Caring for pediatric gynecology patients requires clinical approaches to diagnosis and treatment that may be as unique as each child. Here, we highlight some of the most commonly asked and most pressing questions in pediatric gynecology to aid in the diagnosis and care of a range of conditions such as endometriosis and cancer.
- What's the best way to diagnose PCOS in teens? Two classic signs of puberty, menstrual irregularity and hyperandrogenemia, may also appear with polycystic ovarian syndrome (PCOS) in teens. This can sometimes confound a straightforward diagnosis of the syndrome. Proper use of appropriate screening tools may guide clinical decision-making and lead to optimal care for young patients, who may question whether their uncomfortable symptoms are normal signs of puberty or something else.
- What are the options for diagnosing vaginismus in pediatric patients without a pelvic exam? Vaginismus can make performing a vaginal examination nearly impossible in some pediatric patients. Gentle questioning, requesting consent and sharing information during the exam may help some young patients overcome their fear. Alternatives to transvaginal ultrasound, such as transabdominal ultrasound, may allay a young patient's anxiety during the procedure while also providing the opportunity to visualize the uterus, ovaries, pelvic floor muscles and peritoneal structures and obtain necessary diagnostic information.
- Can ultrasound be used to diagnose endometriomas in teens? Endometriosis is often overlooked in children and teenagers, delaying diagnosis and treatment that can help to preserve fertility and quality of life. However, research over the last decade suggests clinical progress — a growing number of endometriomas are diagnosed more swiftly with ultrasound. Ultrasound also offers a gentler alternative to hysterosalpingography or laparoscopy for young patients.
- What does a trauma-informed pediatric gynecology exam look like? Children who have experienced some form of abuse or injury may carry the traumatic experience with them into the exam room, making a routine exam daunting. Incorporating the tenets of trauma-informed care in the pediatric gynecology exam can provide comfort while upholding best practices.
- Should sex ed for teens include fertility education? With fertility rates on the decline globally, there is a growing push to include fertility education in sexual health education for teenagers. The aim is to educate young people about the potential health risks of conceiving later in life and offer them a chance to learn fertility planning and reproductive health beyond their adolescence. As this discussion plays out, clinicians are ideally poised to foster a healthy learning environment for young patients where they can learn about all aspects of their reproductive health.
- What are the fertility preservation guidelines for young male cancer patients? When surveyed, 80 percent of clinicians expressed concern about the effect of cancer treatment on male fertility. However, only about two-thirds of these providers reported regularly referring male patients of reproductive age or younger to a fertility preservation specialist before cancer treatment. Knowledge of fertility preservation guidelines and a review of both surgical and nonsurgical options can help enable these patients to plan for a future family, arming them with information to make informed decisions before and after cancer treatment.
Pediatric gynecology presents a host of singular challenges in clinical practice. Through education, diagnosis and treatment, clinicians play a valuable role in helping young patients make informed health decisions.
