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Study Objective To study the feasibility of virtual visits for ambulatory encounters in pediatric and adolescent gynecology Design A retrospective review Setting Boston Children's Hospital Participants Patients who were seen virtually through the Division of Gynecology between January 1, 2020 and June 1, 2020 Main Outcome measure(s) Patient demographics, visit diagnoses, and operational characteristics of the completed visits Results There were a total of 654 virtual visits for 614 patients. Ninety-one percent (n=558) of patients were in-state, and the median age of patients was 17 years (range 0 – 37 years). The majority were return visits (n=502, 76.8%), 115 (17.6%) were new patient visits, and 32 (4.89%) were post-operative visits. The median virtual visit duration was 12 minutes and 39 seconds (range 5 minutes to over 1 hour). The most common gynecologic diagnoses were dysmenorrhea/endometriosis (n=485, 74.2%), abnormal uterine bleeding (n=225, 34.4%), and pelvic pain (n=82, 12.5%). The percentage of virtual visits which required an in-person follow-up visit within 90 days was low (n=14, 2.1%). Five of these were within 30 days from the initial virtual visit, 6 were within 60 days, and 3 were within 90 days. Conclusion Telemedicine is a feasible method for expanding access to, and healthcare delivery for, pediatric and adolescent gynecology, with low rates of short interval in-person follow-up required. Virtual visits can be conducted for a range of patients with a variety of gynecologic conditions, upon initial presentation and follow-up.

Acne vulgaris is a common skin condition encountered in specialties outside of dermatology, including obstetrics and gynecology. The pathophysiology of acne is complex and includes disruption of the cutaneous microbiome, abnormal keratinization, inflammation, and hormonal influences. Various topical and systemic treatment modalities target each component of acne pathophysiology. Clinically, acne can be broken down into noninflammatory, inflammatory, or mixed subtypes. The age of the patient at presentation and signs and symptoms of hormonal imbalance might prompt workup for underlying disorders. The severity as well as type of acne dictates the type of treatment.

Background: In pediatric and adolescent gynecology, ovarian-sparing surgery (OSS) is an approach for preserving the ovaries affected by tumors and torsion during surgical treatment. Materials and M...

Transgender and gender diverse adolescent and young adults (AYA) may seek gender-affirming surgeries (GAS) as part of their gender affirmation. A number of GAS are related to reproductive and sexual health, and pediatric and adolescent gynecology (PAG) clinicians are well positioned as sexual and reproductive health experts to provide care in this area. PAG clinicians may encounter patients presenting for preoperative counseling (including discussions regarding fertility, family building, future sexual function, and choice of oophorectomy at time of hysterectomy), requesting referrals to GAS clinicians, or requiring GAS aftercare, or those seeking general sexual and reproductive health care who have a history of GAS. This article reviews presurgical considerations for AYA seeking GAS, types of GAS, their impact on pelvic, sexual, and reproductive health, and aftercare that may involve PAG providers, with the goal of helping PAG clinicians to better understand these procedures and to empower them to engage collaboratively with GAS teams. With this knowledge, reproductive health clinicians can have an integral role as skilled collaborators in the world of AYA GAS in partnership with GAS surgeons.

Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare congenital condition of the female urogenital tract, presenting intraoperative challenges. We demonstrate the utility of three dimensional intraoperative ultrasound to better delineate anatomy and aid in optimal resection of the vaginal septum. Case: A 12-year-old female was referred to pediatric and adolescent gynecology for irregular periods and evaluation of her gynecologic organs. Imaging studies confirmed OHVIRA syndrome. She underwent uncomplicated vaginal septum resection, guided by three dimensional intraoperative ultrasound. Summary and Conclusion: Intraoperative ultrasound can better delineate challenging anatomy. We show that three dimensional intraoperative ultrasound offers significant advantages over traditional two dimensional ultrasound and is a supplement to MRI, which may be helpful in complex anatomical cases like OHVIRA syndrome.

