Taking care of adolescent gynecological needs

Carrie Holton, MSN, WHNP-BC, Department of Pediatric and Adolescent Gynecology at Children’s Hospital of Colorado, gave a presentation on gynecological care for adolescent patients at the 25th Annual Conference on Women’s Health Care at NPWH in Houston, Texas, from Sept. 29 to 2 october.¹

Holton first outlined how health care providers can offer preventive health screenings and provide guidance for preteens, teens, and parents in pediatric gynecology. Conditions such as vulvovaginitis in children, lichen sclerosus, genital injuries, labial adhesions, congenital malformations of the reproductive system, suppression of the menstrual cycle, neoplasms, premenstrual syndrome, premenstrual dysphoric disorder, and breast problems in young men are treated with medicine. Pediatric gynecology, as well as fertility preservation or hormone replacement.

During an office assessment, there should be a welcoming environment for teen patients, according to Holton. Healthcare providers will require technical skills to complete hymen examinations, single-digit exams, and microbats. They will also need to be patient to listen to teens and parents, along with knowing their patients’ history.

Confidentiality was also discussed. Holton noted that teens should be made aware of situations where information is not confidential, such as suicidal thoughts or murder. Minors’ consent laws should be known, as many states allow minors to consent to family planning, pregnancy care, substance abuse-related care, and outpatient mental health services. All states allow minors to consent to a sexually transmitted infection test.

When arranging and administering a test for teens, the decision should be between the teen and the provider, although a companion is required. Providers must explain all components of the test to the patient and the parent. Patients should be reassured that they are in control of their body and the examination can be stopped at any time.

When moving to the next step, providers must request permission to pull the paper back. Holton reminded them to explain female anatomy in appropriate terms, and to educate parents and patients. The breasts and pubic hair should be examined to determine the stage of Tanner, and the external genitalia should be examined for normal anatomy.

In the presentation, Holton discussed normal pubertal development along with abnormalities, and encouraged attendees to learn this information so that they could recognize signs of abnormal development. Providers need to determine the cause first and then determine the treatment. This may include hormone replacement therapy in cases of primary ovarian insufficiency.

Holton also outlined examples of physiological ovulation—when slow maturation occurs in non-ovulatory cycles. This can lead to noncyclic, unpredictable, and inconsistent bleeding. In cases where the bleeding is too much, teens should see an oncologist for testing, especially in cases with a history of bleeding disorders in the individual or family.

In cases of light bleeding without anemia, providers should reassure patients, provide them with prophylactic iron supplementation, and offer hormonal contraceptives if desired. In the event of moderate bleeding accompanied by anemia, caregivers should give patients oral contraceptives, precise oral progestogen, Depo-Provera injection, levonorgestrel intrauterine device (LNg) (IUD), and iron supplementation.

Further treatments, along with hospitalization and blood transfusions, may be needed in cases of severe bleeding. In all cases, Holton stated that iron supplements should be given.

Holton also discussed polycystic ovary syndrome (PCOS), reminding the audience that every case is different. Holton also noted that PCOS is not caused by ovarian cysts or being overweight, and much remains unknown about PCOS. The diagnosis can be given as ‘irregular periods’, and it can present as amenorrhea, hypomenorrhea, and dysmenorrhea.

Treatment for PCOS varies based on the concerns, as it can lead to metabolic concerns, acne, skin concerns, and nutritional concerns. When these concerns arise, examinations should establish a relationship at the first visit. Repeat examinations should be done initially every 3 months, then every 3 to 12 months depending on the patient.

Finally, Holton spoke about dysmenorrhea and endometriosis. Dysmenorrhea is a painful menstrual cycle, and it often increases the risk of anxiety and depression. It can be managed with nutritional, vitamin and herbal remedies along with exercise and yoga, or with pharmacological interventions.

Dysmenorrhea is often caused by endometriosis. Risk factors for endometriosis include early menstruation, no menstruation, shorter menstrual cycles, sexual and physical abuse of children, and more. To treat endometriosis, Holton recommended surgical and medical treatments. Complementary and alternative therapies may also reduce symptoms.

reference

1. Holton C. Adolescent Gynecological Care: A Perspective from PAG WHNP. Presented at: The 25th Annual Conference on Women’s Health Care. Houston, Texas. From September 29 to October 2, 2022.