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Part 1 of ebook Adolescent gynecology: A clinical casebook provide readers with content about: general and developmental approach to adolescents; menstrual disorders; sexually active adolescents; case of a girl with a secret; case of a girl due for human papillomavirus immunization;... Please refer to the ebook for details!
Adolescent Gynecology A Clinical Casebook Hina J Talib Editor 123 Adolescent Gynecology –Hina J Talib Editor Adolescent Gynecology A Clinical Casebook Editor –Hina J Talib, M.D Assistant Professor, Pediatrics Program Director, Post-doctoral Fellowship in Adolescent Medicine Division of Adolescent Medicine Children’s Hospital at Montefiore The Pediatric Hospital for Albert Einstein College of Medicine Bronx, NY, USA ISBN 978-3-319-66977-9 ISBN 978-3-319-66978-6 (eBook) https://doi.org/10.1007/978-3-319-66978-6 Library of Congress Control Number: 2017959188 © Springer International Publishing AG 2018 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland For my mother, a physician and educator in the specialty of Pediatrics, whose footsteps I follow with confidence that comes from her unwavering support Foreword The gynecologic and reproductive health care of female infants, children, and adolescents has often been fragmented without well-accepted guidelines and bodies of evidence However, fortunately for girls and young women, a multidisciplinary medical/surgical subspecialty is now emerging into the mainstream of medical practice in the USA and to a lesser extent in other countries This subspecialty is called pediatric and adolescent gynecology (PAG), and its practitioners include adolescent medicine specialists, endocrinologists, gynecologists, nurse practitioners, pediatricians, urologists, and psychologists/psychiatrists, all of whom have training and expertise in PAG. The case discussions in Adolescent Gynecology: A Clinical Casebook are written by many of the foremost US and Canadian experts in PAG and will serve as a clinical guide for PAG fellowship trainees as well as for medical students and resident trainees and primary care practitioners who are the frontline caregivers for adolescents The clinical case discussion format is particularly useful for addressing the many intersecting and often competing considerations that must be taken into account when providing gynecologic and reproductive health care to the adolescent age group Approaches to common problems including pain with menstruation, excessive menstrual bleeding, menstrual hygiene for girls with special needs, vaginal discharge, and contraception are thoroughly discussed with many helpful suggestions for counseling teens and parents For example, Drs Sieke and Rome offer insights and advice for addressing gynecological concerns of the special needs population They comment that “Although adolescents with disabilities may not have the same level of understanding about pubertal and sexual development as their peers, clinicians must not assume that they are not sexually active or not have a sexual drive… Education [for] adolescents with intellectual disability … should include hygiene, contraception, consent, sexually transmitted infections, and sexual abuse prevention measures.” The issues of consent and confidentiality are central to the practice of adolescent gynecology but also quite difficult to manage in the clinical encounter Drs Scott and Alderman in their “Case of a Girl with a Secret” answer the question, “How should providers balance the rights of adolescents’ privacy regarding certain elements of their health with parents’ responsibility vii viii Foreword to be a part of their adolescent child’s health?” Unintended teen pregnancy, while decreasing in recent years, remains a significant problem in the USA. Access to effective contraception is an important part of the solution Drs Northridge and Maslyanskaya in their “Case of a Girl Seeking Birth Control” provide an in-depth discussion of the use of long-acting reversible contraception in adolescents, including medical eligibility criteria, the insertion procedure, and counseling In addition to cases that discuss common adolescent gynecological issues, Adolescent Gynecology: A Clinical Casebook also provides valuable information about some highly specialized or rare gynecological conditions affecting adolescent girls such as fertility preservation in girls undergoing cancer treatment as well as diagnosis and management of rare causes of primary amenorrhea including uterine and vaginal agenesis [Mayer-Rokitansky-Kuster-Hauser (MRKH)] and primary ovarian insufficiency (POI) Surgical and nonsurgical techniques for creation of a neovagina in adolescents with MRKH are thoroughly reviewed by Drs AdeyemiFowode and Dietrich in the “Case of a Girl with Primary Amenorrhea, Cyclic Pelvic Pain, and Absent Vagina.” Drs Kanj and Gordon in their comprehensive case discussion of POI, “Case of a Girl with Delayed Puberty and High Gonadotropin Levels,” not only point out the appropriate diagnostic testing for this condition but also remind us that “However, even after a thorough evaluation, approximately 90% of cases of spontaneous POI—i.e., those not secondary to cytotoxic therapy such as chemotherapy or radiation—will remain without an identifiable cause.” And they further advise us that “In all cases of POI, the various components of this chronic condition must be considered, including effects