STUDY OBJECTIVE: To compare intraoperative cyst rupture, peritonitis, and cyst recurrence after ovarian dermoid surgery via laparoscopy versus laparotomy in pediatric and adolescent patients. METHODS: A comprehensive sys...STUDY OBJECTIVE: To compare intraoperative cyst rupture, peritonitis, and cyst recurrence after ovarian dermoid surgery via laparoscopy versus laparotomy in pediatric and adolescent patients. METHODS: A comprehensive systematic review and meta-analysis was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews. Five bibliographic databases (MEDLINE, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science) and 3 clinical trial registries were searched from inception to August 29, 2024. Eligible studies included quasi-randomized trials and prospective/retrospective cohort studies evaluating intraoperative cyst rupture, peritonitis, or cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery. Two authors independently performed title-abstract and full text screening and independently extracted data. Meta-analyses of cyst rupture and cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery were performed and presented in forest plots. Risk ratios for cyst rupture were pooled with a random-effects model, and for cyst recurrence were pooled with a fixed-effect model. Quality assessment was assessed using the Newcastle-Ottawa Scale. RESULTS: A total of 1021 studies were identified, with 6 studies included (2000-2022; Canada, United States, Poland). We included 481 (53.9%) patients who underwent laparoscopy, 353 (39.5%) who underwent laparotomy, and 59 (6.6%) who underwent laparoscopy converted to laparotomy. For meta-analysis, 5 studies were included for cyst rupture, and 4 studies were included for cyst recurrence. Random-effects meta-analysis demonstrated a significantly higher risk of cyst rupture with laparoscopy (RR = 2.47; 95% CI, 1.40-4.37). Fixed-effect meta-analysis found no significant difference in cyst recurrence between laparoscopy and laparotomy (RR = 0.92; 95% CI, 0.41-2.08). No cases of chemical peritonitis were observed. CONCLUSION: For the surgical management of ovarian dermoid cysts in children, laparoscopy may carry a higher risk of intraoperative cyst rupture compared to laparotomy, however our work highlights that subsequent post-operative peritonitis was not clinically observed and recurrence rates remained similar.
J Pediatr Adolesc Gynecol
· 2026 Apr · PMID 41270885
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STUDY OBJECTIVE: Concordance between contraceptive preferences and use is an indicator of person-centered contraceptive care. Adolescents and young adults (AYA) face barriers that may prevent them from fulfilling their c...STUDY OBJECTIVE: Concordance between contraceptive preferences and use is an indicator of person-centered contraceptive care. Adolescents and young adults (AYA) face barriers that may prevent them from fulfilling their contraceptive preferences. We sought to assess the prevalence and predictors of preference-concordant contraceptive use among AYA and examine its associated with person-centered contraceptive counseling (PCCC). DESIGN: We conducted a secondary analysis of a cross-sectional survey. SETTING: The survey was nationally representative of the United States and administered in 2022. PARTICIPANTS: The sample included 516 participants, including adolescents (aged 15-17) and young adults (aged 18-24), who were assigned female at birth. MAIN OUTCOME MEASURES: The primary exposure was receipt of PCCC at most recent contraceptive care visit. The main outcome was preference-concordant contraceptive use, measured among contraceptive users and nonusers. RESULTS: Fewer than 60% of AYA had preference-concordant contraceptive use or nonuse, and 19% were uncertain about their preferences. Adolescents were less likely than young adults to use a preferred method and more likely to be content nonusers or uncertain nonusers. Only 28% of participants received PCCC at their most recent visit. PCCC was associated with increased preference-concordant vs preference nonconcordant use (adjusted risk ratio: 1.45; 95% CI: 0.75, 2.82), though this was not statistically significant. CONCLUSION: Many AYA are not fulfilling their contraceptive preferences, and uncertainty about method use is common, particularly among adolescents. Person-centered contraceptive counseling may support preference-concordant use, but broader structural, interpersonal, and informational barriers must also be addressed to promote equitable, preference-aligned contraceptive care and access.
