,PEDIATRIC AND ADOLESCENT SEXUALITY AND GYNECOLOGY:
PRINCIPLES FOR THE PRIMARY CARE CLINICIAN
I. Foreword
II. Introduction
• Pediatric and Adolescent Sexuality and Gynecology
• References
III. Pediatric Gynecology and Sexuality
Chapter 1: Pediatric and Adolescent Sexuality
• Introduction
• Psychosexual Development
• Attitudes and Sexuality: Masturbation
• The Role of CNS Maturation
• Puberty
• Normal Adolescent Sexuality Stages
• Adolescent Coital Experience
• Factors That Impede Normal Sexuality Development
• Adolescent Pregnancy and Sexually Transmitted Diseases
• Hypersexuality
• Sexual Abuse
• Dating Violence
• Adolescent Sexual Offenders
• Chronic Illness and Disability
• Other Consequences
• Responsible Male Sexuality
• Clinicians as Counselors
, • Homosexuality
o Perspectives on Homosexuality
o Psychological Perspectives
o Diagnostic Perspectives
o Homosexual Identity Perspectives
o Same-Sex Identity Acquisition
o Parents’ Reactions
o Social Perspectives
o Evaluation and Management
▪ Initiating the Evaluation
▪ Evaluation and Management Process
▪ Evaluating Support Systems
▪ Evaluating Social Relationships
▪ Depression and Suicide
▪ Sexually Transmitted Diseases (STDs)
• Conclusion
• Acknowledgments
• References
• Resources
Chapter 2: Prepubertal Office Gynecology
• Introduction
• Genitourinary Examination
o Positioning the Patient
o Documentation of Findings
o Sample/Specimen Collection
• Presenting Symptoms
o Erythema
, 1. Non-specific Vulvovaginitis
2. Diaper Dermatitis
3. Contact Dermatitis
4. Bacterial Vulvovaginitis
o Vulvar Rash
1. Lichen Sclerosus
2. Drug-induced Eruptions
3. Psoriasis
4. Molluscum Contagiosum
o Vaginal Discharge
1. Bacterial Vaginosis
2. Chlamydia, Gonorrhea, Trichomoniasis
3. Foreign Body
o Vaginal Bleeding
1. Sexual Abuse and Trauma
o Perianal Conditions
1. Pinworm Infection (including pinworm vulvovaginitis)
2. Failure of Midline Fusion and Rectal Prolapse
3. Lymphangioma
4. SSSS and Toxic Shock Syndrome
o Miscellaneous
1. Vulvar Hemangioma
2. Labial Agglutination
• References
Chapter 3: Gynecologic Endocrinology
• Introduction
• Development of the Female Reproductive System in the Fetus
, • Development of the Ovarian Follicles
• Pattern of Hormone Secretion in the Female Fetal Reproductive Axis
• Ovarian Hormone Production
• Differentiation of Female Internal and External Reproductive Structures
• Development of Female External Genitalia
• Disorders of Sexual Differentiation in the Female
1. Disorders of Gonadal Determination
2. Virilization of the 46,XX Infant
3. Undervirilization of the 46,XY Fetus/Infant
4. True Hermaphroditism
5. Other Syndromes
• Changes in the Female Reproductive Axis
o Infant and Child
o Puberty/Adolescence
• Disorders of Pubertal Development
o Precocious Puberty (Central, Peripheral, Pseudoprecocious)
o Delayed Puberty
• Polycystic Ovarian Syndrome (PCOS)
• Menstrual Disturbances
• Obesity and Insulin Resistance
• Hirsutism
• Conclusion
• Acknowledgments
• References
Chapter 4: Genetic Syndromes in Adolescent Gynecology
• Introduction
• Conditions with Significant Gynecologic Abnormalities
, o Turner Syndrome
o AIS
o MRKH Syndrome
o Kallmann Syndrome
o Albright Hereditary Osteodystrophy
o McCune-Albright Syndrome
• Common Genetic Syndromes with Occasional Gynecologic Manifestations
o Noonan, Prader-Willi, CHARGE, Kabuki, Angelman, NF, Down, Williams, VCFS
• Conclusion
• References
Chapter 5: Sexual and Physical Abuse
