INTRODUCTION: Prophylactic bilateral gonadectomy is typically recommended for girls with mosaic Turner syndrome with Y chromosome (TS + Y) due to risk for gonadoblastoma. However, reports demonstrating lower malignancy r...INTRODUCTION: Prophylactic bilateral gonadectomy is typically recommended for girls with mosaic Turner syndrome with Y chromosome (TS + Y) due to risk for gonadoblastoma. However, reports demonstrating lower malignancy rates and cases of spontaneous puberty have prompted reconsideration. DESCRIPTION: An 8-year-old girl was found to have TS + Y, with genetic analysis showing absence of Y chromosome short arm material. Her anti-müllerian hormone declined over three months, indicating decrease in ovarian reserve. She underwent bilateral gonadectomy with ovarian tissue cryopreservation and was found to have functional ovarian tissue. CONCLUSION: In contrast to most TS + Y cases, our patient demonstrated functional ovarian tissue. Characterization of which Y chromosome segments are present may predict gonadal tissue type and gonadoblastoma risk, assisting decision-making regarding gonadectomy timing and the option for fertility preservation.
STUDY OBJECTIVE: To assess serum betatrophin levels in normal-weight and overweight adolescents with polycystic ovary syndrome and examine associations with anthropometric, hormonal, and metabolic parameters, including i...STUDY OBJECTIVE: To assess serum betatrophin levels in normal-weight and overweight adolescents with polycystic ovary syndrome and examine associations with anthropometric, hormonal, and metabolic parameters, including insulin resistance. METHODS: This cross-sectional study included 90 adolescent females (16-23 years); overweight polycystic ovary syndrome (n=30), normal-weight polycystic ovary syndrome (n=30), and age-matched healthy controls (n=30). Anthropometric measurements, hormonal profiles, fasting glucose and insulin, homeostasis model assessment of insulin resistance, inflammatory markers, lipid parameters, and serum betatrophin concentrations were assessed. Multivariable logistic regression identified independent predictors of elevated betatrophin. Associations between betatrophin levels and polycystic ovary syndrome status, adiposity, insulin resistance, and metabolic parameters were analyzed. RESULTS: Serum betatrophin levels differed significantly among groups (p=0.010) and were higher in overweight polycystic ovary syndrome compared with controls (p=0.002). Betatrophin positively correlated with body mass index (r=0.267, p=0.009), homeostasis model assessment of insulin resistance (r=0.463, p<0.001), and estradiol (r=0.378, p=0.001). Multivariable regression identified overweight status as an independent predictor of elevated betatrophin (OR=6.71, 95% CI: 1.23-36.50, p=0.028), whereas insulin resistance showed an inverse association (OR=0.09, 95% CI: 0.02-0.50, p=0.006). Polycystic ovary syndrome status and C-reactive protein were not independently associated. CONCLUSION: Betatrophin levels are elevated in overweight adolescents with polycystic ovary syndrome and correlate with adiposity and insulin resistance, suggesting its potential as a marker of early metabolic dysfunction.
STUDY OBJECTIVE: To evaluate the impact of daily versus weekly iron supplementation on changes in hemoglobin (Hb) and ferritin over 12 weeks in adolescents with iron deficiency and heavy menstrual bleeding (HMB). METHODS...STUDY OBJECTIVE: To evaluate the impact of daily versus weekly iron supplementation on changes in hemoglobin (Hb) and ferritin over 12 weeks in adolescents with iron deficiency and heavy menstrual bleeding (HMB). METHODS: This was a randomized pilot study including females age 12-18 years recruited from Pediatric Hematology/Oncology or Adolescent Gynecology clinic. Participants received either daily or weekly 325 mg ferrous sulfate. Hb and ferritin levels were measured at baseline, 6 weeks, and 12 weeks. Menstrual patterns were categorized by WHO criteria for menstrual classification at each time point. A Linear Mixed Model (LMM) and Kruskal-Wallis H test analyzed changes over time. RESULTS: Eighteen subjects completed the study. At baseline, 94.4% (17/18) of participants had Heavy/Prolonged bleeding. By 6 weeks, 83.3% (15/18) had improved menstrual patterns, though all three non-responders were in the weekly group. Weekly supplementation showed a significant increase in Hb from baseline to 6 weeks (p ≤.001), but the increase by week 12 was not statistically significant (p=0.24) whereas the daily group showed a steady rise in a between group comparison of daily versus weekly supplementation. Ferritin increased significantly over time in the weekly group (p=0.044), but not daily, with the most rapid rise by 6 weeks. By 12 weeks, ferritin levels of the weekly and daily groups were similar to each other. CONCLUSION: Weekly dosing led to faster ferritin increase, but both daily and weekly iron dosing improved Hb and ferritin over time. For patients undergoing menstrual improvement for HMB that also require iron supplementation, weekly or daily dosing may be appropriate. but both led to a similar endpoint.
