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1. Alexa Kaskowitz, MD, MPH* 2. Elisabeth Quint, MD* 1. *Department of Obstetrics-Gynecology, University of Michigan, Ann Arbor, MI * Abbreviations: BV: : bacterial vaginosis CDC: : Centers for Disease Control and Prevention HPV: : human papillomavirus HSV: : herpes simplex virus NAAT: : nucleic acid amplification test PID: : pelvic inflammatory disease STI: : sexually transmitted infections Pediatricians caring for adolescent girls should know how to screen for high-risk behaviors and sexually transmitted infections and how to diagnose and treat vaginal discharge, vulvar ulcers, pelvic pain, and simple ovarian cysts. After reading this article, readers should be able to: 1. Recognize the need for confidential discussions with teenagers as part of general health care. 2. Identify, evaluate, and manage some vulvovaginal disorders in teenagers, including vaginitis, vulvar ulcers, and condyloma. 3. Describe the screening and treatment methods of the most common sexually transmitted infections in adolescents. 4. Identify and evaluate the most common gynecologic causes of pelvic pain in a teenager, including ovarian cysts and masses. The pediatrician plays an important role in the transition of female patients through puberty and will frequently be the first health care professional an adolescent turns to for gynecologic care and guidance. This review focuses on the evaluation and management of gynecologic issues seen by pediatricians. It addresses the following common gynecologic symptoms: vulvovaginal concerns, sexually transmitted infections (STIs), pelvic pain, and adnexal masses. Abnormal bleeding, a common reason for a teen to seek health care, and screening adolescent gynecology have been addressed in previous articles in Pediatrics in Review . (1)(2) Adolescence is a transition time from childhood to adulthood and can be relatively smooth for some teens and difficult for others. During this time, the pediatrician should be open to discussing topics of adolescent development, such as risk-taking behavior and sexual issues. Usually at approximately age 11 to 12 years, the teen should be able to talk …

Thanks to Powell and colleagues for their comments. The guideline hopefully makes clear that doing a hysterectomy for menstrual management is NOT supported by this document or the American Academy of Pediatrics. This document was not meant to address sterilization, which is a … E-mail: equint{at}med.umich.edu

The onset of menses for adolescents with physical or intellectual disabilities can affect their independence and add additional concerns for families at home, in schools, and in other settings. The pediatrician is the primary health care provider to explore and assist with the pubertal transition and menstrual management. Menstrual management of both normal and abnormal cycles may be requested to minimize hygiene issues, premenstrual symptoms, dysmenorrhea, heavy or irregular bleeding, contraception, and conditions exacerbated by the menstrual cycle. Several options are available for menstrual management, depending on the outcome that is desired, ranging from cycle regulation to complete amenorrhea. The use of medications or the request for surgeries to help with the menstrual cycles in teenagers with disabilities has medical, social, legal, and ethical implications. This clinical report is designed to help guide pediatricians in assisting adolescent females with intellectual and/or physical disabilities and their families in making decisions related to successfully navigating menarche and subsequent menstrual cycles.