This case report describes the management of severe menorrhagia in a 13-year-old girl diagnosed with Glanzmann thrombasthenia (GT), a rare inherited platelet disorder. The patient presented with excessive menstrual bleed...This case report describes the management of severe menorrhagia in a 13-year-old girl diagnosed with Glanzmann thrombasthenia (GT), a rare inherited platelet disorder. The patient presented with excessive menstrual bleeding, leading to hypovolemic shock. Diagnosis was confirmed by flow cytometry and genetic testing. Treatment included blood product transfusions, tranexamic acid, and ormeloxifene administration. This case required complex management beyond typical hypovolemic shock protocols because of the underlying platelet dysfunction. Long-term management involves oral contraceptives, desmopressin, and counseling on bleeding precautions. This case highlights the challenges in managing GT, emphasizing the need for a multidisciplinary approach, tailored treatment strategies, and consideration of future therapeutic options such as hematopoietic stem cell transplantation and gene therapy. The report also discusses the rationale behind the treatment choices, including the use of ormeloxifene and cryoprecipitate, and compares the management approach to established guidelines. Additionally, it addresses the importance of genetic counseling, patient education, and ongoing research in improving outcomes for patients with GT.
BACKGROUND: Sterile abscess formation after leuprolide acetate (LA) injection is rare and can lead to discomfort, scarring, and decreased treatment efficacy. Our objective is to highlight this rare side effect to aid in...BACKGROUND: Sterile abscess formation after leuprolide acetate (LA) injection is rare and can lead to discomfort, scarring, and decreased treatment efficacy. Our objective is to highlight this rare side effect to aid in more thorough patient administration counseling. CLINICAL CASE: A 19 year-old female with history of LA treatment for precocious puberty and new diagnosis of endometriosis developed a severe injection site sterile abscess requiring surgical incision and drain placement, and hospitalization after first LA injection for endometriosis treatment. CONCLUSION: LA is a common treatment for refractory endometriosis in pediatric patients, but providers may be unaware of the risk of sterile abscess. We did not identify any predictive or preventative factors but propose that prior treatment may have increased risk in this case.
STUDY OBJECTIVE: To describe the treatment options, experiences, and outcomes in vulvodynia among pre-pubertal, peri-pubertal, and post-pubertal patients. METHODS: A retrospective chart review, primarily descriptive in n...STUDY OBJECTIVE: To describe the treatment options, experiences, and outcomes in vulvodynia among pre-pubertal, peri-pubertal, and post-pubertal patients. METHODS: A retrospective chart review, primarily descriptive in nature, of female patients aged 0-21 years who presented to the pediatric and adolescent gynecology clinic of a tertiary care hospital with a diagnosis of vulvodynia between January 1, 2015 to August 31, 2022. Patients who were pregnant or diagnosed with other gynecological conditions that could be a source of pain were excluded. Data was summarized using frequencies and proportions for categorical variables and mean and standard deviation for continuous measures. RESULTS: There were 24 identified patients, 9 (37.5%) of which were pre-pubertal, 6 (25.0%) peri-pubertal, and 9 (37.5%) post-pubertal. The average age at the time of diagnosis was 11.0 ± 4.19 years. Most of the patients were White, accounting for 58.3% of the population, followed by Hispanic at 25.0%. Treatment approach for patients was variable and non-standardized. Success often required use of multiple medications, and no one treatment alone was identified to be the most effective. The most commonly identified burdens of disease were mood and sleep disturbances, and missing school. CONCLUSION: Vulvodynia is a disease of variable presentation with individualized treatment plans. No obvious patterns were identified in presentation or treatment response based on pubertal status. More data is needed to determine if a standard of care can be developed in this population. Furthermore, early diagnosis and initiation of treatment may reduce the psychological stress of having a chronic pain condition and improve function.