This Clinical Opinion replaces the NASPAG Clinical Recommendation: Pediatric Lichen Sclerosus published in 2014. The objective of this document is to provide guidance in the diagnosis and management of vulvar lichen sclerosus (LS) in the pediatric and adolescent patient in order to treat patient symptoms and reduce long-term sequelae. LS is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, loss of pigmentation and vulvar adhesions with loss of normal vulvar architecture. Management includes topical agents for induction and maintenance therapy, as well as long-term follow-up for identification and treatment of recurrence and sequelae. This document is intended for use by both primary and specialty pediatric and adolescent gynecology (PAG) providers, including specialists in pediatrics, gynecology, adolescent medicine, and dermatology.

Background: Ovarian torsion without an adnexal mass is an uncommon finding in an adolescent girl. Ipsilateral recurrent ovarian torsion is even more rare. This article presents a case of a recurren...

Background: Cystadenofibromas (CAFs) are defined as benign mixed mullerian tumors. They are diagnosed mainly in the ovary. Nonetheless, extraovarian locations, such as endometrium, uterine cervix, ...

Adolescents are at high risk for unintended pregnancy and rapid repeat pregnancy, both of which can be associated with negative health and social outcomes. Intrauterine device (IUD) use has been shown to decrease unintended pregnancy and rapid repeat pregnancy. Evidence supports IUD insertion postabortion and postpartum as safe and practical for nearly all women, including adolescent and young adult women. Providers of adolescent gynecology can play an important role in decreasing repeat and unintended pregnancy among adolescents by increasing access to IUDs, reducing barriers to care, and providing IUDs immediately postabortion and postpartum.

Study Objective Although various treatment options have been proposed for the treatment of labial adhesions, there are currently no clearly outlined limits on the duration of topical therapy, amount of lateral traction to apply, and methods to decrease the recurrence. This clinical trial was undertaken to assess the need for estrogen for treatment of prepubertal labial adhesions. Design Randomized, double-blinded, controlled trial. Setting Pediatric and Adolescent Gynecology Clinic at a children's hospital in a metropolitan area. Participants Prepubertal girls ages 3 months to 12 years with labial adhesions. Interventions Lateral traction with topical estrogen or topical emollient. Main Outcome Measures The primary outcome was resolution of labial adhesions. The secondary outcome was the change in severity of labial adhesions over time between the 2 groups. Results Forty-three girls were enrolled and 38 (88%) completed the study. The difference in complete resolution between the topical emollient group (19%) and the topical estrogen group (36%) was not statistically significant (P = .21). There was a statistically significant decrease in severity of labial adhesions over time, with the magnitude of improvement favoring the topical estrogen group. Conclusion Although labial adhesion severity decreased when treated with lateral traction and topical emollient or topical estrogen, the magnitude of the effect was significantly greater for topical estrogen.

The transition from adolescence to young adulthood in patients with reproductive health care needs such as disorders of sexual development and congenital anomalies is a complex process that occurs over several years. The transition process for these patients is still poorly understood. The patients with disorders of sexual development and reproductive issues have specific and unique issues regarding timing of disclosure of diagnosis, genital examinations, gonadectomy, vaginal treatments, surgical procedures, hormone replacement therapy, use of long-term medication, and potential cancer screening. The purpose of this review is to briefly describe complex genital malformations and their associated anomalies with long-term concerns and then provide an overview of what has been published at this time regarding the transition of care to provide some guidance for providers who care for those patients.

Study Objective We aim to show that there is a knowledge deficit among pediatric and general practitioner (GP) trainees in pediatric and adolescent gynecology (PAG) and that this has implications for increased morbidity in girls. Design, Setting, Participants, Interventions, and Main Outcome Measures In October 2019 in a tertiary Irish pediatric hospital 50 junior doctors were approached (of a possible 66) and were surveyed in their knowledge of PAG with a written 21-question questionnaire incorporating 10 topics. Results Forty candidates participated (n = 31 pediatric and 9 GP). Sixty percent (n = 24/40) incorrectly misdiagnosed vulvovaginitis as candida; 80% (n = 32/40) could not identify labial adhesions; 47.5% (n = 19/40) were unable to define heavy menstrual bleeding. All of the GP trainees (n = 9/9) said they would prescribe the oral contraceptive pill compared with 51.6% (n = 16/31) of pediatric trainees; 52.5% (n = 21/40) did not consider sexually transmitted infection screening; and 70% (n = 28/40) could not identify female genital mutilation. There was generally no statistically significant difference between GP and pediatric trainees. Conclusion A knowledge deficit among trainees was evident in relation to PAG from common to rare, but serious PAG conditions. Misdiagnosis and delayed treatment could lead to increased morbidity for girls. We recommend the introduction of a standardized training program in PAG for trainees.