• Introduction
• Epidemiology
o Incidence and Effects
o Definitions & Risk Factors
• Clinical Features
o Sexual Abuse
o Physical Abuse
o Adolescent–Specific Issues
• Diagnosis
o Medical Evaluation Approach
o Physical Findings
o STIs & Forensic Evidence
• Treatment and Prevention
o Identification and Reporting
o Prevention Principles
• Conclusions and Future Research
, • References
Chapter 6: Breast Disorders in Children and Adolescents
• Introduction & Embryology
• Normal Adolescent Breast Development
• Breast Examination (Self & Clinical)
• Congenital Anomalies (Nipple, Polymastia/Amastia)
• Timing of Development & Asymmetry
• Underdeveloped, Tub erous, Atrophic Breasts
• Mammary Hyperplasia & Fibroadenomas
• Cystosarcoma Phyllodes & Papilloma
• Breast Cancer
• Infections (Pre-/Post-pubertal)
• Sports-Induced Trauma
• Benign Disease (Fibrocystic Change, Mastalgia)
• Gynecomastia, Nipple Discharge, Galactorrhea
• Acknowledgments
• References
Chapter 7: Menstrual Disorders in Adolescent Females
• Introduction & Physiology (Follicular, Ovulation, Luteal)
• Dysfunctional Uterine Bleeding & Coagulation Disorders
• Amenorrhea (Primary, Secondary, Athlete Triad)
• Dysmenorrhea (Primary, Secondary)
• PMS & Premenstrual Dysphoric Disorder
• Pelvic Pain (Mittelschmerz, Endometriosis)
• Management Strategies
• Acknowledgments
• References
,Chapter 8: Contraception
• Introduction
• Oral Contraceptives & Contraindications
• Transdermal, Progestin-only, Emergency Methods
• Barrier Methods & IUDs, Implants, Injectables
• Sterilization, Natural Family Planning
• Special Populations & Drug Interactions
• Conclusions
• Acknowledgments
• References
Chapter 9: Pregnancy and Abortion
• Introduction & Diagnosis
• Teen Pregnancy: Risk Factors & Next Steps
• Adoption vs. Termination
• Care of the Pregnant Teen
• Prevention & Public Health
• Conclusion
• References
Chapter 10: Adolescent Sexually Transmitted Infections
• Introduction
• Genital Ulcers (HSV, Syphilis)
• Cervicitis & Urethritis
• Chlamydia & Gonococcal Infections
• Vaginitis (Trichomoniasis, BV, Candidiasis)
• PID & Genital Warts
• STI Prevention
• References
,Chapter 11: Ovarian Tumors in Children and Adolescents
• Introduction & Epidemiology
• Functional Cysts
• Benign, Borderline, Germ Cell, Epithelial, Virilizing Tumors
• Staging, Symptoms, Diagnosis, Treatment, Follow-up
• Advances in Biomarkers
• Lab Tests Summary
• Conclusion
• References
Chapter 12: The Female Athlete
• Introduction, History, Psychology, Physiology
• Breast and Sports Injuries
• Menstrual Dilemmas & Female Athlete Triad
• Exercise in Pregnancy
• Iron Deficiency & Urinary Incontinence
• Injuries & Summary
• Acknowledgments
• References
Chapter 13: Post-partum Depression
• Introduction, Definition, Epidemiology, Pathogenesis
• Clinical Identification & Management
o Non-pharmacologic & Pharmacologic
• Role of the Primary Care Clinician
• Adolescent Considerations
• Summary
• References
Chapter 14: Gynecological Aspects of Eating Disorders
, • Introduction & Pubertal/Hormonal Changes
• Role of Abuse & Sexuality
• Gynecologic Effects (Amenorrhea, Bone Loss, Fertility)
• Sexuality Assessment
• Management
• Summary
• References
IV. Acknowledgments
V. About the Editors & Institutional Profiles
• Chapter 15: About the Editors
• Chapter 16: Division of Adolescent Medicine, University of Kentucky
• Chapter 17: Dept. of Pediatrics & Human Development, Michigan State Univ.