STUDY OBJECTIVE: To review the evidence on reproductive health outcomes in women treated for osteosarcoma during childhood (<15 years old). METHODS: We searched the following electronic databases from inception to May 20...STUDY OBJECTIVE: To review the evidence on reproductive health outcomes in women treated for osteosarcoma during childhood (<15 years old). METHODS: We searched the following electronic databases from inception to May 2025: MEDLINE (Ovid), EMBASE (Ovid), Scopus, Web of Science and The Cochrane Library. The search strategy involved variations on key search terms relating to: "osteosarcoma," "childhood" and "fertility." Eligible papers where those that included patients treated for osteosarcoma during childhood and reported on reproductive health outcomes. We assessed the risk of bias of included papers using the Newcastle Ottawa Scale. Results were synthesized narratively. RESULTS: After deduplication, 2,683 titles were screened and a total of 8 studies were eligible for inclusion in the review, with a total of 231 participants. Seven studies were retrospective. The length of follow-up ranged from 3 months to the longest median follow up of 23.9 years. Menstrual function was the most commonly used marker of reproductive health. There were ten cases who had irregular menstrual cycles following treatment and 6 cases of primary amenorrhea, there was 1 case of delayed puberty requiring hormone replacement therapy. Three papers reported on biochemical markers of ovarian reserve, including anti-Müllerian hormone (AMH), inhibin B and follicle-stimulating hormone (FSH). Only 2 studies reported pregnancy outcomes. CONCLUSION: Most participants in the included studies did not experience any immediate impact to their reproductive health following treatment for osteosarcoma in childhood. However, our findings should be interpreted with caution and are limited by small sample sizes, relatively short follow up periods and variation in treatment protocols. Additionally, pregnancy outcomes were not reported in most studies. As a result, the long-term impact of childhood osteosarcoma treatment on future fertility remains unclear. This uncertainty highlights the importance of fertility counselling and proactive discussions about fertility preservation options before gonadotoxic treatment for osteosarcoma.
Özcan H, Albana J, Yarde F
… +12 more, Dekker JJML, Roos EJ, Goverde AJ, van Dorp W, Ortiz MI, Hewitt GD, Simms-Cendan J, Al-Jefout M, Cooper N, Huirne JAF, de Leeuw RA, Burger NB
OBJECTIVE: To achieve consensus on a standardized definition and diagnostic criteria of primary dysmenorrhea. METHODS: A modified Delphi procedure was conducted from January to October 2024. Consensus on a question was p...OBJECTIVE: To achieve consensus on a standardized definition and diagnostic criteria of primary dysmenorrhea. METHODS: A modified Delphi procedure was conducted from January to October 2024. Consensus on a question was predefined as a rate of agreement of 70% or higher. Participants were experts defined by their clinical experience in managing patients with primary dysmenorrhea, publishing on the topic, or membership in international pediatric and/or adolescent gynecology associations. RESULTS: Twenty of 41 invited experts participated. Three rounds were required to achieve consensus, with response rates for each round of 85%, 82%, and 86%, respectively. Experts defined primary dysmenorrhea as dysmenorrhea in absence of any pelvic pathology. Primary dysmenorrhea may not start at menarche. Onset of symptoms may be before or during menstrual blood loss. The diagnosis of primary dysmenorrhea requires the absence or low clinical suspicion of the following conditions: sexually transmitted infection, pelvic inflammatory disease, congenital uterine anomaly, endometriosis, adenomyosis, and fibroids. A pelvic examination is not required for diagnosis. Consensus was reached on using ultrasound examination (transabdominal ultrasound in non-sexually active patients or transvaginal ultrasound in sexually active patients) as the preferred initial diagnostic instrument, with magnetic resonance imaging if results are inconclusive. No minimum duration of dysmenorrhea is required. Severity assessment using a verbal multidimensional scoring system (VMSS) of grade 2 or higher is part of the diagnostic criteria for primary dysmenorrhea. Systemic symptoms are not considered to be necessary for diagnosis. CONCLUSION: Consensus was achieved regarding the definition and diagnostic criteria for primary dysmenorrhea.
