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Among gender-diverse patients who used medical menstrual management, we found improved bleeding, pain, dysphoria, and moods related to menstruation and high continuation and amenorrhea rates. OBJECTIVE: To describe and compare the outcomes of various menstrual-management methods, including method choice, continuation, bleeding patterns, amenorrhea rates, effect on moods and dysphoria, and side effects, in transgender and gender-diverse adolescents. METHODS: This was a retrospective chart review of all patients seen in a multidisciplinary pediatric gender program from March 2015 to December 2020 who were assigned female at birth, had achieved menarche, and used a menstrual-management method during the study period. Data were abstracted on patient demographics and menstrual-management method continuation, bleeding patterns, side effects, and satisfaction at 3 months (T1) and 1 year (T2). Outcomes were compared between method subgroups. RESULTS: Among the 101 included patients, 90% chose either oral norethindrone acetate or a 52-mg levonorgestrel (LNG) intrauterine device (IUD). There were no differences in continuation rates for these methods at either follow-up time. Almost all patients had improved bleeding at T2 (96% for norethindrone acetate and 100% for IUD users), with no difference between subgroups. Amenorrhea rates were 84% for norethindrone acetate and 67% for IUD at T1 and 97% and 89%, respectively, at T2, with no differences at either point. The majority of patients had improved pain, menstrually related moods, and menstrually related dysphoria at both follow-up points. There were no differences in side effects between subgroups. There were no differences in method satisfaction between the groups at T2. CONCLUSION: Most patients chose norethindrone acetate or an LNG IUD for menstrual management. Continuation, amenorrhea, and improved bleeding, pain, and menstrually related moods and dysphoria were high for all patients, indicating that menstrual management is a viable intervention for gender-diverse patients who experience increased dysphoria related to menses. [ABSTRACT FROM AUTHOR]

To describe menstrual history, associated dysphoria, and desire for menstrual management in transgender male and gender diverse adolescents who were assigned female at birth Retrospective chart review Tertiary care children's hospital All patients seen in a multidisciplinary pediatric gender program from March 2015 through December 2020 who were assigned female at birth, identified as transgender male or gender nonbinary, and had achieved menarche None Patient demographics, menstrual history, interest in and prior experiences with menstrual management, parental support, and concerns about menstrual management Of the 129 included patients, 116 (90%) identified as transgender male and 13 (10%) as gender nonbinary, with an average age of 15 (SD 1.6) years. Almost all (93%) patients reported menstrual-related dysphoria. Most (88%) were interested in menstrual suppression. The most common reasons for desiring suppression were achievement of amenorrhea (97%) and improvement of menstrual-related dysphoria (63%). Most gender diverse patients assigned female at birth reported dysphoria associated with menses and desired menstrual suppression. This information can encourage physicians to raise this topic and offer menstrual management for gender diverse patients who experience distress related to menses, especially for those who are not ready for or do not desire gender-affirming hormonal treatment. Future research is needed to better understand patients' experiences with menses and to determine the optimal menstrual management methods. This could be an important intervention to improve outcomes for this vulnerable population. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Intrauterine devices (IUDs) are increasingly being used in adolescents and nulliparous women for contraception. Levonorgestrel IUDs also have beneficial effects on bleeding and pain. Although they are recommended for menstrual suppression in adolescents with disabilities, there are limited data on their use in this population. Our objective is to describe the characteristics and experiences of levonorgestrel IUD use in nulliparous children, adolescents, and young adults with physical, intellectual, and developmental disabilities. METHODS: A retrospective chart review was conducted for all nulliparous patients ages ≥22 with physical, intellectual, or developmental disabilities who had levonorgestrel IUDs placed between July 1, 2004, and June 30, 2014, at a tertiary-care children's hospital. Descriptive statistical analysis and survival analysis were performed. RESULTS: In total, 185 levonorgestrel IUDs were placed in 159 patients with disabilities. The mean age was 16.3 (3.3; range of 9-22) years. Only 4% had ever been sexually active; 96% of IUDs were inserted in the operating room. IUD continuation rate at 1 year was 95% (95% confidence interval: 93%-100%) and at 5 years was 73% (95% confidence interval: 66%-83%). The amenorrhea rate was ~60% throughout the duration of IUD use among those with available follow-up data. Side effects and complications were ≥3%. CONCLUSIONS: In this study, we provide evidence for the therapeutic benefit and safety of levonorgestrel IUD use in adolescents and young adults with physical, intellectual, and developmental disabilities. It should be considered as a menstrual management and contraceptive option for this population. [ABSTRACT FROM AUTHOR]

