Table Of ContentPediatric and Adolescent
Gynecology
SECOND Edition
2000
LIPPINCOTT WILLIAMS & WILKINS
530 Walnut Street, Philadelphia, PA 19106 USA, LWW.com
0-7817-1781-7
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
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copyright.
Printed in the USA
Library of Congress Cataloging-in-Publication Data
Pediatric and adolescent gynecology/ editors, Sue Ellen Koehler Carpenter, John A. Rock — 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-7817-1781-7
1. Pediatric gynecology. 2. Adolescent medicine. I. Carpenter, Sue Ellen Koehler. II. Rock, John A.
[DNLM:1. Genital Diseases, Female— Adolescence. 2. Genital Diseases, Female— Child. 3. Adolescent Medicine. WS 360 P3705 2000]
RJ478.P43 2000
618.92x098—dc21
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 for limited use in restricted research settings. It is the responsibility of the health care
provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.
10 9 8 7 6 5 4 3 2 1
EDITORS
Sue Ellen Koehler Carpenter M.D.
Department of Reproductive Endocrinology, Crawford Long Hospital, Emory Clinic; Assistant Professor, Department of Gynecology and Obstetrics,
Emory University School of Medicine, Atlanta, Georgia
John A. Rock M.D.
Professor and Chairman
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
SECONDARY EDITORS
Lisa McAllister
Acquisitions Editor
Gina Gerace
Developmental Editor
Melanie Bennitt
Production Editor
Colin Warnock
Manufacturing Manager
Mark Lerner
Cover Designer
Lippincott Williams & Wilkins Desktop Division
Compositor
Edwards Brothers
Printer
Contributing Authors
Robert A. Ambros M.D.
Associate Professor
Department of Pathology and Laboratory Medicine, The Albany Medical College, Albany, New York 12208
Jean Anderson M.D.
Associate Professor
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
Ricardo Azziz M.D., M.P.H.
Professor
Departments of Gynecology and Obstetrics and Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233
G. William Bates M.D.
Clinical Professor
Department of Gynecology and Obstetrics, Vanderbilt University Medical Center, Nashville, Tennessee 37240
Gary D. Berkovitz M.D.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
Lesley L. Breech M.D.
Instructor
Department of Gynecology and Obstetrics, Washington University School of Medicine, St. Louis, Missouri 63110
Sue Ellen Koehler Carpenter M.D.
Department of Reproductive Endocrinology, Crawford Long Hospital, Emory Clinic; Assistant Professor, Department of Gynecology and Obstetrics,
Emory University School of Medicine, Atlanta, Georgia 30322
Sandra Ann Carson M.D.
Professor
Department of Gynecology and Obstetrics; Chief, Baylor Assisted Reproductive Technology, Baylor College of Medicine, Houston, Texas 77030
Carol M. Choi M.D.
Attending Physician
Department of Gynecology and Obstetrics, The University Hospital; Assistant Professor, Department of Gynecology and Obstetrics, University of
Cincinnati, Cincinnati, Ohio 45267
Andrew S. Cook M.D.
Private practice
Metairie, Louisiana 70002
Vanessa E. Cullins M.D., M.P.H.
Vice President and Medical Director
Department of Technical Resources, AVSC International, New York, New York 10001
Mark A. Damario M.D.
Consultant and Assistant Professor
Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, Minnesota 55905
David L. Dudgeon M.D.
Director
Pediatric Surgery, Department of Surgery, Rainbow Babies and Children's Hospital; Professor, Department of Surgery and Pediatrics, Case Western
Reserve University, Cleveland, Ohio 44106
Peter J. Fagan M.D.
Sexual Behaviors Consultation Unit, Baltimore, Maryland 21205
Nancy N. Fajman M.D., M.P.H.
Medical Director
Egleston Child Protection Program, Egleston Children's Hospital; Assistant Professor, Department of General Pediatrics, Emory University School of
Medicine, Atlanta, Georgia 30322
Mark R. Feneley M.D., F.R.C.S.(UROL.)
The James Buchanan Brady Urological Institute, Johns Hopkins University School Of Medicine, Baltimore, Maryland 21287
John P. Gearhart M.D.
