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Adolescent gynecology research at Children's Hospital Colorado aims to promote and advance the health of young women across their reproductive lifespan, from childhood through adolescence and continuing into adulthood. To achieve this goal, we routinely collaborate within our division and also with other medical subspecialties including endocrinology, urology, general surgery, psychiatry and adolescent medicine. Our researchers investigate conditions and treatments and help develop standards of care relating to the female reproductive system. Our goal is to improve the physical and psychological health of developing adolescents and our research directly impacts our patient's care now and influences the future of treatment for young women.
Study title: A study of adolescent female genitalia: What is normal?
Study overview: Women of all ages have shown increased concerns about external genital appearance; adolescent females often share these concerns with their primary or secondary care providers. Labiaplasty, a surgical procedure to adjust the length or shape of the labia minora, is on the rise, and many distressed adolescent patients request the surgery to correct what they perceive is an abnormality.
Our researchers conducted a 34-month study that included 44 female patients aged 10 to 19 who underwent a routine surgical procedure. The study aimed to examine a small sample of normal adolescent females for genital measurements and structure descriptions, focusing on the size and morphology of the labia minora.
Labia widths, lengths, color and texture differed significantly, and there was no correlation between labia minora size and patient age, height, weight or race. Researchers concluded female genital anatomy widely varies, and there is not an established normal range. Researchers proposed extreme caution should be given to the role of labiaplasty in adolescents.
Study title: Clinical predictors of isolated tubal torsion: A case series
Study overview: Adolescents commonly complain of abdominal pain. Isolated tubal torsion (ITT) is a rare, yet serious potential cause of this pain.
Our researchers conducted a large case series in an effort to describe the presentation and management of ITT. They studied 19 females, 3 to 21 years old, who were diagnosed with ITT at Children's Colorado between January 2004 and August 2015.
Our researchers found a 100% correlation with side of adnexal pathology in the 16 patients with unilateral abdominal pain. Most cases were managed with laparoscopy. 78% of patients had abnormal findings ipsilateral to the ITT, often a simple paraovarian cyst. The most common intraoperative finding was a paratubal cyst. When Doppler flow was performed, a paratubal cyst was present in 88% of patients. Findings suggest the high occurrence of paratubal cysts is a pathologic predisposition for ITT. Providers should maintain a high index of suspicion for ITT and not assume that presence of Doppler flow rules this condition out. Laparoscopy and detorsion of the fallopian tube are appropriate treatments to preserve fertility.
Study title: Use of the Levonorgestrel IUD in adolescent and young adult solid-organ transplant recipients: A case series
Study overview: Females who undergo solid organ transplants are at risk for unplanned pregnancy.
Our researchers conducted a case series to study the safety and efficacy of the levonorgestrel 52-mg intrauterine system (IUS) in adolescent and young adult solid organ transplant recipients. The retrospective study reviewed six transplant recipients who received the levonorgestrel 52-mg reversible intrauterine device (IUD). The organs transplanted were: liver, small bowel, kidney (2) and heart (2). There were no unintended pregnancies among the patients studied and there were no cases of pelvic inflammatory disease. While there are limitations to the study, including case size, this is the largest case series published in the adolescent and young adult transplant population, demonstrating the safety of the LNG 52-mg IUS in six solid organ transplant recipients.
Researchers determined that healthcare providers should feel comfortable using IUDs in this population.