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This advocacy statement endeavors to clarify the concept of the hymen as a symbol of "virginity". The anatomic variants of this structure precludes any correlation to prior sexual activity and the value of physical assessment of this structure is thus questioned. Moreover, physical examination of the hymen is painful, traumatic and humiliating and is a form of gender-based violence. This statement exhorts various sectors-governments, educators, the medical community and the general public-to discard the concept of the "virgin hymen", avoid its use when documenting sexual abuse, and provide progressive education to affirm female sexuality., (Copyright © 2024. Published by Elsevier Inc.)

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Study Objective: To examine the clinical characteristics and prevalence of congenital bleeding disorders (CBDs), with emphasis on congenital factor VII (FVII) deficiency and other rare bleeding disorders, in adolescent and young adult females referred to a hemophilia treatment center (HTC) for evaluation and management of heavy menstrual bleeding (HMB) and iron deficiency anemia (IDA) DESIGN: In this single-center retrospective study, we reviewed the clinical characteristics and prevalence of CBDs in postmenarchal females, younger than 22 years of age, referred to an HTC from 2015 to 2021 for evaluation of HMB with or without IDA., Results: One hundred females, with a mean age of 15 years (range 9-20 years), met initial study criteria, and 95 were included in the final analysis. Forty-five (47%) females were ultimately diagnosed with a CBD. The most prevalent diagnoses were FVII deficiency and type 1 von Willebrand disease (VWD) (42.3%, n = 19 each). Forty-two percent of patients with FVII deficiency had a low-for-age FVII activity level, 21.1% were only positive for the FVII R353Q variant associated with borderline FVII levels, whereas 36.8% had both a low-for-age FVII activity level and a positive R353Q variant. Eighty percent of patients with a CBD were found to have relatives with abnormal bleeding symptoms., Conclusion: Congenital FVII deficiency is prevalent among female adolescents experiencing HMB with or without IDA. In addition to VWD, evaluation for this specific factor deficiency should be considered as part of the initial CBD workup. Presence of abnormal bleeding history in the family could also help to predict presence of a CBD., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022. Published by Elsevier Inc.)

Shigella vulvovaginitis is an uncommon aetiology of prepubertal vaginal bleeding that should be considered in the differential diagnosis, especially in patients who have travelled to developing countries. A young girl presented with prepubertal vaginal bleeding, pelvic pain, occasional dysuria and no gastrointestinal symptoms. After a year-long extensive workup, including vaginoscopy and biopsy, genital culture and Gram stain revealed vulvovaginitis due to Shigella flexneri After review of bacterial sensitivity, the patient was given a 30-day course of sulfamethoxazole-trimethoprim. The patient returned to the clinic 1 month later with no signs of vaginal bleeding, discharge or pelvic pain. This case prompted review of the indicated evaluation and differential diagnosis of prepubertal vaginal bleeding, including infectious aetiologies such as Shigella vulvovaginitis with the authors' goal to expedite diagnosis and treatment in paediatric patients., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and objective Patients' demographics (race, age, gender, and ethnicity) have been determined to affect patients' health status. It has been established that chronic disease prevalence varies by race, age, gender, and ethnicity; however, not much is known about how these demographic factors influence presenting conditions or complaints within a student-run clinic (SRC). This study aimed to investigate how demographic factors in the Apopka community in Florida determine what internal medicine (IM) conditions or complaints patients present with at a student-run free clinic. Methods Electronic medical record (EMR) data for adult patients seen at the clinic from February 2019 to February 2020 were reviewed to collect information on patient demographics, IM presenting conditions or complaints, and body mass index (BMI). Binary logistic regressions were employed to investigate the relationship between demographic factors and presenting conditions or complaints. Results The majority of the patients were female (62.2%), with an almost equal representation of Hispanic (50.3%) and non-Hispanic individuals. About half of the patients visiting the clinic were either overweight or obese. Of the 167 patients, the average age was 44.17 and 44.32 years for males and females respectively. The most common presenting conditions or complaints included cardiac conditions (25.07%), diabetes (9.64%), gastric pain (9.21%), and upper respiratory infection (URI)/allergies (6.15%). Cardiac conditions were further broken down into hypertension (18.94%), dyslipidemia (3.94%), and palpitations (2.19%). Patient age was a contributing factor to the incidence of diabetes (p=0.002), hypertension (p<0.0001), and cardiovascular conditions excluding hypertension (p=0.021). There was a significant relationship between obesity and diabetes (p=0.036) and hypertension (p=<0.001). Conclusion SRCs can make use of the information obtained from this study to advocate for coverage of medications to treat diabetes and hypertension in this undocumented population to prevent morbidity rates. We believe our findings can also provide guidance in terms of instituting screening programs for these illnesses among the broader population and SRCs with different patient makeups., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, El-Said et al.)