• Chapter 18: Adolescent Health Unit, Univ. of Athens
• Chapter 19: NICHD, Israel
• Chapter 20: Health and Human Development Series
• Index
PRINCIPLES FOR THE PRIMARY CARE CLINICIAN
I. Foreword
II. Introduction
• Pediatric and Adolescent Sexuality and Gynecology
• References
III. Pediatric Gynecology and Sexuality
Chapter 1: Pediatric and Adolescent Sexuality
• Introduction
• Psychosexual Development
• Attitudes and Sexuality: Masturbation
• The Role of CNS Maturation
• Puberty
• Normal Adolescent Sexuality Stages
• Adolescent Coital Experience
• Factors That Impede Normal Sexuality Development
• Adolescent Pregnancy and Sexually Transmitted Diseases
• Hypersexuality
• Sexual Abuse
• Dating Violence
• Adolescent Sexual Offenders
• Chronic Illness and Disability
• Other Consequences
• Responsible Male Sexuality
• Clinicians as Counselors
, • Homosexuality
o Perspectives on Homosexuality
o Psychological Perspectives
o Diagnostic Perspectives
o Homosexual Identity Perspectives
o Same-Sex Identity Acquisition
o Parents’ Reactions
o Social Perspectives
o Evaluation and Management
▪ Initiating the Evaluation
▪ Evaluation and Management Process
▪ Evaluating Support Systems
▪ Evaluating Social Relationships
▪ Depression and Suicide
▪ Sexually Transmitted Diseases (STDs)
• Conclusion
• Acknowledgments
• References
• Resources
Chapter 2: Prepubertal Office Gynecology
• Introduction
• Genitourinary Examination
o Positioning the Patient
o Documentation of Findings
o Sample/Specimen Collection
• Presenting Symptoms
o Erythema
, 1. Non-specific Vulvovaginitis
2. Diaper Dermatitis
3. Contact Dermatitis
4. Bacterial Vulvovaginitis
o Vulvar Rash
1. Lichen Sclerosus
2. Drug-induced Eruptions
3. Psoriasis
4. Molluscum Contagiosum
o Vaginal Discharge
1. Bacterial Vaginosis
2. Chlamydia, Gonorrhea, Trichomoniasis
3. Foreign Body
o Vaginal Bleeding
1. Sexual Abuse and Trauma
o Perianal Conditions
1. Pinworm Infection (including pinworm vulvovaginitis)
2. Failure of Midline Fusion and Rectal Prolapse
3. Lymphangioma
4. SSSS and Toxic Shock Syndrome
o Miscellaneous
1. Vulvar Hemangioma
2. Labial Agglutination
• References
Chapter 3: Gynecologic Endocrinology
• Introduction
• Development of the Female Reproductive System in the Fetus
, • Development of the Ovarian Follicles
• Pattern of Hormone Secretion in the Female Fetal Reproductive Axis
• Ovarian Hormone Production
• Differentiation of Female Internal and External Reproductive Structures
• Development of Female External Genitalia
• Disorders of Sexual Differentiation in the Female
1. Disorders of Gonadal Determination
2. Virilization of the 46,XX Infant
3. Undervirilization of the 46,XY Fetus/Infant
4. True Hermaphroditism
5. Other Syndromes
• Changes in the Female Reproductive Axis
o Infant and Child
o Puberty/Adolescence
• Disorders of Pubertal Development
o Precocious Puberty (Central, Peripheral, Pseudoprecocious)
o Delayed Puberty
• Polycystic Ovarian Syndrome (PCOS)
• Menstrual Disturbances
• Obesity and Insulin Resistance
• Hirsutism
• Conclusion
• Acknowledgments
• References
Chapter 4: Genetic Syndromes in Adolescent Gynecology
• Introduction
• Conditions with Significant Gynecologic Abnormalities
, o Turner Syndrome
o AIS
o MRKH Syndrome
o Kallmann Syndrome
o Albright Hereditary Osteodystrophy
o McCune-Albright Syndrome
• Common Genetic Syndromes with Occasional Gynecologic Manifestations
o Noonan, Prader-Willi, CHARGE, Kabuki, Angelman, NF, Down, Williams, VCFS
• Conclusion
• References
Chapter 5: Sexual and Physical Abuse
• Introduction
• Epidemiology
