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Background: Several organs may be damaged by strangulation by hair or strings that cause ischemia and necrosis. There have been sporadic case reports of such events. Injuries to the hands, feet, and fingers, as well as penile(1-5) and clitoral injuries(6-8) have been reported., Cases: Three cases of labia minor strangulation by hair are described. A review of the relevant literature is included., Conclusions: Pediatricians, gynecologists, and family physicians must be aware of labial tourniquet syndrome. If the diagnosis is missed or remains without immediate attention, the hair or string may cause necrosis and the resulting amputation of the vital body part.

Most gynecologists lack the unique skills required for communication with female adolescent patients and with their parents. Years of clinical experience are required to develop communication skills that would facilitate the confidence of the young patient already during the first visit. Simulation-based medical education at the Israel Center for Medical Simulation (MSR) has become a powerful force in quality-care training for healthcare providers using empirical educational modalities, enabling controlled proactive experiential exposure to both regular and complex scenarios. Among the various MSR programs, for various medical sectors, training programs have been developed to improve the skills of physicians communicating with adolescents, including primary care physicians and school doctors. This paper describes the first reported simulated patient-based MSR training program for gynecologists in communication with adolescents who present with common complaints encountered in gynecology clinics. Twenty gynecologists participated in eight individual simulated scenarios conducted at simulated physicians' offices, equipped with audio-visual recording cameras and one-way mirrors for observation. Three physicians experienced in debriefing and in facilitating group discussions led the debriefing sessions, using the video recording of the simulated scenario following the simulation exercises. These discussions focused on communication techniques when facing adolescent patients with or without their parents, hidden agendas disclosed by using systematic physical and psychosocial reviews, the emotional load often associated with clinical problems, and the non-judgmental and supportive approach to adolescent patients. The clear recommendation that emerged from the high satisfaction of the program participants was to expand simulated patient-based programs for gynecologists and to include it as an integrated part of the training curriculum in pediatric and adolescent gynecology.

Study Objective: To explore the effect of young age on the outcome of teenage pregnancies by studying teenage deliveries in our unique population., Design, Setting, and Participants: Retrospective chart review of teenage gravidas (age 19 and younger), who had delivered in our hospital., Outcome Measures: Mode of delivery, gestational age at delivery, newborn's weight and Apgar scores and maternal and neonatal complications., Results: We recruited 565 teenage delivery cases from the hospital's computerized database. Mean maternal age was 18 (14-19). Most (96%) were married. Fifty-one percent were Jewish and 44% were Muslim. Most of the girls were nulligravidas. Mean gestational age at delivery was 39 weeks (33-44 weeks). A normal vaginal delivery ensued in 72.7%, while 9% had a cesarean section and 17.4% instrumental deliveries (compared to 85.75%, 10% and 4.25% in our adult population, respectively) and 1% underwent vaginal breech delivery. Mean birth weight was 3108 g (1450-4980 g). Apgar score of 9 at 5 minutes was recorded in 97.8% of the newborns. Prenatal care included a mean of 6 prenatal visits with a range of 1-18. The main complication was anemia; 41% had hemoglobin levels of less than 11 g/dL. The rate of other complications was low., Conclusions: In our homogenous group of teenagers, there was a similar complication rate as in the adult population. The only significant complication was anemia (less than 11 g/dL). There was a higher rate of instrumental deliveries and the cesarean delivery rate was slightly lower than in our adult population. Teenage pregnancy should not be considered as a high-risk situation as long as it is planned and followed with the normal routines of prenatal care.

Weight bearing physical activity plays an important role in bone development. This is particularly important in children and adolescents since bone mineral density reaches about 90% of its peak by the end of the second decade, and because about one quarter of adult bone is accumulated during the two years surrounding the peak bone growth velocity. Recent studies suggested that the exercise-induced increase in bone mineralization is maturity dependent, and that there is a "window of opportunity" and a critical period for bone response to weight bearing exercise during early puberty and premenarchal years. This supports the idea that increase in physical activity during childhood and adolescence can prevent bone disorders (like osteoporosis) later in life. In contrast, strenuous physical activity may affect the female reproductive system and lead to "athletic amenorrhea". The prevalence of "athletic amenorrhea" is 4-20 times higher than the general population. As a consequence, bone demineralization may develop with increased risk of skeletal fragility, fractures, vertebral instability, and curvature. Menstrual abnormalities in the female athlete result from hypothalamic suppression of the spontaneous pulsatile secretion of gonadotropin releasing hormone. Recent studies suggested that reduced energy availability (increased energy expenditure with inadequate caloric intake) is the main cause of the central suppression of the hypothalamic pituitary-gonadal axis. Therefore, effort should be made to optimize the nutritional state of female athletes, and if not successful, to reduce the training load in order to prevent menstrual abnormalities, and deleterious bone effects in particular during the critical period of rapid bone growth.