STUDY OBJECTIVE: This study evaluated changes in symptoms of depression, anxiety, and stress among adolescents using the etonogestrel subdermal implant. It analyzed psychometric score variations and the proportion of par...STUDY OBJECTIVE: This study evaluated changes in symptoms of depression, anxiety, and stress among adolescents using the etonogestrel subdermal implant. It analyzed psychometric score variations and the proportion of participants with values above normative thresholds to assess the method's safety with respect to mood symptoms. STUDY DESIGN: Prospective cohort study involving female adolescents aged 12-19 years who chose the etonogestrel subdermal implant for contraception. Participants completed the Depression, Anxiety, and Stress Scale for Adolescents (EDAE-A) at baseline, and at 3 and 6 months postinsertion. We performed statistical analyses using the Friedman test, chi-square tests, and relative risk estimates. Subgroup analyses were conducted for participants with elevated baseline scores. Significance was set at P ≤ .05. RESULTS: Of the 97 participants enrolled, 66 completed all follow-up stages. The median age was 17 years. Baseline EDAE-A scores indicated mild symptoms of depression and anxiety and normal stress levels. Approximately 50% of participants scored above normative thresholds across all time points, but scores remained stable over 6 months, with no statistically significant changes in any domain. Among adolescents with elevated baseline symptoms, we observed a trend toward reduced depressive symptoms (P = .06). Prior hormonal contraceptive use did not significantly influence scores. CONCLUSION: Use of the etonogestrel implant was not associated with significant changes in depression, anxiety, or stress symptoms among adolescents over 6 months. The findings support the psychological safety of the method and suggest that mood symptoms are more common in this population and are more likely related to developmental factors than to contraceptive use.
STUDY OBJECTIVE: To determine the prevalence of anxiety and depression in women with Mayer-Rokitansky-Kϋster-Hauser (MRKH) syndrome in Malaysia. METHODOLOGY: This was a cross-sectional study conducted on women with MRKH...STUDY OBJECTIVE: To determine the prevalence of anxiety and depression in women with Mayer-Rokitansky-Kϋster-Hauser (MRKH) syndrome in Malaysia. METHODOLOGY: This was a cross-sectional study conducted on women with MRKH living in Malaysia. The study collected the sociodemographic and medical profiles of participants. Two translated and validated questionnaires were used: Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), to determine the prevalence of anxiety and depression, respectively. RESULTS: A total of 77 women participated in this study. The participants had a mean age of 29.1 ± 8.3 years, and the mean age at MRKH syndrome diagnosis was 20.5 ± 5.0 years. Based on GAD-7 outcomes, up to 29 women (37.7%) experienced anxiety. Following assessment of depression prevalence using the PHQ-9, 25 participants (32.5%) were classified into the depressed group. There was no statistically significant difference in participants' attributes on the basis of the examination of sociodemographic and clinical characteristics between the 2 groups. Further analysis identified that participants with MRKH in the B40 income bracket (<RM 4850, the lowest income bracket group in Malaysia) were 12 times more likely to develop depressive symptoms (OR = 12.83; 95% CI 1.14-143.77; P < .05). Furthermore, participants with MRKH portraying anxiety symptoms were 10 times more likely to also experience depressive symptoms (OR = 10.7; 95% CI 3.18-35.96; P < .05). CONCLUSION: More than a third of women with MRKH syndrome in Malaysia experienced depression and anxiety, which needs to be addressed.