o Incidence and Effects
o Definitions & Risk Factors
• Clinical Features
o Sexual Abuse
o Physical Abuse
o Adolescent–Specific Issues
• Diagnosis
o Medical Evaluation Approach
o Physical Findings
o STIs & Forensic Evidence
• Treatment and Prevention
o Identification and Reporting
o Prevention Principles
• Conclusions and Future Research
, • References
Chapter 6: Breast Disorders in Children and Adolescents
• Introduction & Embryology
• Normal Adolescent Breast Development
• Breast Examination (Self & Clinical)
• Congenital Anomalies (Nipple, Polymastia/Amastia)
• Timing of Development & Asymmetry
• Underdeveloped, Tub erous, Atrophic Breasts
• Mammary Hyperplasia & Fibroadenomas
• Cystosarcoma Phyllodes & Papilloma
• Breast Cancer
• Infections (Pre-/Post-pubertal)
• Sports-Induced Trauma
• Benign Disease (Fibrocystic Change, Mastalgia)
• Gynecomastia, Nipple Discharge, Galactorrhea
• Acknowledgments
• References
Chapter 7: Menstrual Disorders in Adolescent Females
• Introduction & Physiology (Follicular, Ovulation, Luteal)
• Dysfunctional Uterine Bleeding & Coagulation Disorders
• Amenorrhea (Primary, Secondary, Athlete Triad)
• Dysmenorrhea (Primary, Secondary)
• PMS & Premenstrual Dysphoric Disorder
• Pelvic Pain (Mittelschmerz, Endometriosis)
• Management Strategies
• Acknowledgments
• References
,Chapter 8: Contraception
• Introduction
• Oral Contraceptives & Contraindications
• Transdermal, Progestin-only, Emergency Methods
• Barrier Methods & IUDs, Implants, Injectables
• Sterilization, Natural Family Planning
• Special Populations & Drug Interactions
• Conclusions
• Acknowledgments
• References
Chapter 9: Pregnancy and Abortion
• Introduction & Diagnosis
• Teen Pregnancy: Risk Factors & Next Steps
• Adoption vs. Termination
• Care of the Pregnant Teen
• Prevention & Public Health
• Conclusion
• References
Chapter 10: Adolescent Sexually Transmitted Infections
• Introduction
• Genital Ulcers (HSV, Syphilis)
• Cervicitis & Urethritis
• Chlamydia & Gonococcal Infections
• Vaginitis (Trichomoniasis, BV, Candidiasis)
• PID & Genital Warts
• STI Prevention
• References
,Chapter 11: Ovarian Tumors in Children and Adolescents
• Introduction & Epidemiology
• Functional Cysts
• Benign, Borderline, Germ Cell, Epithelial, Virilizing Tumors
• Staging, Symptoms, Diagnosis, Treatment, Follow-up
• Advances in Biomarkers
• Lab Tests Summary
• Conclusion
• References
Chapter 12: The Female Athlete
• Introduction, History, Psychology, Physiology
• Breast and Sports Injuries
• Menstrual Dilemmas & Female Athlete Triad
• Exercise in Pregnancy
• Iron Deficiency & Urinary Incontinence
• Injuries & Summary
• Acknowledgments
• References
Chapter 13: Post-partum Depression
• Introduction, Definition, Epidemiology, Pathogenesis
• Clinical Identification & Management
o Non-pharmacologic & Pharmacologic
• Role of the Primary Care Clinician
• Adolescent Considerations
• Summary
• References
Chapter 14: Gynecological Aspects of Eating Disorders
, • Introduction & Pubertal/Hormonal Changes
• Role of Abuse & Sexuality
• Gynecologic Effects (Amenorrhea, Bone Loss, Fertility)
• Sexuality Assessment
• Management
• Summary
• References
IV. Acknowledgments
V. About the Editors & Institutional Profiles
• Chapter 15: About the Editors
• Chapter 16: Division of Adolescent Medicine, University of Kentucky
• Chapter 17: Dept. of Pediatrics & Human Development, Michigan State Univ.
• Chapter 18: Adolescent Health Unit, Univ. of Athens
• Chapter 19: NICHD, Israel
• Chapter 20: Health and Human Development Series
• Index