STUDY OBJECTIVE: Polycystic ovary syndrome in adolescence is a condition associated with long-term cardiovascular, metabolic, and psychological outcomes. The diagnosis of PCOS in adolescence poses diagnostic challenges f...STUDY OBJECTIVE: Polycystic ovary syndrome in adolescence is a condition associated with long-term cardiovascular, metabolic, and psychological outcomes. The diagnosis of PCOS in adolescence poses diagnostic challenges for obstetricians and gynecologists due to pubertal variability and the use of criteria distinct from adult standards. Inter-clinician variability and the role of large language models (LLMs) in this context remain insufficiently explored. This study evaluated guideline adherence among physicians and LLMs using a vignette-based design. METHODS: Ten guideline-based adolescent PCOS vignettes (ESHRE/ASRM 2023), validated by three obstetrics and gynecology specialists, were administered to obstetricians and gynecologists in Türkiye (n=150). The same vignettes were presented to four LLMs (ChatGPT-5.2, Gemini 3 Flash, Grok 4, DeepSeek V3.2) via a standardized prompt using two independent user accounts in standard and reasoning modes. Inter-account consistency was assessed using accounts. RESULTS: Physicians achieved a mean of 5.0 ± 1.9 correct responses out of 10 vignettes (each scored as 1 point), whereas large language models demonstrated significantly higher performance (7.6 ± 1.1; p < 0.001. Physicians with national assisted reproductive technology certification achieved higher scores in difficult cases. Inter-rater agreement among physicians was low (κ=0.127, κ=0.032, κ=0.027). ChatGPT-5.2 (reasoning mode) and Gemini 3 Flash (standard mode) showed high inter-account agreement (p<0.001). Reasoning mode increased overall LLM accuracy. CONCLUSIONS: Significant inter-clinician guideline discordance was observed in adolescent PCOS diagnosis. Strengthening this domain is critical for adolescent health. Given their non-deterministic and evolving architectures, LLMs should be positioned as adjunctive tools supporting clinical judgment rather than as independent guideline authorities.
INTRODUCTION: Education in pediatric and adolescent gynecology (PAG) is limited across medical training programs and existing educational PAG content may not be easily accessible to those outside the field. Podcasts have...INTRODUCTION: Education in pediatric and adolescent gynecology (PAG) is limited across medical training programs and existing educational PAG content may not be easily accessible to those outside the field. Podcasts have become an efficient modality to broadly provide medical education. This report is an early description of the reach and listener characteristics of an educational PAG podcast. METHODS: In January 2025, a monthly educational PAG podcast ("PAG Over Pastries"), based on the 2024 NASPAG Essential of Pediatric and Adolescent Gynecology textbook, was created by a PAG fellow and attending physician. Members of the North American Society for Pediatric and Adolescent Gynecology (NASPAG) were recruited as volunteer speakers. Between April and December 2025, a cross-sectional survey assessed podcast discovery sources, preferred listening platforms, career stages and specialties, and NASPAG membership status. Survey data was summarized descriptively. This project did not constitute human subject research per institutional determination. RESULTS: As of March 2026, 18 episodes were released with over 3600 downloads. Thirty-one listeners completed the survey. Most respondents discovered the podcast through the NASPAG listserv (41.9%). Preferred platforms were Spotify (38.7%) and Apple Podcast (38.7%). Respondents represented a full range of career stages, from students to senior attendings, and junior attendings were the most represented (29.0%). Respondents' specialties included PAG (35.5%), adolescent medicine (25.8%), obstetrics/gynecology (22.6%), and pediatrics (6.5%). Most respondents were NASPAG members (74.1%). CONCLUSION: 'PAG over Pastries' reached a multidisciplinary audience across career stages and specialties. The early engagement with this podcast suggests interest in a new PAG educational resource.