STUDY OBJECTIVE: Between 10 and 25% of adolescents in the United States experience menstrual inequity, or insufficient access to menstrual products or education. The emergency department (ED), which often serves as a saf...STUDY OBJECTIVE: Between 10 and 25% of adolescents in the United States experience menstrual inequity, or insufficient access to menstrual products or education. The emergency department (ED), which often serves as a safety net for adolescent health access, has been identified as a strategic venue for public health interventions. The Child Opportunity Index (COI) is a validated, multidimensional neighborhood measure of structural opportunity that can impact child health and development. Therefore, the purpose of this project was to measure the prevalence of menstrual inequity in a pediatric ED and examine associations with the COI. METHODS: This cross-sectional study analyzed electronic survey data from adolescents 13-21 years old who visited a pediatric ED from January 2024 to February 2025. Participants were included if they had started menstruation and responded to validated questions that assessed menstrual inequity. Home addresses were geocoded into census tracts and linked to COI version 3.0. The prevalence of menstrual inequity was calculated, and logistic regression was used to measure associations between menstrual inequity and COI. RESULTS: One-third reported experiencing menstrual inequity during the past 12 months. Patients living in areas with low neighborhood opportunity had higher odds of experiencing menstrual inequity than those in high-opportunity areas. CONCLUSION: Menstrual inequity is common among adolescent pediatric ED patients, particularly among those from low-resourced neighborhoods. Future work should explore increasing advocacy efforts at the institutional level through menstrual product drives and distribution, as well as larger, national-level efforts to influence policy changes.
STUDY OBJECTIVE: To assess knowledge and perceptions of abortion and emergency contraception (EC) among adolescents and young adults (AYA) in a state with protected abortion access following the Dobbs v. Jackson Women's...STUDY OBJECTIVE: To assess knowledge and perceptions of abortion and emergency contraception (EC) among adolescents and young adults (AYA) in a state with protected abortion access following the Dobbs v. Jackson Women's Health Organization decision. METHODS: We conducted a cross-sectional survey of patients aged 14-24 presenting to a Title X-supported sexual health clinic in Colorado between April 2023 and January 2024. A 50-item anonymous survey measured knowledge of abortion and EC laws, beliefs about abortion myths, and sociodemographic characteristics. Knowledge scores were categorized as high (≥50% correct) or low (<50% correct). RESULTS: Among 244 respondents, most were female (94.2%) and aged 18 or older (85%). While 83.3% were familiar with the Dobbs decision, 64.6% were unaware of any changes to abortion laws in Colorado. Less than half (45%) demonstrated high knowledge of abortion laws. Gaps were particularly notable regarding parental consent and gestational limits. In contrast, 76% demonstrated high EC knowledge, though 58.8% either believed EC could end an early pregnancy or were unsure. High abortion knowledge was associated with higher education, prior pregnancy, and awareness of Dobbs. Belief in abortion myths was more common among those with lower knowledge. CONCLUSION: Despite living in a state with legal abortion protections, many AYA remain unclear about abortion laws and hold common misconceptions, which may delay care. EC knowledge was higher, but misunderstandings persist. Targeted efforts are needed to improve reproductive health literacy among youth and ensure access to accurate, state-specific information.
Lehembre-Shiah E, Adams M, Soliman M
… +4 more, Kaur H, Brookhart CD, Das K, Gomez-Lobo V
J Pediatr Adolesc Gynecol
· 2026 Apr · PMID 41187870
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STUDY OBJECTIVE: Published information on the sexual health and well-being of individuals with complete androgen insensitivity syndrome (CAIS) remains limited. In this study, we aimed to evaluate the vaginal lengths, sex...STUDY OBJECTIVE: Published information on the sexual health and well-being of individuals with complete androgen insensitivity syndrome (CAIS) remains limited. In this study, we aimed to evaluate the vaginal lengths, sexual well-being and body image findings of a relatively large, young cohort of individuals with CAIS, with the goal of guiding clinical practice toward more accurate and individualized patient-centered counseling. METHODS: In this interim analysis of a prospective IRB-approved AIS Natural History Study funded by the National Institutes of Health (NIH), we collected demographic information and vaginal length measurements from 23 individuals with CAIS between 2021 and 2025. Participants over 18 were invited to complete the PROMIS Sexual Function and Satisfaction (PROMIS SexFS) questionnaire and the Body Image Scale (BIS) questionnaire. RESULTS: The cohort (n = 23) ranged in age from 14 to 65 (median = 19). Fourteen participants (61%) identified as heterosexual, 7 (30%) had undergone complete gonadectomy, and 1 had undergone vaginoplasty. Three participants reported practicing serial vaginal dilations. Vaginal length measurements (n = 14) ranged from 25 to 90mm (median = 60mm). Of those who completed the PROMIS SexFS (n = 11), mean t-scores were within one standard deviation of normalized U.S. female population ranges. Of those who completed the BIS (n = 15), the average mean-item score was 0.9 on a Likert scale from 0 "not at all" to 3 "very much". CONCLUSION: Aside from one outlier, vaginal lengths in our cohort did not differ significantly from those reported in the general population, and most participants reported a positive body image and the ability to engage in fulfilling sexual activity.
