Congenital anomalies, pre-pubertal vaginitis or bleeding, and post-pubertal issues like heavy or painful menses or polycystic ovarian syndrome (PCOS) occurring in children or adolescents may warrant referral to pediatric and adolescent gynecology specialists, according to Jennifer Howell, MD, pediatric and adolescent gynecologist at Duke Health.

“These issues are challenging to diagnose correctly, especially for someone unfamiliar with the pre-pubertal population,” she says. Without the experience and expertise caring for this unique patient population, presentations of pre-pubertal bleeding, for example, might be misattributed to cancer or abuse.
“Pre-pubertal bleeding has many benign causes, such as vaginitis, foreign bodies like toilet paper, dermatitis, lichen sclerosis, or urethral prolapse,” Howell notes. “Pre-pubertal anatomy is very different from a body under the influence of estrogen and other hormones. That’s why it is important to consider referral. Misdiagnosis is easy.” 

However, in addition to unique anatomy, standard diagnostic tests for gynecological conditions like vaginitis and sexually transmitted diseases require specialized interpretation when used for younger patients as the tools are only validated for use in adults.

Many adolescent reproductive health issues can and should be handled by primary and general gynecologic care providers, but fellowship trained or board-certified pediatric adolescent gynecology specialists offer additional insight and expertise for many conditions occurring in pre-pubescent or adolescent children, including: 

• Dysmenorrhea and heavy periods after failure of first-line therapy
• Amenorrhea
• Complex contraception needs
• Pre-pubescent bleeding or vaginitis
• PCOS
• Congenital anatomic differences

The Pediatric and Adolescent Gynecology team at Duke Health is one of the region’s only programs offering dedicated access to fellowship-trained and board-certified pediatric and adolescent gynecologists. The multi-disciplinary team at Duke specializes in caring for the reproductive health of these young patients at three convenient locations.