BACKGROUND: Although menstruation is a universal biological experience for women, American Indian (AI) adolescent girls in the United States (US) face multifaceted, culturally distinct challenges that contribute to dispr...BACKGROUND: Although menstruation is a universal biological experience for women, American Indian (AI) adolescent girls in the United States (US) face multifaceted, culturally distinct challenges that contribute to disproportionate health disparities. Despite the public health implications of adolescent menstruation experiences, a critical knowledge gap about menstruation experiences and their impact on education persists in the US. The aim of this study was to describe the menstruation-related experiences of AI adolescent girls living in rural, reservation communities in the upper Midwest. METHODS: Using a qualitative, community-engaged approach, focus groups were conducted with middle and high school students in three reservation communities in North Dakota and South Dakota. Using a semi-structured interview guide, participants were asked about experiences with menstruation, learning about menstruation, menstruation at school, limitations due to menstruation, and cultural beliefs/teachings related to menstruation. Following data collection, transcripts were analyzed using descriptive content analysis. RESULTS: One hundred and ten girls participated in a total of thirteen focus groups (middle school n=6; high school n=7) equally distributed across three reservation communities. Four main themes were identified in the data: 1) learning about menstruation-often mistimed and inadequate, 2) menstruation at school,-challenges related to management, school performance and participation, 3) experiencing menstruation,-emotional and physical symptoms, and 4) making meaning of menstruation-becoming more confident and positive associations with age. DISCUSSION: This study provides a critical understanding of the menstruation experiences of AI adolescent girls living in rural reservation communities in the upper Midwest. Findings reveal that menstruation is a complex experience shaped by familial, cultural, educational, and institutional factors. These findings underscore the urgent need for early, culturally responsive menstrual health education and school policies that affirm and support menstruating students.
OBJECTIVE: This study aimed to examine reproductive health and the experience of adolescents and young adult females with sickle cell disease (SCD). We investigated reproductive health experiences of adolescents and youn...OBJECTIVE: This study aimed to examine reproductive health and the experience of adolescents and young adult females with sickle cell disease (SCD). We investigated reproductive health experiences of adolescents and young adults aged 13-21 with SCD, examining menstruation's impact, sexual activity patterns, contraceptive use, and counseling received at Children's National Hospital. STUDY DESIGN: A cross-sectional quality improvement project surveyed 75 females with SCD (ages 13-21) presenting to routine hematology visits from April to December 2024. We administered a 20-question survey that included sexual activity, pubertal, menstrual, and contraceptive history. RESULTS: The median age of thelarche and menarche was 12 years; 12% of participants reported heavy periods or bleeding for >7 days. Seventy-five percent used hydroxyurea therapy. Twenty-three participants (31%) were sexually active, with 100% using contraception; 34.78% hormonal and 65.2% non-hormonal types. Only 25% received contraceptive counseling, significantly associated with older age (p = .01). Participants >18 years old reported significantly more pain crises related to menses (46.15%) than those 13-18 years (8.33%), p < .001; no significant difference in catamenial pain crises between those on hormonal vs. non-hormonal contraception 57.1% vs. 33.33% respectively (p = .38). CONCLUSION: This study revealed significant age-related patterns in menstruation-associated pain crises and contraceptive counseling among SCD adolescents and young adults. Despite high contraceptive use among sexually active participants, overall contraceptive counseling rates remain low. The high prevalence of disease-modifying therapies such as hydroxyurea may influence pubertal timing compared to historical data, suggesting evolving reproductive health patterns in contemporary SCD management.
BACKGROUND: Peripheral precocious puberty (PPP) results from estrogen excess independent of gonadotropin activation. In cases of ovarian activation, McCune-Albright syndrome (MAS) and autonomous functional ovarian cysts...BACKGROUND: Peripheral precocious puberty (PPP) results from estrogen excess independent of gonadotropin activation. In cases of ovarian activation, McCune-Albright syndrome (MAS) and autonomous functional ovarian cysts should be considered. In the latter condition, clear evidence-based management guidelines are currently lacking. CASE: A girl with PPP presented with premature thelarche, recurrent vaginal bleeding and elevated estradiol with ultrasound detection of ovarian cysts. MAS was excluded by clinical, radiological and genetic evaluation. Progressive pubertal development, recurrent bleeding, and advanced bone age led to initiation of off-label letrozole. RESULTS: We reported a regression of uterine maturation and ovarian cyst, a normalization of blood tests and a cessation of vaginal bleeding, without adverse effects. CONCLUSIONS: Letrozole may represent an effective therapeutic option for non-MAS PPP.