This chapter discusses the history of hysteroscopy, emerging technology, and potential applications in adolescent gynecology, including both diagnosis and for therapeutic procedures, with approaches that preserve the hymen. Hysteroscopy is safe and with rare complications, particularly when performed with a narrow diameter hysteroscope. Potential vaginal, cervical, and endometrial pathologies that are closely associated with endometriosis are also described, demonstrating the utility of hysteroscopy when assessing endometriosis. Hysteroscopy is also useful for evaluating and treating dysfunctional bleeding, dysmenorrhea, recurrent discharge, abnormal imaging of the genital tract, genital tract anomalies, adenomyosis, polyps, and myomas.

Resident education in pediatric and adolescent gynecology (PAG) is challenging. It encompasses patients from neonates to young adults with different disorders involving multiple subspecialties. Residents have inadequate exposure to PAG topics and report lack of knowledge in this area. The objective of this study was to determine if the North American Society for Pediatric and Adolescent Gynecology (NASPAG) Short Curriculum improves self-reported knowledge in PAG among obstetrics and gynecology (ObGyn), family medicine, and pediatric residents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Participants were 47 US ObGyn, family medicine, and pediatric residency training programs across a 4-month study window, from September to December 2016. The NASPAG Short Curriculum was distributed to them with a request to complete a retrospective pre- and post-test survey. Primary outcome measure was improvement in self-perceived knowledge after exposure to the curriculum.Forty-eight programs responded to the study comprising a total of 1130 residents. One program was excluded because of logistical barriers to the distribution of study incentive. In total, 1080 residents were invited and 103 chose to participate (10% response rate); 68 residents completed all survey questions to be included in the final analysis. After completing the curriculum, self-reported knowledge improved in all 10 learning objectives, across all 3 specialties (47% [32/68] to 82% [56/68]; P .01). Pre-test knowledge correlated with previous clinical exposure to PAG patients, but did not correlate with year of residency training, type of residency, or previous PAG lectures.Significant deficiencies exist regarding self-reported knowledge of core PAG topics among ObGyn, family medicine, and pediatric residents. Use of the NASPAG Short Curriculum improves self-reported knowledge in PAG trainees across all 3 specialties.

Study Objective The goal was to develop a multispecialty committee to address deficiencies in pediatric and adolescent gynecology (PAG) resident education through curricular development under the auspices of the North American Society for Pediatric and Adolescent Gynecology. Design, Setting, Participants, Interventions, and Main Outcome Measures A multispecialty North American committee was organized to develop short as well as long curricula in PAG through a combination of conference calls and face-to-face meetings. Content was guided by objectives of national accrediting organizations. The curricula used print as well as interactive electronic resources. Results After publication of the short and long curricula, a dissemination strategy was developed to present the information at national meetings. A curricular study was performed after introduction of the curriculum to evaluate its efficacy. Long-term plans for further curricular components and expansion of educational tools are ongoing. Conclusion We gathered a diverse multispecialty group of doctors to collaborate on a unified educational goal. This committee developed and disseminated resident PAG curricula using a variety of learning tools. This curricular development and implementation can occur with a minimal financial burden.

