Pediatric and Adolescent Gynecology Medical Education Videos

Experts in Children's Hospital Colorado's Department of Pediatric and Adolescent Gynecology are dedicated to advancing the field to improve the care and lives of all young females with gynecologic conditions. That's why we conduct research to advance care techniques that can be used for our patients and kids anywhere. Watch the gynecology medical education videos below for protocols and research from our experts to help improve the care of your patients.

Heavy menstrual bleeding is common in adolescents, with about 15% to 40% of teens experiencing heavy bleeding, but many teens don’t recognize that their bleeding is abnormal. Heavy menstrual bleeding frequently interferes with a patient’s physical, social and emotional health and negatively impacts their quality of life.

In this video, Tricia Huguelet, MD, provides an overview of normal menstrual flow, screening for heavy menstrual flow in teens, and identifying red flags for an underlying bleeding disorder. She also explains why it is important to check ferritin levels for iron deficiency and discusses the etiology of abnormal uterine bleeding, with most heavy menstrual bleeding in adolescents and young adults due to ovulatory dysfunction or inherited bleeding disorders.

Female straddle injuries

Acute genital bleeding in girls is most caused by accidental trauma, such as straddling a bicycle or falling on playground equipment. These minor accidents result in injury because the genital tissues in children, without estrogen, are very thin and easily traumatized.

In this video, Veronica Alaniz, MD, provides guidelines for examining and understanding genital lacerations and hematomas resulting from vulvovaginal trauma, including blunt trauma or straddle injury and penetrating.

Non-sexually active genital ulcers in the adolescent female

Non-sexually acquired genital ulcers (NSGUs) in adolescent females are uncommon, painful skin lesions on the mucous membranes of the vulva and vaginal structures, unrelated to sexual activity. NSGUs are caused by an autoimmune response following a viral illness and are unrelated to sexual activity. The lesions are often mistaken for bacterial cellulitis or lesions associated with other viral infections, such as herpes simplex virus.

In this video, Stephen Scott, MD, provides an overview of how to properly identify and manage NSGUs and the timeline for healing. While the ulcers generally resolve on their own and most patients never experience another outbreak, about 25% will have subsequent occurrences. These patients require immunology or rheumatology consultations to prevent more serious and chronic autoimmune conditions, such as Behcet’s syndrome.

Teens with complex medical issues, including developmental and physical disabilities, may have concerns about their periods. Similar to their peers, they can experience problem periods, such as heavy and painful bleeding. In addition, periods may exacerbate other medical issues or they may prefer to have no periods due to hygiene or other concerns. Health providers are the key source of accurate information on puberty and menstrual periods and can offer safe and effective treatment.

In this video, adolescent gynecologist Eliza Buyers, MD, reviews options for menstrual suppression, how they work, and various considerations for teens with complex medical issues. The importance of patient/family preference along with individualization based on medical history and treatment goals is reviewed. Options covered in the video include: the levonorgestrel IUD, norethindrone acetate, the subdermal implant, combined hormonal contraception and depot medroxyprogesterone acetate. After viewing, providers will be better able to counsel patients and their families on treatment methods as well as provide them with updated resources on this topic.

Polycystic ovary syndrome (PCOS) is one of the most common metabolic conditions affecting at least 10% of women of reproductive age. PCOS occurs due to a complex interaction of genetic and environmental factors can affect the menstrual cycle, hair growth, skin, weight and the ability to have children. Early identification and treatment can lead to improved quality of life for individuals with PCOS and prevention of diabetes and cardiovascular disease.

In this video, adolescent gynecologist Eliza Buyers, MD, reviews the pathophysiology and diagnosis of PCOS in adolescent patients. She discusses how diagnosis requires both ovulatory dysfunction and hyperandrogenism, and she shares recommendations for PCOS treatment – from lifestyle changes to possible medications.

In 2019, there were over 1.7 million new cases of cancer, with 10,270 cases occurring among children ages 0 to 14 years of age and 70,000 occurring in adolescents and young adults. With a five-year survival rate of 84%, there are 100,000 annual survivors of reproductive age. Of these survivors, 75% will experience at least one adverse effect, termed late effects of cancer therapy.