STUDY OBJECTIVE: To assess resident physician comfort regarding menstrual suppression in gender diverse adolescents (GDA). Secondly, to explore perceived barriers to managing menstrual suppression in GDA. METHODS: This i...STUDY OBJECTIVE: To assess resident physician comfort regarding menstrual suppression in gender diverse adolescents (GDA). Secondly, to explore perceived barriers to managing menstrual suppression in GDA. METHODS: This is an IRB-approved survey study of Family Medicine (FM), Pediatrics, and Obstetrics and Gynecology (OBGYN) residents from all ACGME-accredited programs. Participants completed a survey evaluating their comfort managing: (1) a cisgender adolescent desiring contraception; (2) a cisgender adolescent with dysmenorrhea; and (3) a GDA desiring menstrual suppression. Participants selected their top 3 barriers for each case. RESULTS: A total of 375 participants consented to the survey, and 293 (78%) participants completed the survey. Of the total, 169 (45%) were FM residents, 99 (26%) were Pediatrics residents, and 62 (17%) were OBGYN residents. The majority of FM, Pediatrics, and OBGYN residents were comfortable managing contraception and menstrual concerns in cisgender patients, while 29% of FM residents, 27% of Pediatrics residents, and 50% of OBGYN residents were comfortable managing menstrual suppression in GDA. OBGYN residents were significantly more likely to report comfort managing menstrual suppression in GDA compared to FM (OR 2.44, 95% CI [1.35, 4.45], p = .003) and Pediatrics (OR 2.64, 95% CI [1.37, 5.15], p = .004). All 3 specialties selected lack of education/experience as the top barrier in caring for GDA. CONCLUSION: FM, Pediatrics, and OBGYN residents indicated comfort managing contraception and menstrual concerns, yet all residents, especially FM and Pediatrics residents, reported discomfort in managing menstrual suppression in GDA. Efforts should focus on enhancing education on caring for gender diverse patients in all 3 residency programs.
Pediatric and adolescent gynecology (PAG) is a growing specialty, but despite the complexity of many patients' experiences, few hospitals employ dedicated social workers trained to support these patients and their famili...Pediatric and adolescent gynecology (PAG) is a growing specialty, but despite the complexity of many patients' experiences, few hospitals employ dedicated social workers trained to support these patients and their families. This is true despite the fact that PAG providers routinely care for individuals with multiple conditions where patients and families could benefit from support around long-term implications for reproductive health and fertility; surgical decision making; counseling in the wake of sexual trauma; comprehensive sex education and counseling; and referrals to other social services. This commentary is designed to provide examples of the types of care that can benefit from the involvement of a skilled, experienced behavioral health practitioner as well as potential barriers to hiring a social worker for a multidisciplinary team. There is a need for leaders in PAG to make a multipronged effort to increase training and networking opportunities in PAG social work alongside negotiating increased funding for social care in the PAG setting. This commentary is designed to provide suggestions for a pathway forward.
OBJECTIVE: Obstructed hemivagina is a rare congenital anomaly typically presenting in adolescence and is commonly associated with ipsilateral renal anomalies. Diagnosis is frequently delayed, and existing classification...OBJECTIVE: Obstructed hemivagina is a rare congenital anomaly typically presenting in adolescence and is commonly associated with ipsilateral renal anomalies. Diagnosis is frequently delayed, and existing classification systems provide limited support for surgical planning. This study aimed to describe clinical and anatomical variations in obstructed hemivaginas, evaluate surgical outcomes following specialist management, and identify anatomical features relevant to systematic description. METHODS: This retrospective cohort study included all patients who underwent surgery for obstructed hemivagina at a single specialist referral center between 2014 and 2024. Patients with MRI-confirmed obstructed hemivagina were included; those with cervical-level obstruction, cloacal anomalies, or bladder exstrophy were excluded. Demographic data, presenting symptoms, pre-referral management, radiological findings, surgical details, and outcomes were analyzed. The primary outcome was re-obstruction. RESULTS: Sixty-one patients were included (median age 15 years, range 11-31) with median follow-up of 29 weeks. One-third were not receiving menstrual suppression at referral, and one-quarter had undergone emergency or incomplete procedures before specialist review. All patients underwent vaginal septal excision. Re-obstruction occurred in 2/61 (3.3%), both following excision of high-inserting septa. Among 17 patients with high-inserting septa, 15 did not experience re-obstruction. MRI classification was concordant with intraoperative findings in 51/61 cases (83.6%), with reduced accuracy for higher septa. CONCLUSION: Vaginal septal excision in a specialist setting was associated with a low re-obstruction rate. Variation in pre-referral management highlights opportunities to optimize preoperative management and referral pathways. Marked anatomical heterogeneity supports the value of a structured descriptive framework to document features of obstructed hemivaginas relevant to surgical planning and longitudinal care.
