Ebook Good practice in pediatric and adolescent gynecology: Part 1

Part 1 of ebook Good practice in pediatric and adolescent gynecology provide readers with content about: vulvovaginitis in childhood; delayed puberty; diagnosis and treatment of genital malformations in infancy and adolescence; gonadal failure; dysmenorrhea; dysfunctional uterine bleeding;... Please refer to the part 1 of ebook for details!

Good Practice in Pediatric and Adolescent Gynecology Anna Maria Fulghesu Editor 123 Good Practice in Pediatric and Adolescent Gynecology Anna Maria Fulghesu Editor Good Practice in Pediatric and Adolescent Gynecology Editor Anna Maria Fulghesu Department of Obstetrics and Gynecology University of Cagliari Cagliari Italy ISBN 978-3-319-57161-4    ISBN 978-3-319-57162-1 (eBook) https://doi.org/10.1007/978-3-319-57162-1 Library of Congress Control Number: 2017954378 © 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 Preface This book is a very useful text to consult when a specific gynecological problem affects a child or a young girl who needs your help This text is focused on a special time of women’s lives when the prevention of sexual and reproductive problems is very important, and it is aimed at clinical pediatricians and gynecologists Each author is an expert scientist in the field, a member of the Italian Society of Gynecology of Childhood and Adolescence (SIGIA), and every chapter reports the most up-to-date knowledge The text has a strong practical relevance, and represents the guidelines of this scientific society The order of the chapters follows the age of girls from infancy, with genital malformations, vulvovaginitis, to puberty, studying delayed puberty and postpubertal gonadal failure Menstruation disorders, such as dysmenorrhea, heavy menstrual bleeding, menstrual irregularities, eating disorders and polycystic ovary syndrome, are studied in depth in individual chapters The prescription of contraceptives and the diagnosis and treatment of ovarian cysts are specifically tailored to the adolescent age Sexual mutilation and abuse are also dealt with, and how to prevent, diagnose, and treat the most frequent sexually transmitted diseases Finally, pregnancy in adolescence, which represents a difficult clinical responsibility for gynecologists because of the high frequency of pregnancy-related disorders, is described Happy reading! Cagliari, Italy Anna Maria Fulghesu v Contents 1 Vulvovaginitis in Childhood������������������������������������������������������������������������  1 Cristina Vezzani, Gilda Di Paolo, Terryann Spagnuolo, and Gabriele Tridenti 2 Delayed Puberty ����������������������������������������������������������������������������������������  19 Metella Dei and Francesca Pampaloni 3 Diagnosis and Treatment of Genital Malformations in Infancy and Adolescence ����������������������������������������������������������������������������������������  35 Tiziano Motta and Chiara Dallagiovanna 4 Gonadal Failure������������������������������������������������������������������������������������������  63 Maria Francesca Messina and Alfonsa Pizzo 5 Dysmenorrhea��������������������������������������������������������������������������������������������  77 Gabriele Tridenti and Cristina Vezzani 6 Dysfunctional Uterine Bleeding����������������������������������������������������������������  99 Tiziano Motta, Antonio Simone Laganà, and Salvatore Giovanni Vitale 7 Menstrual Disorders in Post-menarcheal Girls������������������������������������  117 Francesca Pampaloni and Pina Mertino 8 Eating Disorders in Adolescence������������������������������������������������������������  131 Vincenzina Bruni and Metella Dei 9 Diagnosis of Polycystic Ovarian Syndrome in Adolescence����������������  143 Anna Maria Fulghesu, Cristina Porru, and Elena Canu 10 Recommendations for the First Prescription of Hormonal Contraception in Adolescence������������������������������������������  161 Floriana Di Maggio and Gilda Di Paolo 11 Ovarian Cysts in Adolescence����������������������������������������������������������������  171 M Chiara Lucchetti 12 Female Genital Mutilations��������������������������������������������������������������������  183 Lucrezia Catania, Omar Abdulcadir, and Jasmine Abdulcadir vii viii Contents 13 Sexual Abuse and Genital Trauma���������������������������������������������������������� 193 Maria Rosa Giolito, Giulia Mortara, and Monica D’Amato 14 Sexually Transmitted Diseases in Adolescence���������������������������������������� 211 Gilda Di Paolo 15 Pregnancy in  Adolescence ����������������������������������������������������������������������  239 Gabriele Tridenti and Cristina Vezzani About the Author Anna Maria Fulghesu  is a medical doctor specializing in obstetrics and gynecology As researcher of Obstetrics and Gynecology, from 1988 until 2000, she worked in the Department of Obstetrics and Gynecology at the Sacred Heart of Rome (Policlinico Gemelli), and since 2000 in Cagliari as Associate Professor at the Università degli Studi She is founder and is responsible for the Outpatient Service of Pediatric and Adolescent Gynecology (PAG) in Calgliari At the same hospital, she has been involved in the Sexual Abuse Service in Childhood and Adolescence As an invited speaker, she has taken part in several national and international events As a teacher, she has given her services on many courses for medical doctors and health caregivers She has herself organized several courses on PAG, including six national day courses Author of more than 100 published scientific papers, she is also a referee for several national and international scientific journals and she is a member of the following scientific