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 How good does a female athlete have to be before we just call her an athlete? ~Anon What is an Adolescent Gynecologist? A bridge from pediatrician to adult physician. What do we offer our young women patients? Education, Empowerment, No Judgement... - I hope to bridge the transition from pediatrician to adult physician comfortably for our young women. My patients are encouraged to call me from college or summer camp with concerns or questions. All our conversations are kept strictly confidential.
- We develop a caring relationship over time, so that young women have another adult in their life they can turn to with difficult questions.
- Some adolescents are more comfortable if they get to know their gynecologist over time so they can build a strong, trusting relationship over several visits.
- Gynecology is healthcare for women – starting at any age. Pediatric and adolescent gynecology provides reproductive care for girls from infancy.
- Preventive health and guidance for teens and parents.
- Strategies to pick a partner, reduce risk of date rape, dating violence, unplanned pregnancy & STIs.
Pediatric & Adolescent Gynecologists • We understand the variations of normal prepubertal anatomy and physiology, and know how to communicate with a child, her parents, and the different needs of teens. • Examinations, only done when deemed necessary, are done in a gentle, light-hearted, educational way that is reassuring and without discomfort, using instruments and equipment especially designed to examine young children and teens. Importance of Adolescent Gynecology • Within a year after a girl has her first menstrual period, she should consider having her first healthy-girl visit to a gynecologist. Most girls have their first period sometime between ages 9 and 15. Twelve is the average age for onset of menstruation. • The gynecologic consult rarely requires a pelvic exam, and we do not begin Pap smears until age 21. Instead, it provides an opportunity to answer questions about development and to provide medical reassurances and information about issues of health and sexuality. • Adolescent gynecologists are also trained to address other health-related concerns of adolescents, such as acne and body image, eating disorders, female athlete triad, and drug or alcohol abuse. Reasons Your Pediatrician May Refer You to an Adolescent Gynecologist: 1. Menstrual problems - Early or delayed puberty
- Heavy or Frequent bleeding
- Infrequent bleeding (oligomenorrhea)
- Absent menstrual periods (amenorrhea)
- Excessive cramping (dysmenorrhea
- Menstrual suppression in girls with developmental delay or complex medical problems
- Premenstrual dysphoric dysfunction: (PMDD): depression associated with menses.
- Menstrual migraines
2. Adolescent sexuality - Partner selection
- Abstinence benefits
- Criteria for sexual activity
- Getting out of/Avoiding difficult situations
- Delaying initiation of sexual activity until prepared
- Limiting lifetime number of partners
- Condom use
- Violence Prevention
- Date rape and alcohol use
- What to do if your friend experiences date rape
- STD prevention
- STD evaluation and treatment
- Pelvic infection
3. Hormonal problems - Acne: often related to sudden hormonal influx of puberty. An adolescent gyn has alot of experience in dealing with the hormonal swings of early puberty. She should be your first call, even before the dermatologist, if your acne is cyclical - around your menstrual cycle.
- Hirsutism: Excess facial and body hair. Often a result of a sensitivity to testosterone that can be treated in combination with other methods, so hair doesn't continue to be a problem.
- PCOS: Polycystic Ovarian Syndrome – A common hormonal disorder that is first considered because of irregular periods. It can cause insulin resistance, diabetes, elevated cholesterol, fertility difficulty
- Late-onset congenital adrenal hyperplasia
- Irregular menses due to thyroid disease, prolactinoma
  3. Ovarian cysts: the #1 reason teen girls visit the ER:- Pain
- Rupture
- The pain from ovarian cysts can be excruciating, leading young women to believe she has appendicitis, or worse. Once diagnosed by ultrasound, pain management and time is all that is needed for the cyst to resolve on it's own.