Maslowsky J, Esbrook E, Odom-Konja R
… +3 more, Stritzel H, Gimbrone C, Mandell D
J Pediatr Adolesc Gynecol
· 2026 Feb · PMID 41161470
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STUDY OBJECTIVE: To describe patterns of postpartum contraception use among primiparous and multiparous adolescent mothers. METHODS: Cross-sectional data came from the Pregnancy Risk Assessment Monitoring System Phase 7...STUDY OBJECTIVE: To describe patterns of postpartum contraception use among primiparous and multiparous adolescent mothers. METHODS: Cross-sectional data came from the Pregnancy Risk Assessment Monitoring System Phase 7 (2012-2015). The analytic sample included postpartum respondents ages 15-19 in 40 US states (N = 5535). Exposures included age, race, parity, intimate partner violence, psychosocial stressors, prenatal care utilization, postpartum home health visits, and insurance type. The primary outcome was postpartum use of effective contraception. The secondary outcome was reasons for not using postpartum contraception. RESULTS: Adolescents who attended postpartum check-ups (AOR = 2.12; 95% CI 1.58-2.84) or received home health visits (AOR = 1.37; 95% CI 1.06-1.77) were more likely to use effective contraception postpartum, whereas those experiencing more stressors were less likely (AOR = 0.93; 95% CI: 0.86-1.00). Non-Hispanic Black adolescents were less likely to use effective contraception (AOR = 0.69; 95% CI 0.50-0.94) compared to non-Hispanic White adolescents. Among those who did not use contraception postpartum, having a postpartum home health visit was associated with lower odds of endorsing contraceptive side effects (AOR = 0.33; 95% CI 0.18-0.60) or not wishing to use contraception (AOR = 0.43; 95% CI 0.22-0.86) as reasons for nonuse. CONCLUSION: Access to postpartum care via home health and postpartum clinic visits was associated with significantly higher likelihood of using effective contraception. However, disparities persisted among non-Hispanic Black adolescents and those experiencing high levels of psychosocial stress. For postpartum adolescents who do not desire a subsequent birth, increasing their ability to obtain effective contraceptives can be achieved through increased access to postpartum care, particularly for underserved populations.
STUDY OBJECTIVE: To compare norethindrone acetate (NA) and combined oral contraceptives (COC) in managing adolescents with acute abnormal uterine bleeding (AUB). METHODS: We recruited adolescents and young adults (AYA) a...STUDY OBJECTIVE: To compare norethindrone acetate (NA) and combined oral contraceptives (COC) in managing adolescents with acute abnormal uterine bleeding (AUB). METHODS: We recruited adolescents and young adults (AYA) aged 10-21 years, with a diagnosis of AUB or other specified irregular menses from January 2022 to March 2023, who were first treated at our emergency department (ED) and then enrolled at our adolescent medicine clinic. We distributed questionnaires, focusing on days until bleeding cessation with treatment, hospitalizations related to bleeding, patient satisfaction, and side effects. Data were grouped as NA or COC and compared. A P < .05 was considered statistically significant. RESULTS: Of fifteen patients, seven were treated with NA and eight patients were treated with COC. The average length of stay (LOS) in the hospital was 2.3 days (SD = 0.6) in the NA group and 2.4 days (SD = 0.9) in COC group. The time to bleeding cessation was 2.6 days in both groups. Most patients who took NA (86%) experienced no side effects compared to the COC group (25%) (P = .041). CONCLUSIONS: In our small sample, NA appeared to be as efficacious as COC. We found no difference in the time to bleeding cessation and length of hospital stay. Those treated with NA had fewer side effects than those treated with COC. We hope this pilot study will promote further inquiries as to whether NA may be the better choice for acute AUB in young women.