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., (Copyright © 2021. Published by Elsevier Inc.)

Girls and adolescents, aged 0-19 years make up almost 30% of the world's female population yet their specific healthcare needs often slip between the gaps of pediatrics and adult women's health. Pediatric and adolescent gynecology is the clinical field that endeavors to address the reproductive health needs of this age group. The environment and psychosocial well-being, social determinants of health, have direct bearing on reproductive health, affecting menstrual cycles, menstrual hygiene, and risks for unintended pregnancy and sexually transmitted infections. This narrative review will highlight common gynecologic conditions of adolescents, especially where diagnosis and management are distinct from adult women. It will also present preventive health strategies to improve reproductive health through vaccination, improved access to hygiene supplies and contraception., (© 2021 International Federation of Gynecology and Obstetrics.)

Background: Development of culturally competent nursing students is a core objective in nursing education., Method: One hundred sixty nursing students completed an online survey assessing sociodemographic information, Spanish language, service-learning participation, and cultural competency., Results: Degree of participation in the multidisciplinary farmworkers clinic (r = .374, p = .013), federally qualified health center (FQHC) (r = .387, p = .032), and short-term international medical mission trip (r = .433, p = .021) was associated with higher cultural competency. Furthermore, several demographic factors including being a native Spanish-speaker (p = .022), female (p = .004), Latino (p = .045) or a student of low socioeconomic status (p = .026) were associated with higher cultural competency., Conclusion: Participation in service-learning opportunities involving care for minority and disadvantaged communities, whether required or voluntary, was correlated with higher cultural competency scores, as long as the students' experiences involved direct patient care responsibilities. These findings highlight the need for identifying more diverse opportunities for service-learning and more diverse direct patient care opportunities to foster students' cultural competence. [J Nurs Educ. 2021;60(1):29-33.]., (Copyright 2021, SLACK Incorporated.)

Introduction Latent tuberculosis infection (LTBI) screening with targeted treatment has been successful in eradicating tuberculosis (TB) as an endemic infection in the United States. The Centers for Disease Control and Prevention (CDC) recommends screening for high-risk patients. The aim of this study was to increase LTBI screening, detection, and treatment in our student-run free clinic while providing an innovative platform for education in primary care topics. Methods A questionnaire for screening for LTBI was adapted from CDC guidelines. Medical students and providers received education on the screening process and administered questionnaires to patients. We analyzed the rate of performed LTBI screening, the rate of diagnostic testing for patients with positive screening, and the feasibility of implementing a preventive screening initiative. Results Fifty-two patients completed primary care visits. Forty patients were screened for LTBI. Of those screened, 42.5% were positive for the screening. Of those with positive screening, 70.6% were followed up via diagnostic testing, with the rest of them being lost for follow-up due to not attending the clinic for care. Conclusions This educational intervention combined with a screening tool was effective in increasing LTBI screening rates amongst patients in a student-run free clinic., Competing Interests: The authors have declared that no competing interests exist.

Gynecologic examination of the pediatric adolescent patient provides a valuable opportunity for patient education and diagnosis, yet presents special challenges, including achieving comfort for the patient and guardian and finding equipment that are sized for pediatric patient. Anatomic changes due to the hormonal environment evolve from newborn through pubertal development. As pediatric adolescent gynecology has evolved as a specialty, techniques and training for providing optimal office and surgical examination have emerged. Where possible, the patient should be engaged with the examination through use of a mirror or positioning. Smaller swabs should be used for testing for vaginal infection in prepubertal patients. When speculum or office examination is not possible, use of narrow-caliber, flexible, and rigid hysteroscopes allow vaginoscopy for assessment., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Most medical schools in the United States have an associated student-run free clinic (SRFC) providing medical care to the underserved population around the campus. SRFCs provide students with opportunities to practice history-taking and diagnosis skills. There have been a few studies that have evaluated patient satisfaction within SRFCs; however, these studies report limited aspects of care within these clinics. This study hopes to determine the levels of satisfaction with clinical staff and operations and to ensure that the medical needs of patients are being met. Results showed that 91% of the patients were satisfied or very satisfied with their overall clinic experience. The highest scoring parameters were "courtesy/respect of staff", "availability of free or affordable medications", and "doctor's knowledge". Overall, the patients are satisfied with the staff, care, and availability of medicine provided by the Keeping Neighbors in Good Health Through Service (KNIGHTS) clinic. Most patients enjoy participating in the training and education of future physicians and would recommend this clinic to a friend or family member. The lowest satisfaction rates were associated with length of visit and wait time. In the future, SRFCs should work together to assess patient satisfaction in the clinics, identify problem areas, and develop generalizable interventions for improvement., Competing Interests: The authors have declared that no competing interests exist.

