Pediatric and Adolescent Gynecology

• Hymen defects (including imperforate hymen): The hymen is a thin tissue near the vaginal opening. A defect can make it difficult for menstrual blood to flow out or cause pain with tampon use or intercourse. Common signs: pain, absent menstrual flow despite other signs of puberty, or a bulge at the vaginal opening.
• Müllerian duct anomalies: The Müllerian ducts form the uterus, cervix, fallopian tubes, and upper vagina. When they don't develop normally, it can affect menstruation, fertility, and sexual function.
• Uterine duplication (uterine didelphys, bicornuate uterus, septate uterus): Some people are born with two uterine cavities instead of one. Depending on the type, this can affect menstruation, fertility, and sexual function.
• Vaginal agenesis and MRKH syndrome: Vaginal agenesis is a condition in which the vagina, and sometimes the uterus, is missing or underdeveloped. When both the vagina and uterus are absent, it is called MRKH syndrome. It often first appears in the teen years as an absence of menstrual periods (primary amenorrhea).
• Vaginal septum: A vaginal septum is a wall of tissue that partially or fully blocks the vagina. A complete septum can trap menstrual blood and cause pelvic pain; a partial septum may cause pain with tampons or intercourse.
• Vaginal cysts: Vaginal cysts are fluid-filled sacs in the vaginal wall. They are usually painless and non-cancerous, but can occasionally become infected or painful.
• Hematocolpos: Hematocolpos occurs when a blockage, such as an imperforate hymen or vaginal septum, prevents menstrual blood from leaving the body, causing it to build up in the vagina. This can lead to pelvic pain, difficulty urinating, or constipation.

• Ovarian cysts, masses, and tumors: These are growths on or within the ovaries that may be non-cancerous or, less commonly, cancerous. They can cause significant pain or lead to ovarian torsion (twisting of the ovary), which is a surgical emergency.
• Endometriosis: Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, causing painful periods, chronic pelvic pain, and sometimes infertility. Diagnosing and treating endometriosis in adolescents differs from adults and our team has specific expertise in caring for young patients.
• Genital trauma: Injuries to the genital area from accidents, falls, sports, straddle/playground injuries, or violence. Our team provides sensitive, age-appropriate evaluation and care.
• Pelvic inflammatory disease (PID): PID is an infection of the reproductive organs, often causing pelvic pain, fever, and abnormal vaginal discharge. Prompt antibiotic treatment is important to reduce the risk of future infertility.
• Vulvovaginitis: Vulvovaginitis is inflammation of the vulva and vagina that can cause itching, pain, redness, or abnormal discharge. Because the cause may be bacterial, fungal, allergic, or a skin condition, an accurate diagnosis is essential for the right treatment.

• Irregular periods & menstrual pain: Menstrual disorders are common in young girls and teens. Some menstrual conditions we treat include heavy or frequent bleeding, dysmenorrhea (painful menstruation) and infrequent menstruation.
• Amenorrhea (No period): The absence of menstruation, either by age 16 (primary) or when periods stop for three or more months (secondary).
• Dysmenorrhea (Painful Periods): Painful cramping that occurs with menstruation.
• Polyendocrine metabolic ovarian syndrome (PMOS): Formerly known as PCOS, PMOS is a hormonal disorder linked to irregular periods, acne, and excess hair growth. Diagnosing PMOS in teens requires a different approach than in adults. Our team works with other specialists to manage symptoms and prevent future complications like diabetes or infertility.
• Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD): Our gynecologists work with adolescents and young adults to determine the best treatment approach to cyclic mood changes and changes in ADHD symptoms associated with the menstrual cycle.

At K. Hovnanian Children's Hospital, we provide expert diagnosis and treatment for gynecologic birth defects in patients from infancy through young adulthood.

While some reproductive tract anomalies are identified at birth, others may not become apparent until later in childhood or during puberty. Whenever a diagnosis occurs, our specialized pediatric gynecology team is prepared to help you and your child manage the structural, hormonal, and future reproductive impacts of these conditions.

We offer comprehensive care for a wide range of anomalies, including:

• Imperforate hymen and other vaginal obstructions
• Cloacal anomalies
• Genital ambiguity (Differences in Sex Development / DSD)
• Other reproductive system birth defects

This program offers care for patients with vaginal agenesis (absent vagina), vaginal atresia (narrowing), and MKRH (missing the vagina and uterus). Our team provides comprehensive and sensitive support tailored to each patient.

• Care includes: Age and developmentally appropriate counseling, creating an individualized treatment plan, and providing psychosocial support.
• Techniques include: Non-surgical options like guided self-dilation, as well as surgical procedures when necessary.

Our multi-specialty program addresses the hormonal and metabolic imbalances of PMOS (formerly PCOS), recognizing that diagnosis in teens requires a different approach than in adults. Our pediatric gynecologists partner with pediatric endocrinologists to manage the condition and its effects.

Our goals are to:

• Manage symptoms like menstrual irregularities, obesity, acne, and excess hair growth.
• Prevent future complications such as diabetes, metabolic syndrome, infertility, and endometrial cancer.
• Guide patients through medication and lifestyle changes.

This program is dedicated to protecting the reproductive health of girls and young women before, during, and after cancer treatment. Our gynecologists work closely with pediatric oncologists and reproductive endocrinologists to create a plan that considers the long-term effects of cancer therapy.

Services include:

• Fertility Preservation: Ovarian tissue, oocyte (egg), and embryo cryopreservation (freezing).
• Ovarian Transposition: A surgical procedure to move the ovaries out of a radiation field.
• Hormone Management: Monitoring hormone levels and providing hormone replacement when needed.

Our team has specific expertise in the unique ways endometriosis presents and is treated in teens and young women. We understand how pelvic pain can impact school, extracurricular activities, and well-being, and our program provides comprehensive care to manage the condition. \

Our program provides:

• Advanced diagnostic services
• A wide range of treatment options, including hormone therapy and minimally invasive surgery
• Collaboration with Pediatric Rehabilitation for pelvic floor therapy

A pediatric gynecologist is a doctor who specializes in the gynecologic care of infants, children, adolescents, and young adults.

They are experts in:

• Making treatment plans that are appropriate for a growing body
• Considering and protecting future fertility
• Creating a positive and non-invasive first experience with a gynecologist

Our pediatric gynecology team treats patients from birth through adolescence. We also help manage the transition to an adult gynecologist when the time is right.

Pediatric gynecologists manage a wide variety of conditions, providing everything from routine check-ups to complex conditions.

This includes office visits and both minimally invasive and general surgery for issues related to:

• Menstrual problems (painful, heavy, or irregular periods)
• Pelvic pain (caused by ovarian cysts, endometriosis, etc.)
• Congenital conditions (birth defects of the uterus, hymen, or vagina)
• Genital trauma

For a routine visit: The first check-up is recommended between ages 13 and 15 for healthy girls without specific medical issues.

For a specific problem: Your child should be seen sooner if they are experiencing any gynecologic problems, such as pelvic pain or menstrual issues.

The most important thing to know is that for most young girls and teens, an internal pelvic exam is not necessary. A visit to a pediatric gynecologist is not the same as it is to an adult gynecologist. Instead, the visit is often focused on conversation and education.

Here are a few tips to help your child feel prepared:

• Explain the "why": It’s helpful to let your child know that a gynecologist is a doctor who helps make sure their private parts are healthy.
• Listen to their concerns: Ask them if they have any worries about the visit and talk through them.
• Encourage questions: Suggest they write down any questions they have in advance to ask the doctor.

Our team will always explain every step of the visit to you and your child before doing anything.