From the Editor
- The US Supreme Court's ruling in Dobbs v. Jackson reversed nearly 50 years of legal precedent following the Roe v. Wade decision in 1973. This decision was an assault on reproductive justice that disproportionately impacts adolescents and young adults. The decision allowed states to enact laws curtailing induced abortions; in some states trigger laws had been enacted prior to the overturn of Roe v. Wade leading to an almost immediate ban on abortions. Some of these laws have been enjoined from enforcement, but others have gone into effect.
- The study “Exploring factors associated with decisions about feminizing genitoplasty in differences of sex development” by Kremen et al aimed to address if Prader stage, clitoral size, parental uncertainty, anxiety, depression, or dissatisfaction with genital appearance correlated with surgical decision-making in children under age 2 with a difference of sex development (dsd). Most of the 58 children were diagnosed with 46 XX congenital adrenal hyperplasia (CAH), and all but 5 underwent surgery before age 2.
- 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.
- I 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.
- 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.
- The 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.
- Precis: Despite their limitations, case reports can be valuable additions to the medical literature. We should encourage frontline providers to submit case reports. Although a single case report cannot be used to draw inferences, a collection of high-quality case reports can inform hypotheses which can be tested in larger studies and can sometimes be synthesized into evidence to inform decision-making.
- Climate change is the single biggest health threat facing humanity. In 2021, the climate crisis was visible to most of us. Examples of climate change included extreme heat and fires in the Western United States, floods in Central Europe, droughts in Africa, wildfires in Australia, and hurricanes throughout the globe. No one in the world is safe from the health impacts of climate change, but these effects are disproportionately felt by the most vulnerable and disadvantaged, not only those living in low- and middle-income countries.