From the Editor
Pediatric and Adolescent Gynecology as a TapestryI recently inherited my grandmother's cherrywood floor loom, a beautiful machine that I am learning to use to create fabric, enjoying the process of learning a new craft and becoming a weaver. I've concluded that woven fabric is a good metaphor for my life's work. The field of pediatric and adolescent gynecology (PAG) also represents a tapestry to which many of us from different backgrounds contribute to care for those children and adolescents who were assigned female at birth.
Pediatric and Adolescent Gynecology: The Science is Coming of AgeThe Journal of Pediatric and Adolescent Gynecology (JPAG) is coming of age. I think we're beyond our childhood, continuing our journey through a journal's lifespan. In previous editorials, I've written about PAG and science, discussed the value of case reports, and addressed the maturation of the field of pediatric and adolescent gynecology.1,2 Each year, at the end of the calendar year, I review a report that is termed our “Accountability” report for the year. Throughout the year, David Newcombe, JPAG's wonderfully knowledgeable, consistent, and unfailingly dependable Managing Editor, sends me accountability reports on a weekly basis, allowing me to compare data with last year and previous years.
Reproductive Justice and Adolescents in a Post-Roe United StatesThe 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 Association between Surgeon Dissatisfaction with Infant Genital Appearance and Surgical Decision-Making Surrounding ClitoroplastyThe 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.
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.
Adolescents with Vulvar Ulcers: COVID-19 disease, COVID-19 Vaccines, and the Value of Case ReportsPrecis: 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.
Call for Leadership: Climate Change and the Future Health of GirlsClimate 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.
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.
Contraceptive Counseling for Adolescents: Current Evidence and Road Map for the FutureThe past 3 decades have seen significant advancements in the area of adolescent contraceptive services and steady improvement in teen birth rates. Available contraceptive options have markedly increased. We have seen the expansion of short-acting hormonal contraceptive types, the entrance of long-acting reversable contraceptives, and the arrival of over-the-counter emergency contraception. Concurrent with this increase in contraceptive options and access, rates of teen births in the United States have steadily declined.
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
Reprint of: Obstetric Trauma-Informed Care: Pregnant Adolescents’ VoicesAlthough rates of births to young women aged 15-19 years have declined significantly in the United States between 2007 and 2017, a total of 194,377 babies were born to young women in this age group in 2017.1 Numerous studies have established that social determinants of health such as race, low socioeconomic status, and inadequate education among pregnant adolescents are associated with adverse maternal and birth outcomes.2 Of special concern in recent years has been the effect of a history of trauma and adverse childhood experiences (ACEs) on pregnant and parenting adolescents.
Obstetric Trauma-Informed Care: Pregnant Adolescents’ VoicesAlthough rates of births to young women aged 15-19 years have declined significantly in the United States between 2007 and 2017, a total of 194,377 babies were born to young women in this age group in 2017.1 Numerous studies have established that social determinants of health such as race, low socioeconomic status, and inadequate education among pregnant adolescents are associated with adverse maternal and birth outcomes.2 Of special concern in recent years has been the effect of a history of trauma and adverse childhood experiences (ACEs) on pregnant and parenting adolescents.
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 Gynecologic Problems Continue During the COVID-19 PandemicGreetings, dear readers, from shelter-in-place COVID-19 land, a very different place from where we all were (literally, and figuratively) when I wrote my last editorial on Pediatric and adolescent gynecology (PAG) in the time of a pandemic. Most of us are still reeling from the many changes that COVID-19 infections have necessitated.
Introducing a New Journal Club Feature for JPAGNASPAG, in conjunction with the Journal of Pediatric and Adolescent Gynecology (JPAG), is pleased to announce a new journal club feature. The journal club will be published quarterly online on the NASPAG website to highlight an article published in JPAG, with associated questions to help guide readers in critically appraising the emerging literature within the rapidly growing field of Pediatric and Adolescent Gynecology (PAG).
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.”
Pronouns and PAGI confess that I really enjoy grammar, and have a passion for the English language and its words, phrases, clauses, sentences and parts of speech. I attribute this to my mother's similar enthusiasm, no doubt inculcated in me at a young age. When I started to learn to speak French in elementary school, I remember being puzzled that French nouns had grammatical gender. Why are some French nouns feminine (the table, la table) and others masculine (a book, un livre)? It doesn't make sense to me, and to this day I struggle in my attempts to learn the grammatical gender of nouns in other languages.