In this video, the Director of the Fertility Preservation and Reproductive Late Effects Program, Leslie Appiah, MD, discusses the prevalence of reproductive late effects and female risk stratification based on age and therapy doses. Dr. Appiah also reviews the expert consensus position statements that provide guidance on how providers should care for this population, including informing patients about options for fertility preservation and future reproduction prior to treatment. She reviews the services that the Program provides, such as inpatient and outpatient consults, fertility preservation services and reproductive healthcare, and how to request consultation.

Menstrual bleeding in adolescents can be chaotic. When is it best to reassure, and when is it necessary to evaluate? Although anovulatory cycles are common in the years after menarche, there are established norms and, alternatively, abnormal findings that require further investigation. Uterine bleeding that is coming more often than every three weeks, lasting longer than seven days in a row, or resulting in excessive product use and frequent bleeding through clothes should be evaluated.

In this video, adolescent gynecologist Eliza Buyers, MD, discusses the management of abnormal uterine bleeding (AUB) in adolescent patients. She provides an overview of the physiology and evaluation of AUB, including recommendations on when to consider referring patients to our Spots and Dots Clinic. Dr. Buyers also reviews treatment options, including menstrual suppression, with a focus on key counseling points to help patients and families decide which method is best for them.

Cystic ovarian masses commonly occur in infants, children and adolescents. They may be discovered due to symptoms, during a routine physical exam or incidentally through imaging studies. Historically, these masses were surgically removed, often involving removal of the entire ovary. Over the last decade, however, the management of ovarian masses has shifted toward a more conservative approach with the goal of ovarian preservation.

In this video, Chief of Pediatric and Adolescent Gynecology, Tricia Huguelet, MD, discusses the epidemiology, clinical features and management of ovarian cysts that may occur during the fetal and neonatal periods, and on through adolescence. She also discusses the preferred diagnostic modality and when to consider surgery. In addition, she reviews the potential for ovarian torsion, including signs and symptoms, evaluation and management.

Menstrual pain and cramps are very common in women and affect 50% to 90% of female teens. However, it is when the pain gets progressively worse and occurs outside the menstrual cycle, that it might be time to consider a pathological cause, such as endometriosis. Watch the video to learn the differences between primary and second dysmenorrhea and how to diagnose and treat endometriosis.

Tricia Huguelet, MD, Chief of Pediatric and Adolescent Gynecology, describes the typical presentation of hymen imperforations in adolescents and young adults, as well as obstructing and non-obstructing müllerian anomalies. Dr. Huguelet also reviews the basic embryology and treatment approach for these conditions and explains when the best time is to perform surgery.

Chronic pelvic and abdominal pain can be debilitating for a young girl. Finding the source of this pain in adolescent females and diagnosing the condition can also be particularly challenging.

In this video, Stephen Scott, MD, MPH, emphasizes the fact that pain originates from nerve signaling and uses this understanding to help him identify the source of pain and its cause. Watch the video to learn how Dr. Scott teams up with specialists from urinary and gastrointestinal medicine to develop a holistic approach to identifying and managing chronic pelvic pain in adolescent girls.

Affecting approximately one in every 4,500 newborn girls, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome can be challenging to treat both medically and psychologically, due to the potential loss of fertility. In this video, Veronica Alaniz, MD, MPH, talks about the types of Müllerian agenesis associated with MRKH. This includes the process for diagnosis and considerations for work-up, evaluation and treatment, such as support and counseling.

Gynecological examination of the prepubertal girl can be challenging. In the office setting, the examination should be limited to external inspection only; speculum exams should not be performed in pediatric patients. Procedures such as vaginoscopy can be used for the diagnosis of gynecologic conditions in prepubertal girls.

In this video, pediatric and adolescent gynecologist Veronica Alaniz, MD, discusses the indications, proper technique and risks of vaginoscopy and hysteroscopy. Vaginoscopy is a diagnostic procedure that can be used to evaluate the inside of the vagina and is recommended for girls who are too young for a speculum exam or cannot tolerate one. Hysteroscopy is a procedure to evaluate and manage issues of the uterine cavity and is typically only performed in adolescents when indicated. Hysteroscopy is performed in the operating room under general anesthesia. When indicated, both vaginoscopy and hysteroscopy procedures can be performed by a pediatric and adolescent gynecologist at Children’s Hospital Colorado.