 Dr. Nelson was with the U.S. Public Health Service, working at the National Institute for Child Health and Disease, division of intramural research, and is known for his important work on defining and addressing primary ovarian insufficiency (POI).2 Our lunch conversation was wide ranging, but the conversation struck a chord when we started talking about the menstrual cycle.
Pediatric and Adolescent Gynecology: Where's the Science?In 2010, I was asked by colleagues at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to moderate a Pediatric and Adolescent Gynecology Research Think Tank Panel. I prepared a presentation on the science of pediatric and adolescent gynecology (PAG) in which I addressed the history of PAG, highlighting that PAG is a “young” and developing subspeciality, with an evolution of scholarship. At that meeting, I showed a chart (Fig. 1), which indicated that the type of article most commonly published in the Journal of Pediatric and Adolescent Gynecology (JPAG) was a case report.
Trauma-Informed Care in Pediatric and Adolescent GynecologyThe older I get, the more I reflect on how much has changed since I was a medical student. When I was in medical school, wife abuse (now characterized more broadly as interpersonal violence or domestic violence), child abuse or neglect, rape, and sexual assault were all occurring in our society and against individuals worldwide. Physicians had some awareness of these traumas—particularly if they had occurred in their own lives or in their own families, or if they had asked the right questions of individual patients.
Compassion Fatigue, Burnout, and a SabbaticalWhen I started my sabbatical in September 2020, I didn't realize that I was experiencing some signs of “burnout.” I would have said that I had always I loved my work, and would have denied that I was “burned out.” In truth, I was experiencing emotional exhaustion, and feeling that I wasn't accomplishing much with my work.
Pediatric and Adolescent Gynecology AdvocacyThis issue of the Journal of Pediatric and Adolescent Gynecology (JPAG) contains 2 very important statements from the Advocacy Committee of the North American Society for Pediatric and Adolescent Gynecology (NASPAG)—the NASPAG Position Statement on Gender Affirming Care for Minors, and the NASPAG Position Statement on COVID-19 vaccine and Gynecologic Concerns in Adolescent and Young Adults.1,2
A Pandemic Year: The Good, the Bad, and Social ConsciousnessSo much of the last year has been difficult for so many people. Activities that we used to take for granted—like seeing friends and colleagues every year at the Annual Clinical and Research Meeting (ACRM) of the North American Society for Pediatric and Adolescent Gynecology (NASPAG)—have been absent. Zoom was OK for the ACRM meeting content, but we missed the chance hallway meetings and chats, the dinner conversations, and the happy hour encounters that keep us connected to our colleagues across the United States and internationally, and that foster a group sense of purpose in improving the health of young and adolescent girls.
Pediatric and Adolescent Gynecology Is Care for the UnderservedWhen I was a resident in Obstetrics and Gynecology from 1977 to 1981, I had no idea what pediatric and adolescent gynecology (PAG) was. I'll save you the trouble of calculating how long ago that was; it's been 40 years since I completed my residency, and yes, that was a long time ago. As an ob/gyn resident, I learned about adolescent obstetrics, and I learned a lot about contraception for adolescents. Preventing adolescent pregnancies was clearly an important priority and educational objective. I also learned a lot about unplanned and unintended pregnancies, and learned the techniques of safe and legal first- and second-trimester abortions.
Moving Forward with HopeEven if you don't live in the United States, you are likely well aware of the recent US Presidential election. A record number voted; 66.5% of eligible voters cast ballots, the highest turnout rate since 1900.1 Of course in 1900, eligible voters included only men. African Americans and other people of color faced barriers at the polls, including poll taxes, literacy tests, and intimidation.2 It has only been since 1920 that women finally won the right to vote. As I am learning new realities of history beyond what I was taught in elementary school, I have learned that Native American women were not granted citizenship and the right to vote until 1924, with the Indian Citizenship Act, although some state laws still barred Native Americans from voting long after this date.
