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Summer 2008 Pediatric and Adolescent Gynecology
The American College of Obstetricians and Gynecologists recommends that a young woman’s first visit with an obstetrician–gynecologist occur between the ages of 13 and 15. This first visit allows time to establish a relationship between physician and patient and to discuss issues of a confidential nature. Important topics to review include normal pubertal development and menstruation, healthy eating habits and body image, safety, and prevention of pregnancy and sexually transmitted diseases. The extent of the examination should be tailored to the patient’s age and relevant history. This initial obstetrician–gynecologist office visit is an ideal time to discuss preventive health care, including availability of the quadrivalent human papillomavirus vaccine. This vaccine has been approved for administration to females aged 9–26 years. Although maximally effective if received prior to exposure to HPV, it is also beneficial for females who are already sexually active. This vaccine offers protection against HPV genotypes 16 and 18, which cause over 70% of cervical cancers, and against HPV genotypes 6 and 11, which cause 90% of genital warts. Currently, protection is considered to last at least five years; the need for a booster is not yet determined. Regardless of vaccination status, cervical cytology screening recommendations are unchanged: cervical cancer screening is not indicated until one has been sexually active for three years or reaches 21 years of age.
Routine preventive health care may identify gynecologic problems in infants, children, and adolescents; these disorders are often different from the problems that affect adult women. Common gynecologic disorders in these age groups range from vaginal discharge to menstrual disorders, from pelvic pain to congenital anomalies of the reproductive tract, and from abnormal puberty to amenorrhea. Children and adolescents with gynecologic problems have unique needs and require specialized evaluation, treatment, and follow–up by a gynecologist with expertise in these disorders. At Yale Reproductive Endocrinology, we offer evaluation and treatment of a vast array of gynecologic conditions that can affect children and adolescents. All examinations are age–appropriate and, if necessary, an examination under sedation can be performed in the pediatric operating room at Yale–New Haven Hospital. If further consultation is needed, the vast resources of the Yale–New Haven Children’s Hospital are available. Educational resources are made available for patients and their families. Our goal is to provide sensitive and comprehensive care, as well as a multidisciplinary approach, if indicated. |