- Ovarian cyst torsion: the heavier cysts (larger than 5 cm, or made of some solid material, such as a dermoid, can cause the ovary to twist on its blood supply, called "torsion", this is very painful, and is often associated with other symptoms, such as nausea, low-grade temp, vomiting, decreased appetite and belly pain. This needs to be treated surgically, as soon as it is recognized, to untwist the ovary so that it can be saved. The cyst is removed at same time. This procedure is done through a laparoscope (under the belly button 1 cm incision, with 2 other 5 mm incisions, and you can generally go home same or next day.)
4. Genital (vulvar or vaginal) infection or pain - Vulvovaginitis - Inflammation of the vagina and/or vulva
- Lichen sclerosus – a thinning of vulvar skin, causes itching, whitening.
- Bacterial vaginosis - A vaginal infection, not sexually transmitted
- Genital warts (condyloma) - Warts (appear like tiny “cauliflower-like lesions )on the inside or outside areas of labia. May spread to the surrounding skin or to sexual partner.
- Bartholin’s cysts - painful fluid-filled cysts at the opening of the vagina
- Vulvar rash
- Vulvar lump or tumor
- Vulvar vestibulitis - Inflammation of the opening to the vagina and surrounding tissues
- Vulvar pain (vulvodynia)
5. Genital injuries - "Straddle" injuries from bicycle, etc...
- Following sexual assault
6. Abnormal Pap smear: (If done before age 21) - Cervical dysplasia - Abnormal growth of cells on the surface of the cervix
- Human Papillomavirus (HPV)
7. Pelvic pain, Disabling Cramps - Menstrual pain (dysmenorrhea)
- Endometriosis - Tissue normally inside the uterus grows in other areas of the pelvis
- Chronic pelvic pain
8. Genital anomalies - Absent vagina and/uterus
- Imperforate hymen - No hymenal opening
- Hymenal obstruction (bands, vaginal septum)
- External genitalia malformations
 9. Breast problems- Asymmetry
- Abnormal form
- Cysts, lumps
- Nipple discharge
10. Puberty Problems - Precocious: signs of puberty at age 8
- Delayed: no breasts by age 14, no menses by 16
11. Pregnancy prevention: contraception options - How to place condoms, the absolute necessity for consistent condom use
- Spermicide: for use to make condom more effective
- Birth control pills
- Birth control vaginal ring (Nuvaring)
- Birth control implant (Implanon)
- Intrauterine device (IUD—Mirena and Paraguard)
- Birth control for adolescents with complex medical problems
- EC: emergency contraception, safety and how to obtain, when to use.
 12. Pregnancy-related problems in teens- Unintended pregnancy
- Tubal pregnancy
- Miscarriage
13. Dating Concerns - Dating violence
- Healthy relationships
- Internet safety
- Texting/sexting
- Developing your own criteria and timeline for dating and sexual activity before you’re in a relationship.
14. Lesbian Teens - May have special gynecologic healthcare needs
- Some schools do not teach about sexual orientation because of objections from some religious and political groups.
- Whatever your sexual orientation, you are normal.
- Information should be obtained from supportive sources, such as your gynecologist.
- If you are sexually active, you should practice safe sex. Sexually transmitted diseases can be passed from one woman to another.
- Lesbians have increased rates of substance abuse, alcohol, tobacco, school dropouts, run aways, and depression.
- You should see your health care providers regularly for routine examinations, tests, and immunizations, and honest conversation.
15. Vaccines - The Vaccine against HPV (human papilloma virus), an STD that can, over time, in some patients, cause precancerous change to the cervix, and even cervical cancer, brought vaccines to the gynecologist’s office for the first time. If you have not received the full 3-shot series, we recommend it, and have it available for you, if desired.
 16. Forethought - Agreement made in advance with your parents, for a ride home (with no questions asked if you feel like you are in a difficult situation. (see sadd.org for the contract and communication tips.)
- Also see "teen depression" entry on this site for more info.
- This "contract" is a chance to talk about life decisions ahead, peer pressure and destructive behavior. It was specifically designed for older teens to encourage communication between young people and their parents about destructive decisions related to alcohol, drugs, peer pressure and behavior.
“It takes two people to speak the truth: One to speak and another to hear.” ~ Henry David Thoreau |
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