April 04, 2019
Pediatric and adolescent gynecology, also known as PAG, is a unique subspecialty in the field of obstetrics and gynecology. The specialty provides gynecologic care to infants, children and adolescents. Children and adolescents have special needs compared to their adult counterparts. Pediatric and adolescent gynecologists have specialized training to provide comprehensive gynecologic care from birth to young adulthood.
To become a pediatric and adolescent gynecologist, physicians must complete a residency program in obstetrics and gynecology, followed by a PAG fellowship training program. Currently, 11 fellowship programs are offered in the United States and two in Canada. There are three programs on the East Coast – two in Massachusetts and one in Washington, D.C.
The fellowship trains physicians to manage both common and uncommon pediatric and adolescent gynecologic conditions, become skilled in a broad range of surgical techniques – including minimally invasive procedures for children – manage complex reproductive anomalies, and employ an interdisciplinary approach to reconstructive surgery.
The national organization supporting the subspecialty, the North American Society for Pediatric and Adolescent Gynecology, is committed to the reproductive needs of children and adolescents. Its mission is to “provide multidisciplinary leadership in education, research and gynecologic care to improve the reproductive health of youth.” To access further information about pediatric and adolescent gynecology, visit its website.
PAG training helps bridge the gap between adult gynecology and pediatrics. At a pediatric visit, reproductive health is one of many topics a pediatrician will cover. At a PAG visit, sexual and reproductive health is the focus of the visit. Gynecologists like to think of the menstrual cycle as an additional vital sign in assessing a patient’s overall health status. Just like abnormal blood pressure or heart rate may be key to diagnosing health conditions, identifying abnormal menstrual patterns might improve early identification of potential reproductive health concerns.
At an initial reproductive health visit ... internal pelvic examinations are rarely necessary and only recommended for symptomatic patients.
A PAG provider also works collaboratively with pediatricians to assure optimal care. Annual visits with a pediatrician are important and once a relationship with a pediatric and adolescent gynecologist is established, it is recommended they, too, are seen annually during adolescent years. Pediatric patients can be seen by a PAG provider on an episodic, as-needed basis. Once patients reach adolescence, they can be seen yearly to address changing developmental stages.
The American College of Obstetricians and Gynecologists recommends initial reproductive health visits begin with a gynecologist between the ages of 13 and 15 years. An initial visit allows a pediatric and adolescent gynecologist to develop a patient-physician relationship, counsel patients and parents about healthy behaviors, and dispel myths and fears. The scope of an initial visit will depend on the patient’s individual needs, her physical and emotional development, and medical history.
The visit is predominately educational to discuss normal pubertal development and assess the menstrual cycle. It also provides the opportunity to screen for risky behaviors and for the pediatric and adolescent gynecologist to provide education. Reproductive health visits can reassure parents, help their daughters navigate adolescence and assist patients in developing ownership of their health care.
At an initial reproductive health visit, a pediatric and adolescent gynecologist will perform a general physical examination and may examine the breasts and perform an external pelvic exam. Internal pelvic examinations, however, are rarely necessary and are only recommended for symptomatic patients. Early initiation of gynecologic care can assist in the development of adequate preparation before the patient’s first pelvic exam is performed.
Children and adolescent patients visit a pediatric and adolescent gynecology practice for different reasons.
Pediatric patients may have congenital malformations of the reproductive tract, skin conditions of the vulva, vulvovaginitis (inflammation or infection of the vulva or vagina), labial adhesions, retained foreign body (most commonly toilet paper) or signs of early puberty.
Management plans and follow-ups are individualized and determined by a patient’s medical condition. Some conditions can be managed with observation, others with medical intervention. Occasionally, surgery will be needed. Medical treatment can improve conditions such as skin irritation or vaginal infections. Menstrual regulation with hormones either taken orally, through a skin patch, injection, intrauterine devices and other treatments are offered to assist in the management of painful or heavy menstrual cycles, endometriosis, seizures linked to menstrual cycles, or difficulty managing menstrual cycles due to hygiene issues. Minimally invasive gynecologic surgery is often used to treat ovarian cysts and evaluate pelvic pain. Surgical techniques, such as laparoscopy, can shorten the patient’s recovery period.
These, and many other topics, will be discussed here monthly on PhillyVoice, with regular, in-depth columns about gynecologic care for pediatric and adolescent patients, so parents can be better informed about their daughters’ health.
Dr. Rachael L. Polis is a pediatric and adolescent gynecologist at Crozer-Keystone Health System. She sees patients from newborn to 25 years old in Crozer-Keystone OB/GYN offices in Broomall, Media and Upland. Call 610-619-8300 for an appointment.