STUDY OBJECTIVE: The stigma perceived by adolescent and young mothers negatively affects their health and that of their children. This study aimed to identify the factors that influence the stigma perceived by adolescent...STUDY OBJECTIVE: The stigma perceived by adolescent and young mothers negatively affects their health and that of their children. This study aimed to identify the factors that influence the stigma perceived by adolescent and young mothers. METHODS: A cross-sectional survey was conducted with 247 South Korean adolescent and young mothers aged ≤24 years, all of whom had given birth and were caring for their children. Data were collected between January 2024 and March 2024 and analyzed using multiple regression. RESULTS: The mean age of the participants was 22.16 ± 1.80 years. Social support, place of residence, and knowledge of contraception were significantly associated with perceived stigma. The regression model was significant (F = 16.97, p < .001; adjusted R² = 0.34). Social support was negatively associated with stigma (β = -0.27, 95% CI [-0.56, -0.23]), while residing in a parent-owned home increased stigma (β = 0.30, 95% CI [3.72, 8.24]). Knowledge about contraception also reduced stigma (β = -0.18, 95% CI [-6.29, -1.51]). CONCLUSION: Social support was a key protective factor against perceived stigma among South Korean adolescent and young mothers. For clinicians caring for adolescents and young mothers, these findings highlight the importance of nonjudgmental care, assessment of social support, and accessible contraceptive counseling. Although conducted in South Korea, this study may serve as a model for future studies examining stigma among adolescent and young mothers in other settings.
BACKGROUND: The exact etiology of labial adhesion (LA) is unknown; however, it is obvious that the disease has multifactorial causes. Although several local and inflammatory factors have been implicated, the potential co...BACKGROUND: The exact etiology of labial adhesion (LA) is unknown; however, it is obvious that the disease has multifactorial causes. Although several local and inflammatory factors have been implicated, the potential contribution of functional constipation (FC) has not been previously investigated. The aim of this study is to investigate the role of FC in the etiology of primary and recurrent LA. METHODS: This cross-sectional analytical study included 2828 consecutive prepubertal girls evaluated in a pediatric surgery outpatient clinic between May 2021 and December 2024. Patients with inflammatory, dermatologic, traumatic, endocrine, or congenital conditions potentially affecting genital anatomy were excluded. Prevalence, relative risk (prevalence ratio), crude odds ratio, and attributable risk were calculated. Multivariable logistic regression adjusted for age was performed to assess independent association. RESULTS: The overall prevalence of LA was 5.1% (145/2828). FC was present in 17.0% of the total study population. The prevalence of LA was significantly higher in children with constipation (11.4%) compared with those without (3.8%) (P < .001). The relative risk was 2.97 (95% CI: 2.16-4.10). After age adjustment, FC remained independently associated with LA (OR: 2.6; P < .001). The attributable risk percent was 66.4%. Recurrence was observed in 3.4% of patients during follow-up and was more frequent among children with constipation. CONCLUSION: Functional constipation was significantly associated with both primary and recurrent LAs, and may represent a potential contributing factor. Evaluation of bowel habits may be clinically relevant in patients presenting with LA.
OBJECTIVE: To assess over-the-counter emergency contraception pills (ECP) availability in Dallas pharmacies across income levels. METHODS: Secret shoppers visited 83 pharmacies (47 high-, 36 low-income zip codes) to docu...OBJECTIVE: To assess over-the-counter emergency contraception pills (ECP) availability in Dallas pharmacies across income levels. METHODS: Secret shoppers visited 83 pharmacies (47 high-, 36 low-income zip codes) to document ECP visibility and restricted storage. Descriptive statistics and Chi-square tests compared visible availability by income group. RESULTS: ECP was visibly available on the shelves in 53% (44 out of 83) of pharmacies. Of these, 84% (37 out of 44) used restricted storage. Availability was higher in high-income (64%) than low-income areas (39%) (P = .024). CONCLUSION: ECP access remains limited, particularly in low-income communities, underscoring the need for efforts to improve availability.