Gynecologic care of medically complicated adolescents

Abstract

Gynecologic care of adolescents presents a challenge under the best of circumstances, but when the patient has significant medical processes that interact with the process of puberty, the care of these patients may become extremely difficult. A review of the more common medical illnesses of adolescents and the interaction on the events of puberty and normal menstrual function is presented with emphasis on contraception and future fertility. Although many of the contraceptive options present a possible increased risk to these patients, it must be kept in mind that these adolescent patients will develop emotionally and become sexually active at some point in their lives, and the potential risk of the resultant pregnancy must be weighed carefully. The various options of management for gynecologic problems are discussed.

PIP: This paper discusses issues on gynecologic care of medically complicated adolescents. Gynecologists and health personnel should give special attention to the chronic medical illness or disabilities of adolescents throughout their development. They must understand the interactions of the normal endocrinology of development and the pathophysiology of the medical illness. Chronically ill and disabled adolescents are least likely to receive information and guidance on sexual issues. They need to know the potential impact of their illness on pregnancy; genetic risk of their illness, treatment, and disability pose to their unborn children; and their limitations on both sexual function and fertility. In addition, it¿s important that these adolescents be given counseling addressing social and judgmental skills in cases of social isolation. Illnesses related to pubertal developments include: diabetes mellitus; cystic fibrosis; renal insufficiency and failure; gynecologic issues with various other chronic illnesses; sickle cell disease; seizure disorders; asthma; tuberculosis; inflammatory bowel disease; chronic yeast infections; menstrual abnormalities and coagulopathies or thrombocytopenia; adolescent and childhood malignancies; and developmental delayed and physical disability.