STUDY OBJECTIVE: To explore coping strategies among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome following McIndoe vaginal reconstruction, focusing on how they adapt emotionally, cognitively, relationally, a...STUDY OBJECTIVE: To explore coping strategies among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome following McIndoe vaginal reconstruction, focusing on how they adapt emotionally, cognitively, relationally, and spiritually. METHODS: A descriptive phenomenological study was conducted at a tertiary university hospital in Türkiye. Ten women with MRKH syndrome who underwent McIndoe vaginoplasty were recruited. Data were collected through semi-structured, in-depth interviews and analyzed using Colaizzi's seven-step framework. Reporting adhered to the COREQ checklist. RESULTS: Six overarching themes and twelve subthemes were identified: managing silence and avoidance, reframing and positive reappraisal, spiritual coping, relational dynamics of support and stigma, disclosure dilemmas, and pathways to empowerment. Coping strategies were dynamic, shifting from avoidance to eventual empowerment, and were shaped by family dynamics, cultural norms, spirituality, and relational contexts. CONCLUSION: Coping following McIndoe reconstruction extends beyond surgical success to encompass psychological adjustment, relational support, and the creation of cultural and spiritual meaning. Holistic interventions-including psychoeducation, culturally sensitive counselling, family- and couple-based approaches, and structured peer networks-may strengthen resilience and promote well-being in this population.
STUDY OBJECTIVE: Pediatric primary ovarian torsion (POT) is a rare condition related to anatomical predispositions and hormonal triggers. The high recurrence rate of laparoscopic ovarian detorsion (LOD) has led to the co...STUDY OBJECTIVE: Pediatric primary ovarian torsion (POT) is a rare condition related to anatomical predispositions and hormonal triggers. The high recurrence rate of laparoscopic ovarian detorsion (LOD) has led to the consideration of primary oophoropexy (OPX). This study aims to investigate OPX indications in POT and evaluate the efficacy of different fixation techniques. METHODS: A retrospective review was conducted on all pediatric patients (1-14 years) with POT treated with LOD or LOD+OPX at our tertiary care center between 2010 and 2024. The sites of fixation were round ligament, ovarian fossa, utero-ovarian ligament, and uterine body. The data collected included demographic, clinical, imaging, surgical, and follow-up results. Statistical analyses were performed to identify factors associated with recurrence and to compare LOD with LOD+OPX. RESULTS: Eighteen patients (median age 9.4 years) were included in the study. LOD was performed in 56% of cases, while LOD+OPX was performed in 44%. The overall recurrence rate was 44%, with 40% recurrence after LOD and 50% after LOD+OPX (p = 1). Notably, all OPX cases involving the round ligament relapsed (100%), compared to a significantly lower recurrence rate for other OPX sites (20%). Statistical analysis confirmed the round ligament as an inadequate fixation site (P = .027). Follow-up ultrasound revealed normal ovarian morphology in 62% of patients and signs of progressive ovarian atrophy in 38%. CONCLUSION: In our experience, POT predominantly occurred in premenarchal patients with hypermobile utero-ovarian ligaments. Given the high POT recurrence rate after LOD, adjunctive OPX effectively reduced the recurrence rate, except when fixation was performed at the round ligament.