COVID, Science, Vaccines, and Public TrustAs I debated about what to focus on in my editorial for this issue of the Journal of Pediatric and Adolescent Gynecology (JPAG), I wondered if I should focus on something other than the COVID-19 pandemic. Surely readers are tired of hearing about the pandemic by now. I'm tired of it, and ready for us to be “back to normal.” BUT, as of yesterday, October 23, the number of people infected with the SARS2-COVID-19 virus hit an all-time 1-day high in the United States: more than 85,000 new cases were diagnosed.
Pediatric and Adolescent Gynecology (PAG) in the Time of a PandemicSometimes I struggle to decide what I will write about as a topic of editorials for the Journal of Pediatric and Adolescent Gynecology (JPAG). Other times, the news provides an easy choice of topics. Today, I am preoccupied with the topic at the forefront of discussions, news reports, and social media posts—the novel coronavirus COVID-19. As I write, on March 12, the situation in the United States is evolving—as it has been for the last few weeks, and will in the weeks to come in the United States and throughout the world.
Pediatric and Adolescent Gynecology: What's It all About?Being the Editor-in-Chief of the Journal of Pediatric and Adolescent Gynecology (JPAG) continues to be an exciting job. Every other month, when I get the “pick list” of articles ready for me to select and order the articles that are ready for production in the next issue, I am reminded of the diversity of our field, which I've called a potpourri.1 For this issue, I am again struck by the breadth and depth of our field, but also by how the “mix” of topics changes with each issue.
Pediatric and Adolescent Gynecology—A Global PerspectiveYesterday, I returned home from Melbourne Australia and the World Congress of Paediatric and Adolescent Gynaecology (WCPAG). At least I think it was yesterday. I left Melbourne on Saturday December 7th at about 1:30 p.m., and arrived in San Francisco at about 4:30 p.m. on Saturday December 7th, having spent more than 24 hours on a plane or waiting in an airport. Strange, I think; I never did really understand the International Date Line. As Charles M. Schulz, cartoonist of Peanuts fame, is quoted as saying, “Don't worry about the world ending today; it's already tomorrow in Australia.”
Pediatric and Adolescent Gynecology: The Potpourri of Our Clinical PracticesGreetings dear readers. Once again I collate the content for another issue of the Journal of Pediatric and Adolescent Gynecology (JPAG). Some months, as I review the list of articles that have successfully navigated the peer review process and have been accepted to JPAG I see major themes emerging that help me group the submissions. Typically there are several submissions relating to prepubertal gynecologic problems, several addressing contraception, a number that report on ovarian masses and surgeries, and typically some that pertain to medical issues such as heavy menstrual bleeding.
The Peer Review Process and Celebrating Journal ReviewersThe Journal of Pediatric and Adolescent Gynecology (JPAG) and other scientific journals could not publish high-quality scientific reports without the behind-the-scenes work of individuals who contribute considerable time and effort to reviewing manuscripts. These peer reviewers receive little recognition beyond the Editors' heartfelt gratitude and the yearly publication of a list of the names of all of the individuals who provided reviews during the past year. Does anyone look at this list of names? I'm not sure, as JPAG hasn't tracked this, but I will confess that, I DO look at this list for other journals, to find the names of recognized leaders in the field as an indicator of the quality of the journal.
Puberty, Menarche, and the Menstrual Cycle: What Do We Know, and What Do We Teach?The process of pubertal development that ultimately leads to menarche is a critical process in the lives of all women. Understanding normal puberty and normal menstrual function is essential to understanding health and disease among girls and young women. It is crucial to the care that we, as pediatric and adolescent gynecologists and adolescent medicine specialists, provide. There is certainly a great deal about pediatric endocrinologic function that we currently understand, but our understanding is still evolving, and there are fascinating aspects of pubertal growth and trajectory that we do not fully understand.
What is Pediatric and Adolescent Gynecology?When people ask me what I do, I gauge their time and interest. Are they asking out of general politeness, or do we have time for me to share more of what I do? I may answer that I am a physician, which can lead to their telling me a story about their latest encounter with the medical profession, or they may be curious and ask for clarification. If they express interest, I may respond that I am a gynecologist. I am sometimes parsimonious with even this information; I have learned that if I am speaking to a man, the conversation may quickly turn to another topic.