Study Objective To create a composite score to predict adnexal torsion in children and adolescents. Design A prospective cross-sectional study. Setting Emergency department of a tertiary care children's hospital. Participants Three hundred twenty-four female participants aged 6-21 years who presented to the emergency department with lower abdominal pain and underwent ultrasound or computed tomography imaging. Interventions Collection of possible clinical and radiologic predictors of torsion. Main Outcome Measures The primary outcome was a composite score to predict adnexal torsion. We used χ 2 analyses to identify possible risk factors. The classification and regression tree decision method was used to identify risk factor cutoff points. Independent risk factors were combined into a composite score. Receiver operating characteristic curve analyses were used to assessed score performance. Results Of 324 participants with abdominal pain, 241 underwent imaging, and 6.6% (16 of 241) had torsion. Duration of pain, intermittent pain, nausea, and absence of arterial or venous flow were not associated with torsion. Vomiting ( P = .05 in premenarchal subjects; P < .001 in menarchal subjects), adnexal volume ( P = .008 in premenarchal subjects; P < .001 in menarchal subjects), and adnexal volume ratio ( P = .04 in premenarchal subjects; P < .001 in menarchal subjects) were independent predictors of torsion. These predictors were incorporated into a composite score. No torsions were identified with a score of less than 2. There was an increasing risk of torsion for each 1-point score increase. Conclusion Independent predictors of torsion can reliably be combined into a composite score to identify children and adolescents at risk for adnexal torsion. This score might aid in improving triage and management of these challenging patients. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse adults have higher rates of cervical and other anogenital cancers than their cisgender peers. Vaccination against human papilloma virus (HPV) is known to prevent >90% of cervical and other genital cancers, as well as many oropharyngeal cancers, and thus may be an important tool in childhood and adolescence to prevent cancer in adulthood. The objective of this study was to assess the rates of HPV vaccination in gender diverse youth and reasons for not initiating HPV vaccination. This is a retrospective chart review of all patients at least 11 years old who were seen in a multidisciplinary pediatric gender program from March 2015 to December 2020. Data were abstracted on patient demographics, HPV vaccine initiation, and reasons for not initiating vaccination. Frequency counts and percentages were used to describe the total patient population and subgroups based on sex assigned at birth. Outcomes were compared between subgroups using chi-square tests. This study was approved by our institution's Institutional Review Board. Of the 163 patients ages ≥11, 133 (82%) had initiated HPV vaccination. Demographic characteristics of those who had and had not received the HPV vaccine series are listed in Table 1. Patients who initiated the vaccines were significantly older than those who had not (15.1 vs. 13.7 years, P <.001). Although a higher proportion of patients who were assigned male at birth had started the vaccine series than those assigned female at birth (88% vs. 80%), there was no significant difference between these groups. Reasons given for not receiving the HPV vaccines included parental concerns about both short- and long-term side effects, planning to wait until their child was older, and being opposed to vaccines in general or the HPV vaccine specifically. While the majority of our gender diverse patients had initiated the HPV vaccine series and our rate was actually slightly higher than the national average, it was lower than for other age-concordant vaccines. This was especially pronounced for younger patients, despite the early recommended age of vaccination. As transgender and gender diverse patients have higher adult rates of HPV-related cancers, increased uptake of HPV vaccination during childhood and adolescence could have a significant impact in this population. Further research is needed to determine how to improve vaccination uptake in gender diverse youth, especially at earlier ages. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1378479-1-ANY.docx [ABSTRACT FROM AUTHOR]

A lack of training for gynecologic health care professionals treating patients with disabilities contributes to health care disparities; establishing clear guidelines can improve health outcomes. All patients deserve high-quality health care. Patients with disabilities have historically experienced discrimination in health care and subsequently detrimental health outcomes. Health care professionals often lack confidence and preparedness in treating patients with disabilities effectively. Barriers such as communication difficulties, biased assumptions, and inadequate equipment hinder comprehensive care. These barriers to care lead to health inequalities and a diminished overall quality of life for individuals with disabilities. Existing clinical guidelines for care of this underserved population are lacking. This article establishes a comprehensive educational framework and accessible reference tools for gynecologic health care professionals to enhance their ability to offer inclusive and effective care to patients with disabilities. Insights in this article stem from expert consensus among clinicians experienced in this field and ongoing dialog with community-based disability care partners. We present actionable steps to cultivate an open, adaptable, and patient-centric method to actively engage patients and to provide suitable accommodations when needed. [ABSTRACT FROM AUTHOR]