on physical, emotional, and mental health…,” excellent advice that applies to most adolescent gynecological problems In the “Case of the Girl with Vulvar Swelling,” Dr Simms-Cendan clearly addresses the current controversy over cosmetic labiaplasty in teenagers and the lack of an accepted definition of labia minora hypertrophy as well as the large increase in the number of teens requesting this surgical procedure This excellent casebook provides an overview of many of the most common and important gynecological conditions affecting adolescent girls and distills the clinical insights of experienced PAG practitioners to help guide diagnosis and management Its format makes it an accessible, easy-to-use resource for trainees and primary care clinicians I believe, and sincerely hope, that it will contribute to improved gynecologic care for adolescent girls Susan M Coupey, M.D Professor of Pediatrics Chief, Division of Adolescent Medicine Children’s Hospital at Montefiore The Pediatric Hospital for Albert Einstein College of Medicine Bronx, NY USA Preface Pediatric and adolescent gynecology is a multidisciplinary medical/surgical subspecialty that I am passionate about, as it centers on caring for girls and young women, with and without chronic illnesses, as they navigate their changing bodies and developing sexuality, a process that can be rife with physical and emotional challenges These challenges are often undiscovered by health professionals, as adolescent girls may not be forthcoming unless asked directly about symptoms or emotions in a sensitive manner ensuring confidentiality This book aims to raise awareness of common and not-so-common adolescent gynecologic issues; to empower student, physician, and nursing trainees, as well as practicing providers in caring for young girls; and to update readers with advances in adolescent gynecology Although education in the subspecialty of pediatric and adolescent gynecology is a core element of medical training, especially in the disciplines of pediatrics and obstetrics and gynecology, it faces many barriers in training programs including lack of faculty with expertise in the field, lack of a formalized curriculum, and limited opportunities for trainees to evaluate and treat young girls with gynecologic concerns In planning and editing this book, I have been fortunate to draw from my experience as program director of the Adolescent Medicine Fellowship Training Program at the Children’s Hospital at Montefiore and as associate editor of the Journal of Pediatric and Adolescent Gynecology Puberty is a hallmark event in the development of adolescent girls, and it is a time of great physical, emotional, and social change With this in mind, this book is organized in four sections, starting with Part I, “General and Developmental Approach to Adolescents,” which includes chapters addressing adolescent confidentiality, puberty, and well care Part II, “Menstrual Disorders,” recognizes that menstrual complaints are a leading reason for physician office visits by adolescent girls in the USA. Chapters here discuss the varied concerns girls often have with their menses ranging from too heavy, to too painful, to too irregular Part III, “Sexually Active Adolescents,” highlights issues in reproductive health care including sexually transmitted infection and adolescent pregnancy both of which cause significant morbidity in adolescent girls Finally, Part IV, “Special ix x Preface Populations of Adolescents,” includes chapters on girls who have sex with girls, girls who are victims of abuse, and girls with special health-care needs and chronic health conditions Here, common gynecologic health issues are discussed in the context of these special populations to increase sensitivity to and comprehensive care of these girls This book uses clinical cases, a preferred method of learning by trainees, to provide a concise and clinically relevant survey of adolescent gynecology Teaching highlights unique to this text include the case-based format, clinical pearls and pitfalls, and suggested further reading that focuses on clinical references informed by professional society guidelines, up-to-date reviews, and the Centers for Disease Control and Prevention and other large health organizations It is my hope that readers will enjoy learning from these clinical cases just as much as I have and that they will gain knowledge and clinical skills in the care of adolescent girls and young women Hina J. Talib, M.D Acknowledgments This book would not be possible without the support and mentorship of Susan M. Coupey, MD, Chief, Division of Adolescent Medicine at Children’s Hospital at Montefiore Her assistance in conception and organization of the book as well as her review of the chapters was invaluable I would also like to thank the contributing authors, who took time from their clinical practices to share their experiences and educational discussions, which I believe will be an asset to learners looking to increase their knowledge base in adolescent gynecology I also thank Elise M. Paxson, our developmental editor at Springer for her assistance, patience, and gentle guidance in the lengthy process of completing this book Lastly, I must credit the love and support of my husband, Nilam Patel, and the smiles and snuggles from our infant son, Isa, for carrying me through this endeavor and so much more Hina J. Talib, M.D xi ... 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