Background The American College of Obstetrics and Gynecology notes that pregnant athletes require more supervision due to their involvement in strenuous training schedules throughout pregnancy. Currently, rowing is not mentioned in the guidelines despite its increasing popularity, high cardiovascular demands, and risk for abdominal trauma. Methods This study aimed to elicit information from competitive female rowers regarding exercise, training, and competition during pregnancy. We administered a survey consisting of 122 items to female Masters rowers in the United States, aged 21 to 49 years, from June to December 2013. Results A total of 224 recreational and elite rowers met the inclusion criteria. Pregnant rowers self-reported high levels of exercise engagement: 85.2% (n/N = 98/115) exercised during any past pregnancy; exercise adherence decreased throughout pregnancy with 51.3%, 42.4%, and 15.7% meeting and/or exceeding national guidelines during the first, second, and third trimesters, respectively. Rowers were significantly (p < 0.001) more likely to state that an activity at a specified intensity and trimester was unsafe if they were younger, had less rowing experience, or were nulliparous. Decreased perceived rowing safety was associated with on-water training, higher intensity exercise, competition, and increasing gestational age. Primary safety concerns were the risk of oar-induced abdominal trauma and physiological effects due to high intensities required by the sport. Novel barriers to exercise in pregnancy included guilt towards the team and a mental barrier due to decreased performance. Healthcare providers are the number one information source for rowers regarding exercise during pregnancy. Conclusion Pregnant rowers are a relevant obstetrics population and have barriers and sport-specific safety concerns not previously identified in the literature. Rowers consider exercising in pregnancy to be important and struggle to meet exercise guidelines like the general population, indicating the need for healthcare providers to provide prenatal and antenatal education and interventions to support exercise during pregnancy even amongst athletes., Competing Interests: The authors have declared that no competing interests exist.

Introduction: While patients with neglected tropical diseases may present for care in the United States, they are encountered so infrequently that medical professionals may have little chance of being exposed to these illnesses during training. This simulation on dermatological presentations of neglected tropical diseases was used as a teaching tool for multifaceted topics including disease management, interdisciplinary collaboration, and sociocultural issues. To achieve this goal, we created four cases with patients demonstrating clinical and dermatological presentations., Methods: Through the use of a moulage kit, this simulation portrayed four common neglected tropical diseases that are rarely encountered in the United States: dengue fever, cutaneous leishmaniasis, lepromatous leprosy, and yaws. Following the clinical experience, a debrief session discussing sociocultural and dermatological factors of neglected tropical diseases occurred., Results: The feedback obtained regarding the simulation was exceptionally positive. The participants indicated that the simulation improved their medical knowledge of neglected tropical diseases, diagnostic abilities, and interprofessional communication skills., Discussion: This simulation can easily be adapted for use in conferences, health professional education, and patient advocacy, making it relevant for training in a wide variety of settings. Through the application of this simulation, greater progress can be made in the education of medical professionals on neglected tropical diseases and dermatology. Not only will the application of realistic workshops increase medical competency regarding these rarely encountered diseases, it will also provide opportunities to engage with these diseases, which can cultivate interest in the future pursuit of global health., Competing Interests: None to report.