Objective To perform a needs assessment to determine whether a mandatory Pediatric and Adolescent Gynecology (PAG) training experience in each Obstetrics and Gynecology (ObGyn) residency program in Canada is required and feasible. Materials and Methods This was a comparative descriptive design in which the 16 ObGyn Residency Program Directors (PD) in Canada were asked to undergo a 20-minute structured phone interview. These interviews were recorded, and explored how PAG and Reproductive Endocrinology (RE) objectives are met in each program, the PD's awareness of PAG opportunities in North America, and the feasibility of a mandatory training experience. This project is Research Ethics Board (REB) approved. Results Of 16 PDs, 12 gave consent and completed the phone interview. There is at least 1 PAG-trained ObGyn per institution, with a wide variety of clinical and academic experiences in PAG for residents between residency programs. There is much overlap among PAG and RE. All PDs interviewed believe that PAG training is important and should be mandatory; however, many feel that they lack the resources to implement a PAG mandatory training experience and that many barriers to such a curriculum exist. Conclusion PAG training experiences should be mandatory in all ObGyn training programs, according to participating PDs. PAG providers were identified at all the participating residency programs, and efforts should be made to support these providers in delivering the educational PAG content to ObGyn residents so the residents can become competent in the care of young women and children. PDs should be provided with the available PAG resources and resident elective opportunities.

A previous study determined that Obstetrics and Gynecology (ObGyn) residency Program Directors (PD) endorse mandatory Pediatric and Adolescent Gynecology (PAG) training to achieve national PAG objectives. Although barriers exist that limit the achievement of PAG objectives, this paper presents existing PAG tools and curricula. These include the North American Society for Pediatric and Adolescent Gynecology (NASPAG) short and long curricula, a wide variety of PAG electives available across Canada, more than 25 online clinical cases, and a simulation curriculum. This paper details these resources and provides a 4-week PAG schedule to accommodate ObGyn residency training programs.

Journal of Pediatric and Adolescent Gynecology - In Press.Proof corrected by the author Available online since vendredi 14 octobre 2016

Objectives Pediatric and adolescent gynecology (PAG) is an essential part of obstetrics and gynecology (ObGyn) residency programs. There are concerns that RCPSC PAG objectives are not being met and graduating residents will not have the knowledge and skills to care for young female patients. Methods This is a comparative descriptive design where 16 ObGyn residency program directors (PD) in Canada were asked to participate in a 20-minute phone interview. The questions explored how PAG objectives are met in each program, the PD's awareness of PAG opportunities in North America and the feasibility of a mandatory PAG training. This project is REB approved. Results 12 out of 16 PDs consented and completed the phone interview. There is at least 1 PAG-trained ObGyn per institution. There is a wide variety of PAG clinical and academic experiences for residents between the different ObGyn residency programs. All PDs feel that PAG training is important and should be mandatory. Many PDs feel they lack the resources to implement a PAG mandatory training experience and cited many barriers. The PDs also offered solutions to these barriers many of which actually already exist unbeknownst to PDs. Conclusions PAG training experiences should be mandatory in all programs to achieve the RCPSC PAG objectives. PAG providers are available in all Canadian training centers. Efforts should be made to support these providers in delivering educational PAG content to ObGyn residents so they may become competent in the care of young women. PDs need to be educated on the available PAG educational resources.

There is evidence that transfer of care for older adolescent patients to adult care is associated with a deterioration in health, especially in those with chronic conditions. Because several specific conditions in pediatric and adolescent gynecology continue into adulthood, it is important that patients have a seamless healthcare transition. In this commentary, it is argued that instead of arranging transfer, long-term retention of patients by the same physician or physician team may be the more caring, patient-centered approach.

Purpose of review The current review highlights the complexity of the pediatric and adolescent gynecology subspecialty as well as the recent and exciting opportunities for innovation within the field. Recent findings The opportunities for concept, treatment, instrument, and knowledge-transfer innovation to better serve the specific needs of pediatric gynecology patients include novel approaches to neovagina creation using magnets, improving postoperative vaginal wound healing through newly designed and degradable vaginal stents, and complex Mullerian reconstructive surgical planning using virtual reality immersive experiential training. Summary There is a significant window of opportunity to address the needs of pediatric, adolescent and adult gynecological patients with new innovative concepts and tools.

