Pediatric and Adolescent Gynecology Fifth Edition Pediatric and Adolescent Gynecology Fifth Edition S. Jean Herriot Emans, M.D. Professor of Pediatrics Harvard Medical School Chief, Division of Adolescent/Young Adult Medicine Vice Chair for Clinical Affairs, Department of Medicine Children’s Hospital Boston Boston, Massachusetts Marc R. Laufer, M.D. Associate Professor of Obstetrics, Gynecology and Reproductive Biology Harvard Medical School; Chief of Gynecology Children’s Hospital Boston; Division of Reproductive Medicine Department of Obstetrics and Gynecology Brigham and Women’s Hospital; David B. Perini Quality of Life Clinic Dana Farber Cancer Instituite; Boston, Massachusetts Donald P. Goldstein, M.D. Clinical Professor of Obstetrics, Gynecology and Reproductive Biology Division of Gynecologic Oncology Department of Obstetrics and Gynecology Brigham and Women’s Hospital Boston, Massachusetts Acquisitions Editor: Anne M. Sydor Developmental Editor:Kerry Barrett Marketing Manager: Kathy Neely Project Manager:Nicole Walz Senior Manufacturing Manager: Ben Rivera Creative Director: Doug Smock Cover Designer: Larry Didona Compositor: Maryland Composition, Inc. Printer: Edwards Brothers ©2005 by Lippincott Williams & Wilkins 530 Walnut St. Philadelphia, PA 19106 USA www.LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in the United States of America Fourth edition 1998, Lippincott Raven Publishers Third edition 1990, Little Brown 9 8 7 6 5 4 Library of Congress Cataloging-in-Publication Data Pediatric and adolescent gynecology / edited by S. Jean Emans, Marc R. Laufer, Donald P. Goldstein.—5th ed. p. ; cm. Includes bibliogrpahical references and index. ISBN 10: 0-7817-4493-8 ISBN 13: 978-0-7817-4493-5 1. Pediatric gynecology. 2. Adolescent gynecology. I. Emans, S. Jean Herriot. II. Laufer, Marc R. III. Goldstein, Donald Peter. [DNLM: 1. Genital Diseases, Female—Adolescent. 2. Genital Diseases, Female— Child. 3. Genital Diseases, Female—Infant. WS 360 P37076 2005] RJ478.E46 2005 618.92(cid:2)098—dc22 2004017947 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA)clearance or limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDAstatus of each drug or device planned for use in their clinical practice. 10 9 8 7 6 5 4 Dedication To our spouses (John, Sue, and Connie), families, friends, and colleagues who have encouraged us in our goals of improving health care for girls and young women. This project could not have been completed without their love and support. v Contents Contributing Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix 1. Office Evaluation of the Child and Adolescent . . . . . . . . . . . . 1 S. Jean Emans 2. Ambiguous Genitalia in the Newborn . . . . . . . . . . . . . . . . . . . . 51 Ingrid Holm 3. Vulvovaginal Problems in the Prepubertal Child . . . . . . . . . . . 83 S. Jean Emans 4. The Physiology of Puberty . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Catherine M. Gordon and Marc R. Laufer 5. Precocious Puberty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Joan Mansfield 6. Delayed Puberty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 S. Jean Emans 7. Amenorrhea in the Adolescent . . . . . . . . . . . . . . . . . . . . . . . . . 214 S. Jean Emans 8. Dysfunctional Uterine Bleeding . . . . . . . . . . . . . . . . . . . . . . . . 270 S. Jean Emans 9. Androgen Abnormalities in the Adolescent Girl . . . . . . . . . . . 287 S. Jean Emans 10. Structural Abnormalities of the Female Reproductive Tract . . 334 Marc R. Laufer, Donald P. Goldstein, and W. Hardy Hendren 11. Gynecologic Pain: Dysmenorrhea, Acute and Chronic Pelvic Pain, Endometriosis, and Premenstrual Syndrome . . . . . . . . . . 417 Marc R. Laufer and Donald P. Goldstein 12. Education of the Child and Adolescent . . . . . . . . . . . . . . . . . . . 477 Phaedra Thomas, Vicki Burke, and Anne Jenks Micheli vii viii CONTENTS 13. Pediatric Urology in the Pediatric and Adolescent Girl . . . . . . 494 Craig A. Peters 14. Vulvovaginal Complaints in the Adolescent . . . . . . . . . . . . . . . 525 Elizabeth R. Woods and S. Jean Emans 15. Bacterial Sexually Transmitted Infections: Gonorrhea, Chlamydia, Pelvic Inflammatory Disease, and Syphilis . . . . . . 565 Lydia A. Shrier 16. Human Immunodeficiency Virus in Young Women . . . . . . . . 615 Cathryn L. Samples 17. Human Papillomavirus Infection in Children and Adolescents 649 Jessica A. Kahn and Paula A. Hillard 18. Benign and Malignant Ovarian Masses . . . . . . . . . . . . . . . . . . 685 Marc R. Laufer and Donald P. Goldstein 19. The Breast: Examination and Lesions . . . . . . . . . . . . . . . . . . . . 729 Marc R. Laufer and Donald P. Goldstein 20. Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 760 S. Jean Emans 21. Teen Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 844 Angela Maidi Nicoletti 22. Adolescent Sexuality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879 Amy B. Middleman and Maurice Melchiono 23. Gynecologic Issues in Young Women with Chronic Diseases . 893 Marc R. Laufer and S. Jean Emans 24. Sexual Abuse in the Child and Adolescent . . . . . . . . . . . . . . . . 939 R. Ranee Leder and S. Jean Emans 25. Complementary and Alternative Medicine for Gynecology Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 976 Wendy L. Wornham 26. Legal Issues in Pediatric and Adolescent Gynecology . . . . . . . 988 Richard Bourne and the Honorable Susan Ricci Appendix 1: Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1002 Appendix 2: World Health Organization, Medical Eligibilty Criteria for Contraceptive Use . . . . . . . . . . . . . . . . . . . 1010 CONTENTS ix Appendix 3: Instructions for Cyclic and Continuous Birth Control Pills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1020 Appendix 4: Definitions of Anatomical Terms Used in Child Sexual Abuse Evaluations . . . . . . . . . . . . . . . . . . . . . . 1024 Appendix 5: Sexual Assault Forensic Medical Report . . . . . . . . . . . 1030 Appendix 6: Methods for Estimating Percentage Body Fat from Skinfold Measurements in Girls . . . . . . . . . . . . . . . . . . 1037 Appendix 7: Percentages and Estimated Mature Heights for Girls, Using Skeletal Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1039 Appendix 8: Calcium Information for Teens . . . . . . . . . . . . . . . . . . 1046 Appendix 9: Non-Steroidal Anti-Inflammatory Agents . . . . . . . . . . 1049 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1053