To describe the demographic characteristics and psychological symptoms of gender-diverse patients and to compare symptoms between prepubertal and pubertal subgroups This was a retrospective chart review of all gender-diverse patients seen by at least 1 provider at the Nemours Gender Wellness Program from March 2015 to December 2020. The extracted data included demographic and psychosocial characteristics at baseline and 1-year follow-up visits. Pubertal status was determined by Tanner staging by a pediatric endocrinologist or gynecologist. Descriptive statistics were used to compare these variables between prepubertal and pubertal subgroups. Our sample included 177 individuals at baseline and 96 subjects at the 1-year follow-up visit. Most patients were White (83.0%), non-Hispanic (92.0%), transgender male (72.9%), and pubertal (90.4%). Compared with prepubertal patients, at the baseline visit, pubertal patients had significantly higher rates of current (68.1% vs 17.6%, P <.001) and lifetime (80.0% vs 23.5%, P <.001) depressive symptoms, current anxiety symptoms (70.0% vs 41.2%, P =.01), lifetime suicide attempts (12.5% vs 0%, P <.001), and a formal diagnosis of an eating disorder (5.0% vs 0%, P <.001). Symptoms did not change significantly over time from baseline to the 1-year follow-up visit. We found elevated rates of psychological symptoms and diagnoses in gender-diverse youth, with higher rates in pubertal compared with prepubertal patients. By elucidating how the psychosocial characteristics of gender-diverse children and adolescents differ based on pubertal status, these data can be used to improve current outreach and treatment strategies for transgender pediatric patients. [ABSTRACT FROM AUTHOR]

Background: Normative data from pelvic ultrasonography (US) of the pediatric female reproductive organs are outdated and limited by sample size.Objective: The purpose of this study was to report normal uterine and ovarian volumes and endometrial stripe thickness in children and young adults and throughout the menstrual cycle in post-menarchal adolescents.Materials and Methods: Females ages 0 through 20 years who underwent pelvic US between January 2010 and May 2014 were identified. After excluding patients with pelvic and/or endocrine pathology, nomograms of uterine and ovarian volumes and endometrial thickness by age year were created. Data for patients ages 12 years and older with a recorded day of last menstrual period were used to create additional nomograms of volumes/thickness throughout the menstrual cycle. Student's t-tests and linear regression were performed to assess differences in measurements between groups and association of volumes/thickness with age.Results: During our study period, 5,647 patients underwent 6,953 pelvic US examinations. After further review, 907 examinations from 889 patients were included (mean age: 11.3±6.0 years). Mean pelvic US volumes (cm3) per organ were 25.5±27.0 (uterus), 4.5±4.7 (right ovary) and 4.0±4.1 (left ovary). Mean endometrial thickness was 4.5±3.7 mm. Right ovarian volume was significantly larger than the left (P=0.0126). Uterine volume, ovarian volume and endometrial thickness were significantly associated with age (P-values<0.0001). Plots of mean organ measurements with respect to week of menses are provided.Conclusion: We report normal volumes of the uterus and ovaries and endometrial stripe thickness measured by pelvic US throughout childhood and adolescence with reference to the menstrual cycle. These values are significantly associated with age and vary visually by menstrual cycle week. [ABSTRACT FROM AUTHOR]

Gender diverse individuals are those whose sex assigned at birth does not correspond with their gender identity. Gender dysphoria, or the distress associated with the incongruence between an individual's gender identity and sex assigned at birth, is associated with adverse psychosocial and health outcomes. We hypothesize that puberty intensifies this distress, in effect exacerbating mental health symptoms and increasing healthcare utilization across all services. Our study seeks to investigate the influence that puberty has on mental health symptoms and service utilization for a cohort of gender diverse youth at a multidisciplinary care clinic. This is a retrospective chart review of all gender diverse patients seen at the Nemours Gender Wellness Program from 2015-2020. Abstracted data include demographics, pubertal status, symptoms of depression, anxiety and gender dysphoria, body image concerns, self-harm related thoughts and behaviors, and clinic service utilization. Comparisons were made according to pubertal status defined as the onset of secondary sex characteristics. Descriptive statistical analysis was performed using frequency counts, percentages, means and standard deviations. Categorical variables were compared using chi-square and Fisher exact tests. 199 patients were included. Most were White (83%) and non-Hispanic (91%). Participant ages ranged from 5-18 years, with a median of 15 years. 136 (68%) individuals identified as transgender male, 35 (18%) as transgender female, 17 (9%) as non-binary, and 11 (6%) as another gender. Among all participants, 75% reported depressive symptoms, 74% reported anxiety symptoms, and 96% reported gender dysphoria. Prepubertal individuals were less likely than pubertal patients to report symptoms of depression (40% vs. 90%, p< 0.01) and gender dysphoria (94% vs. 99%, p=0.05). There were no differences in anxiety symptoms, body image concerns, suicidal ideation, suicide attempts, or self-harm by pubertal status. The Gynecology service was utilized by pubertal patients more than prepubertal patients (73% vs. 24%, p< 0.001). There were no significant differences in Psychology, Psychiatry, or Endocrinology utilization based on pubertal status. We found high rates of psychological symptoms in gender diverse youth, especially in pubertal patients. However, except for Gynecology, service utilization was not correlated with pubertal status. Understanding how psychological symptoms change around the time of puberty in this population may help families, providers, and policymakers improve on current outreach and treatment strategies for gender diverse youth. [ABSTRACT FROM AUTHOR]