Within the pediatric and adolescent gynecology (PAG) community, an important issue deserving of our attention is expansion of formalized PAG training opportunities for medical students. In addition to those in obstetrics and gynecology, many physicians practicing family medicine, internal medicine, and surgery provide care to young female patients. However, residency programs provide inconsistent training in addressing specific PAG health care needs and communication skills required for delivery of care to pediatric and adolescent patients; opportunities for supervised clinical experience in these areas at the medical school level therefore have great importance because they might not be offered again during some residencies. At the undergraduate medical education level, training opportunities in PAG are currently limited, with only 3 PAG subinternships in North American medical schools. In contrast, other available subinternships include 113 in maternal fetal medicine and 82 in gynecologic oncology. To address this gap in opportunities for medical students, we developed a PAG subinternship and elective for medical students, which we describe in this report. Our 4-week PAG subinternship and 2-week elective expose students to a variety of ambulatory and surgical opportunities, with formal, informal, and self-guided learning activities. In this article, we explain the process of developing the curriculum, gaining alignment from key stakeholders, obtaining formal approval for the course, and advertising the opportunity to medical students. We also provide resources and guidance for medical educators who wish to establish a PAG subinternship or elective course at their institutions.

In 2015 the Resident Education Committee published the Long Curriculum in Resident Education to provide educators with a comprehensive document to be used in post-graduate medical education. The original curriculum was designed to meet the resident learning objectives for CREOG, RCPSC and ABP and to provide a more intensive, broader learning experience. This Committee Document is an updated version of the 2015 Long Curriculum.

Individualized learning plans (ILPs) are helpful tools that can facilitate learner-centered education and can be used with all levels of learners. We introduce the concept of ILPs, the rationale for their use in pediatric and adolescent gynecology education, and review the challenges that learners might face in creating ILPs, and describes how educators can support learners during this process.

Study Objective To describe a hybrid simulation model for pediatric and adolescent gynecology (PAG) examination teaching, to evaluate if it would be feasible to be conducted as a part of the PAG training, and to find out how it would be perceived by the trainees. Design The development process and a 2-day workshop is presented. Setting An academic 2-day PAG simulation training at the Medical University of Lublin Centre of Medical Simulation. Participants Twenty-two obstetrics and gynecology and pediatric residents from various hospitals of the Lublin county region. Interventions Participants took part in a 2-day simulation-based workshop consisting of a theoretical part and 3 high-fidelity PAG simulation scenarios, followed by an anonymous feedback survey on their opinions about the hybrid model teaching strategy. Main Outcome Measures To describe and evaluate feasibility of a hybrid simulation model for PAG examination teaching and to report students’ satisfaction and acceptance of this teaching modality; to share faculty experience and lessons learned during the development process. Results Of 22 initially enrolled residents, 16 of them completed the simulation-based session. All but 1 participant preferred a hybrid model to a task trainer as a teaching modality. The same number of surveyed residents stated that they learned more using the hybrid model. Qualitative feedback from the participants was overall positive. Conclusion A hybrid model for teaching PAG examination is feasible and greatly accepted by the trainees. We are convinced that such a model of training can improve trainees' skills and translate to PAG patients’ comfort and safety. It could be potentially used in teaching more difficult procedures (eg, intrauterine device insertion or examination after sexual assault).

Complementary and alternative health care approaches are prevalent in the patients and families served by practitioners in pediatric and adolescent gynecology. This article addresses gaps in knowledge, including new terminology, prevalence of use, rates of and reasons behind nondisclosure, and potential interactions of herbal products with prescribed medication. It closes with practical complementary health approaches to the adolescent with dysmenorrhea.

Updates in Adolescent Medicine provides an overview of topics, which have been evolving over the past two decades. In this chapter, we provide current reviews of the following topics: 1. Adolescent development 2. Psychosocial and risk behavior assessment of adolescents 3. Substance use (specifically marijuana) in adolescents 4. Adolescent gynecology (including contraception, management of abnormal uterine bleeding, and PCOS) 5. Providing care to LGBTQ adolescents and families 6. The role of technology and media in the care of adolescents 7. The transition from pediatric to adult health care