societies: –– International Federation of Infantile and Juvenile Gynecology (FIGJI) –– Società Italiana di Ginecologia dell’Infanzia e dell’Adolescenza (SIGIA, Italian Society of Gynecology of Childhood and Adolescence): executive board member since 2013 ix Vulvovaginitis in Childhood Cristina Vezzani, Gilda Di Paolo, Terryann Spagnuolo, and Gabriele Tridenti 1.1 Introduction Vulvovaginal complaints account for 80–90% of outpatient pediatric gynecologic visits [40] Most cases may be attributed to vulvovaginitis but other less common conditions, such as vulvar diseases or vulvar manifestations of systemic disease, should be taken into account Rare causes of vulvovaginitis have to be considered especially when symptoms are recurrent or not responsive to standard treatment In this chapter, the causes, manifestations, and management options of vulvovaginitis in childhood will be reviewed Furthermore, common vulvar diseases affecting children were outlined, since their knowledge is essential for differential diagnosis The prepubertal child is particularly susceptible to vulvovaginitis for anatomic, physiologic, and behavioral factors: absence of hair and minimal labial development; close proximity of the vagina to the anus; physiological hypoestrogenism which causes atrophic genital mucosa; neutral pH and unbalanced vaginal flora; absence of cervical mucus; and lack of antibodies [1]; furthermore, children’s tendency to have poor local hygiene and to explore their bodies increases the risk of developing this conditions Germs may easily reach the genital area as a result of contiguity from the rectum, urethra, or the surrounding skin Diffusion of bacteria from the upper C Vezzani, M.D • G Tridenti, M.D Department of Obstetrics and Gynaecology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy e-mail: cristina.vezzani@ausl.re.it; gtride@tin.it G Di Paolo, M.D (*) Pediatric and Adolescent Gynecology Service, Department of Gynaecology and Obstetrics, Santo Spirito Hospital, Pescara, Italy e-mail: gildipa55@gmail.com T Spagnuolo, M.D Studio Madreperla, Pescara, Italy e-mail: terryannspagnuolo@gmail.com © Springer International Publishing AG 2018 A.M Fulghesu (ed.), Good Practice in Pediatric and Adolescent Gynecology, https://doi.org/10.1007/978-3-319-57162-1_1 C Vezzani et al airways is also possible through autoinoculation and occasionally hematic spread [2] Obesity, diabetes, anatomic anomalies, and use of antibiotics may play a role in facilitating vulvovaginitis 1.2 Etiology Vulvovaginitis are easily classified into two groups on the basis of etiology [3] • Nonspecific • Specific Nonspecific vulvovaginitis refers to vulvovaginal irritation without an identifiable pathogen, accounting up to 25–75% of all cases of vulvovaginitis in children [4] Symptoms may often be caused by irritative-allergic reaction to topical or food agents, nickel, or by poor perineal hygiene Vaginal cultures are usually negative or positive for skin flora/anaerobes/enteric organism [5] However, in many cases etiology cannot be found Specific vulvovaginitis are caused by specific pathogens It has been reported that infective vulvo vaginitis were found in one-third of young girls presenting with vulvovaginitis [6] Infectious may be caused by bacterial agents, pinworms, viruses, and sexually associated pathogens Knowledge of the normal vaginal microflora in prepubertal age is an essential prerequisite for definition of the pathogens of the lower genital tract and will limit the overtreatment of non-pathogens (lactobacilli, diphtheroids, alpha-hemolytic streptococci) [7] It has been reported that some microorganisms, other than those traditionally considered part of normal flora, can be isolated from vaginal culture of girls without symptoms (Escherichia coli, Candida, Staphylococci, enterococci, Streptococcus viridans, Streptococcus agalactiae, Corynebacterium, Proteus Mirabilis, Pseudomonas aeruginosa) As these organisms are present in healthy prepubertal girls, their growth in culture is not diagnostic [8] Many of those bacteria may spread from skin or bowel and may act as opportunistic pathogens and cause infection only when the child has a temporary immune system depression Escherichia coli and Candida may be present in vaginal flora, respectively, in and 4% of asymptomatic patient populations [7] Clinician should consider that Candida infection is unlikely unless the girl has predisposing factors: recent antibiotic use, diabetes mellitus, immunodeficiency syndromes, poor perineal aeration, inflammatory skin conditions such as diaper dermatitis, seborrheic dermatitis, and atopic dermatitis [9] Escherichia coli and other enteric opportunistic microorganisms typically spread from intestinal tract after pinworm infestation or poor hygiene or dysfunctional intestinal disorders Staphylococcus aureus may cause opportunistic skin infections which may appear as impetiginous, bullous, or suppurative The non-sexually transmitted pathogens responsible for vulvovaginitis are represented by respiratory pathogens such as group A beta-hemolytic Streptococcus ... ISBN 978-3- 319 -5 716 1-4    ISBN 978-3- 319 -5 716 2 -1? ?? (eBook) https://doi.org /10 .10 07/978-3- 319 -5 716 2 -1 Library of Congress Control Number: 2 017 954378 © Springer International Publishing AG 2 018 This... terryannspagnuolo@gmail.com © Springer International Publishing AG 2 018 A.M Fulghesu (ed.), Good Practice in Pediatric and Adolescent Gynecology, https://doi.org /10 .10 07/978-3- 319 -5 716 2 -1_ 1 C Vezzani et al.. .Good Practice in Pediatric and Adolescent Gynecology Anna Maria Fulghesu Editor Good Practice in Pediatric and Adolescent Gynecology Editor Anna Maria Fulghesu Department of Obstetrics and