Introduction: Innovative and effective curricula for medical students and physicians are needed to increase knowledge and confidence for instructing patients on lifestyle management of diseases. We developed an active collaborative session that integrates evidence-based medicine (EBM), clinical decision-making, nutrition, exercise, and personalized patient care for the instruction of lifestyle management of obesity in the preclinical medical curriculum., Methods: Before the session, learners critically appraised an EBM article (meta-analysis of commercial weight-loss programs' efficacy). In class, there was an EBM discussion assessed and facilitated by multiple-choice questions, followed by a collaborative activity where learners solved a clinical scenario of a patient who wants to use a commercial weight-loss program. Each small group was assigned to a different program but given the same clinical scenario. The objectives of the session were to identify and interpret EBM/non-EBM resources in order to describe the components, advantages, and disadvantages of the weight-loss programs, make a personalized clinical recommendation, and present it to the class., Results: Generating debate and fostering engagement, the session was perceived as a positive learning experience by the learners. By accomplishing the learning objectives, the participants became well versed in various weight-loss programs., Discussion: Our results suggest that learners developed interpretation and knowledge integration skills, which may increase their comfort in discussing the lifestyle management of obesity and other diseases. This activity is designed to be implemented at other institutions seeking to integrate active collaborative learning of nutrition, exercise, and clinical decision-making during preclinical and clinical medical education and clinical practice., Competing Interests: None to report.

Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients' health, we performed a comprehensive analysis of patients' experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p < 0.001) and self-respect (r = 0.66, p < 0.001). Incentives to medical care include continuity of care, faith-based care, having a patient medical provider partnership, and charging a facility fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee.

Background: Guttate psoriasis is frequently associated with a preceding pharyngeal or perianal streptococcal infection in children. Despite Group A beta-hemolytic streptococci (GABHS) being the most common cause of specific bacterial vulvovaginitis in prepubertal girls, there are no reports of streptococcal vulvovaginitis triggering guttate psoriasis., Case: A five-year-old girl presented with guttate psoriasis following an episode of Streptococcal pyogenes vulvovaginitis. Following antibiotic treatment and bacterial eradication she developed vulvar psoriasis that resolved with high potency topical steroids., Summary and Conclusion: Identification of an antecedent streptoccocal infection can help predict the long term prognosis in children with guttate psoriasis. The vulvovaginal area should be considered as a source of GABHS infection in young girls with guttate psoriasis, and cultures should be considered if symptoms are present., (Published by Elsevier Inc.)

Purpose: To assess perspectives of residents: (1) who participated in short-term international medical mission trips (STIMMTs) as medical students regarding impact of the experiences on their professional development; and (2) who did not participate in STIMMTs regarding barriers to participation., Methods: Three hundred seventy-nine residents from 16 programs at two Florida institutions completed surveys requesting Participant and Trip Details and Impact of Participation (including items rating learning, cultural competency, and social responsibility)., Results: One hundred thirty-one residents participated in at least one STIMMT. They identified improved adaptability to new healthcare settings, communication with patients and professionals from different backgrounds, and appreciation for the impact of culture on health as positive outcomes. Leading barriers to STIMMT participation included cost, timing, and lack of availability., Conclusions: Years after participation in STIMMTs, residents perceived sustained benefits in cultural competency, communication skills, adaptability, and desire for service. Institutions may consider facilitating STIMMTs as one way to address standards specified by accrediting authorities to provide training in cultural competency, social responsibility, altruism, and understanding the importance of caring for underserved populations. Barriers to STIMMT participation may be reduced through availability of institution-sponsored scholarships, identification of external grant and scholarship opportunities, and coordination of fund-raising activities.

Background: Infantile hemangiomas may cause vaginal bleeding in prepubescent girls., Case: A 3-year-old girl was referred for evaluation of painless vaginal bleeding. Her initial evaluation was nondiagnostic. The girl's physical examination was remarkable only for an infantile hemangioma of her right hand. A vaginoscopy was performed and a hemangioma of the anterior vaginal wall was identified. The patient was managed conservatively. Her bleeding has decreased in amount and frequency., Summary and Conclusion: Infantile hemangiomas are a potential cause of vaginal bleeding in young girls and should be suspected if a child has a hemangioma on another part of their body. Most infantile hemangiomas resolve without therapy.

The benefit of Papanicolaou screening in reduction of cervical cancer rates has been clearly demonstrated. The incidence has fallen considerably since screening began in the 1940s. Differences in rates of screening occur across generations of women through variation in access, patient education, and routines of practitioners. This article reviews the use of Papanicolaou screening by women of different ages and presents possible methods for increasing use.