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Vaginal agenesis, most commonly referred as Mayer–Rokitansky–Küster–Hauser (MRKH) Syndrome, is mostly diagnosed as primary amenorrhea in teenage girls; although there is plenty of literature concerning the formation of a neovagina, limited research has focused on the psychological burden of this diagnosis to the girls. To enlighten health providers into the finer aspects of sexuality through the own words and experiences of girls with MRKH under our care. Women currently undergoing vaginal dilation or who had completed vaginal dilation within the past year were recruited from February 2019 to January 2020. A gynecologist with training in Sexual Medicine conducted a semistructured interview, which was recorded and then transcribed to identify common themes among interviewees. The main outcome explored was the narrative experiences of women with MRKH. 7 women participated, with a mean age of 19.7 (range 17–22 years). None of the girls felt stigmatized, however one reported significant distress at diagnosis, stemming from the attitude of health care professionals and exacerbated by an earlier age at disclosure. All girls accepted that VDT was successful, when it was initiated after they had felt sexual interest and arousal. Exact quantification of the vaginal length at onset, worried 4 as they felt pressurized to achieve a specific length. A few girls reported anxiety over sharing the diagnosis with an intimate partner. All of them pretended at some point to have menses. Childbearing was an important issue for most of the interviewees, but it did not concern them for the time being. All girls had supporting families. However, 5 did not want to share information about VDT with them. One girl reported that openness in discussing genital anatomy, VDT and sexuality, helped her both in completing treatment and adapting in a sexual relationship. A multidisciplinary team should aim for age-appropriate disclosure and consultation and guide women through VDT and their sexual relations. This is a thorough account of women's perceptions regarding VDT and sexuality in MRKH. However, our conclusions may be limited by the small number of participants. Gradual provision of information at disclosure and adjusted timing at VDT may reduce stress in girls with MRKH. Tsitoura A, Michala L. The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study. J Sex Med 2021;18:2012–2019. [ABSTRACT FROM AUTHOR]

Labial fusion in adolescence is uncommon and is usually secondary to other skin disorders or trauma of the vulvar area. In a five-year period, we treated five patients with labial fusion in our facility with a mean age of 16.4 years. Based on clinical presentation and biopsy of the vulvar skin, lichen sclerosus (LS) was the causative factor. Four out of five had urinary problems and one suffered from an inflamed inclusion cyst. All of them had a long history of pruritus. In all cases, blunt separation of the labia minora under general anaesthesia was performed, followed by local application of a potent glucocorticoid cream and an emollient agent. One patient received additionally oral and local antibiotics. One recurrence was noted, which resolved after re-separation and more meticulous treatment. Early identification and treatment of LS are crucial to prevent distortion of the vulvar anatomy.Impact StatementWhat is already known on this subject? Labial fusion is an uncommon problem in adolescence and an underlying cause should always be investigated. Lichen sclerosus typically affects the anogenital area and can lead to fusion of the labia minora.What do the results of this study add? Urinary symptoms may be the presenting feature of LS in adolescents.What are the implications of these findings for clinical practice and/or further research? Delay in diagnosis and appropriate treatment can result in irreversible changes to the vulva. [ABSTRACT FROM AUTHOR]

Purpose: To ascertain the role of deranged eating behaviours (DEBs) in the development of functional hypothalamic amenorrhoea (FHA) and the reciprocal role of psychopathological traits on both disorders.Methods: A prospective case-control study was conducted spanning the period January 2016 to April 2018. Forty-one consecutive FHA females and 86 healthy controls were recruited. We assessed the DEBs and other FHA predisposing factors via self-reported questionnaires. Possible correlations amongst the variables were examined using the Spearman's correlation coefficient (rho), whilst multivariate logistic regression was carried out to identify independent predictors of DEBs.Results: Mean scores on Eating Attitudes Test-26 (EAT-26) were significantly higher in females with FHA (p < 0.0001). Women with FHA were characterised by significantly higher scores at the sub-scale items of dieting (p = 0.03) and bulimia and food preoccupation (p < 0.001) compared to healthy controls. Significant difference was also observed between the mean scores of the two groups in all other questionnaires: State-Trait-Anxiety-Inventory (STAI) (p < 0.0001), Multidimensional Body-Self-Relations Questionnaire (MBSRQ) (p < 0.0001) and International Physical Activity Questionnaire (IPAQ) (p = 0.004). EAT-26 scores were positively correlated with scores on STAI (ρ = 0.26, p = 0.04), MBSRQ (ρ = 0.79, p < 0.0001) and IPAQ (ρ = 0.35, p = 0.03). High scores on IPAQ and STAI were correlated with a 12.2-fold (p = 0.008) and 4.3-fold (p = 0.04) increased risk for high scores on EAT-26 respectively.Conclusions: DEBs may occur in FHA populations at a higher frequency compared to the general population. Anxiety and overweight preoccupation may underlie and independently contribute to development and maintenance of both DEBs and FHA. This evidence may have future implications for both screening and interventions that target DEBs and other psychological factors. [ABSTRACT FROM AUTHOR]

Purpose: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective method of contraception, while also providing various non-contraceptive benefits. Although targeted primarily to adults, there is increasing experience in its use in adolescence. The aim of this review is to assess the available information on LNG-IUS usage in adolescence.Methods: We conducted an online search on MEDLINE and SCOPUS from inception to May 24, 2015. All studies that examined LNG-IUS use in teen populations were eligible for inclusion. Primary outcome measures included description of indications for LNG-IUS usage and relevant efficacy. Secondary outcomes included complications, such as device-related problems (perforation and expulsion) and other adverse events (pelvic inflammatory disease, PID). Acceptability of the LNG-IUS was also estimated through evaluation of continuation rate and reasons for removal were assessed.Results: Twenty-one studies met our inclusion criteria. We identified only one randomized controlled trial (RCT). All other twenty studies were observational. Pregnancy rates ranged from 0 to 2.7%. Management of heavy or/and painful periods was successful in 92-100%. Menstrual manipulation in patients with developmental delay was achieved in over 93% of cases. Expulsion rates ranged from 0 to 13% and pelvic infection/cervicitis between 0 and 2.7%. There were no reported uterine perforations.Conclusion: Usage of the LNG-IUS in teen populations appears to be safe and efficacious both in terms of contraception and menstrual management. However, more robust evidence is needed so as to provide firm confirmation on benefits and potential side effects. [ABSTRACT FROM AUTHOR]

The purpose of this prospective study was to assess the effectiveness of norethisterone (NET) in the management of abnormal uterine bleeding (AUB) in adolescents in a tertiary care center. This was a prospective audit focused on administering high doses of NET in female adolescents with complaints of AUB. We included female adolescents who presented to our Emergency Gynecological Department or Adolescent Gynecological Outpatient Department from October 2016 to January 2019. The study included 29 female adolescents aged 11-17 (mean, 13.14) years. Patients were administered a daily dose of 10-30 mg, depending on the severity of the condition, bleeding duration, and patient weight. Cessation of vaginal bleeding. Mean age at menarche of our patient sample was 11.4 years (range, 10.7-14 years). AUB presented at a mean time of 24.6 months after menarche (range, 0-79 months). Blood transfusion was deemed necessary in 9 patients. Bleeding stopped at a mean of 46.1 (range, 8-120) hours after onset of treatment with NET. No serious adverse events were reported with NET administration, with only 3 cases of minor side effects. The use of NET is an effective and reliable treatment option among adolescents for whom control of AUB is desired in the acute setting. [ABSTRACT FROM AUTHOR]