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Key Points

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  1. It is important for pediatric surgeons to collaborate as a team with adolescent gynecologists, pediatric urologists, and endocrinologists for the diagnosis and management of complex gynecologic problems from infancy to late adolescence.

  2. Introital masses in infants with urinary symptoms are diagnosed by introital inspection done in either the frogleg or the knee/chest position, the differential diagnosis including aurethral prolapse or a prolapsed ureterocele.

  3. Hymenectomy is typically not necessary for mucocolpos in infancy because accumulated fluid will typically spontaneously resorb; however, in menarchal girls with breast development who present with pelvic and abdominal pain with failure to menstruate, hymenectomy is necessary to relieve the hematocolpos behind the obstructing hymen.

  4. Labial adhesions/agglutination that also obstruct the free flow of urine are best treated by topical estrogen or corticosteroids for a 4 to 6 week course to induce labial separation.

  5. Both simple and complex ovarian cysts diagnosed in utero or in the early neonatal period by ultrasound exam are best observed for 4 to 6 months if they are 5 cm or less in diameter and if they are asymptomatic, with the expected outcome being a complete spontaneous resolution.

  6. Ovarian preservation operative technique is the key directive when planning and carrying out excision of ovarian cysts or benign neoplasms, whether by open or laparoscopic technique.

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Introduction

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Only a few decades ago, pediatric and adolescent gynecology was not recognized as a separate and distinct field in medicine; it was often considered a small focus of general gynecology. Since then, however, it has evolved into a growing subspecialty encompassing both medical and surgical management of gynecologic conditions. This development stems from an awareness that pediatric and adolescent females are not “little women” and conditions affecting this population are unique in both presentation and management. Additionally, attention to the reproductive tract is critical to preserve options for future fertility in young females. Although in many cases it was necessary for surgical gynecologic needs to be managed by the pediatric surgeon alone, now such concerns are often managed by a multidisciplinary team that can involve pediatric and adolescent gynecologists, pediatric surgeons, gynecologic oncologists, and urologists. This chapter will discuss the most common conditions that may affect the pediatric and adolescent age group and may present to a practitioner who surgically manages pediatric and adolescent females. We describe the presentation, evaluation, and surgical techniques with an emphasis on fertility sparing treatment options for this population.

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External Anatomy

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As in other areas of medicine, it is important to take a thorough age-appropriate history. Depending on the age of the patient and the nature of the complaint, it may be pertinent to also take a sexual history and inquire about possible abuse. Given that some questions or topics may be uncomfortable for you and the patient, it is important to establish a good rapport initially with the patient and parent to help ease the interaction. While taking ...

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