Chief
Department of Pediatric Urology, The James Buchanan Brady Urological Institute; Professor, Department of Urology, Johns Hopkins University
School of Medicine, Baltimore, Maryland 21287
Gary A. Glasser M.D.
Atlanta Gynecology and Obstetrics, Decatur, Georgia 30030; Clinical Assistant Professor, Department of Gynecology and Obstetrics, Emory
University School of Medicine, Atlanta, Georgia 30303
Enrique R. Grisoni M.D.
Director
Pediatric Trauma, Department of Pediatric Surgery, Rainbow Babies and Children's Hospital; Associate Professor, Departments of Surgery and
Pediatrics, Case Western Reserve University, Cleveland, Ohio 44106
Sarah E. Herbert M.D.
Director
Psychiatry Obstetrics Consultation/Liaison Service, Department of Psychiatry, Grady Health System; Assistant Professor, Department of Psychiatry
and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322
John S. Hesla M.D.
Portland Center for Reproductive Medicine, Portland, Oregon 97210
Ira R. Horowitz M.D.
Director
Department of Gynecology and Obstetrics, Emory University Hospital; Professor and Vice Chairman, Department of Gynecology and Obstetrics,
Emory University School of Medicine, Atlanta, Georgia 30322
George R. Huggins M.D.
Professor and Chairman
Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224
Eugene Katz M.D.
Director
The GBMC Fertility Center, The Greater Baltimore Medical Center; Assistant Professor, Department of Gynecology and Obstetrics, University of
Maryland, Baltimore, Maryland 21204
William R. Keye Jr. M.D.
Director
Department of Gynecology and Obstetrics, William Beaumont Hospital, Royal Oak, Michigan 48073; Clinical Associate Professor, Department of
Gynecology and Obstetrics, University of Michigan, Ann Arbor, Michigan 48109
Joel S. Krasnow M.D.
Department of Gynecology and Obstetrics, Women's Endocrine Division, University of Wisconsin, Madison, Wisconsin 53792
Robert J. Kurman M.D.
Director
Gynecologic Pathology, Department of Pathology, Johns Hopkins Hospital; Richard Te Linde Distinguished Professor, Gynecologic Pathology,
Departments of Gynecology and Obstetrics and Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
Bhagirath Majmudar M.D.
Chief
Department of Pathology, Grady Health System; Professor, Department of Pathology; Associate Professor, Department of Gynecology and Obstetrics,
Emory University Hospital, Atlanta, Georgia 30322
Claude J. Migeon M.D.
Director
Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
John E. Niederhuber M.D.
Department of Surgery, Stanford University Medical Center, Stanford, California 94305
Wilberto Nieves-Neira M.D.
Clinical Fellow
Department of Gynecology and Obstetrics, Jackson Memorial Hospital; Clinical Assistant, Department of Gynecology and Obstetrics, University of
Miami School of Medicine, Miami, Florida 33136
Leslie Plotnick M.D.
Associate Professor
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
Thomas M. Price M.D.
Director
Department of Reproductive Endocrinology, Greenville Hospital System, Greenville, South Carolina 29605; Associate Professor, Department of
Gynecology and Obstetrics, University of South Carolina, Columbia, South Carolina 29203
Janet S. Rader M.D.
Associate Professor
Department of Gynecology and Obstetrics, Washington University School of Medicine, St. Louis, Missouri 63110
Spencer S. Richlin M.D.
Fellow
Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30322
John A. Rock M.D.
Professor and Chairman
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30322
Ricardo Sainz De La Cuesta M.D.
Formerly at Department of Gynecology and Obstetrics, Emory University Hospital and Emory University School of Medicine, Atlanta, Georgia 30322
Joseph S. Sanfilippo M.D.
Chairman
Department of Gynecology and Obstetrics, Allegheny General Hospital; Professor, Department of Gynecology and Obstetrics, MCP Hahnemann
School of Medicine, Pittsburgh, Pennsylvania 15212
Betsy Schroeder M.D.
Director
Division of Pediatric and Adolescent Gynecology, Department of Gynecology and Obstetrics, MCP Hahnemann School of Medicine, Allegheny General
Hospital, Pittsburgh, Pennsylvania 15212
Sander S. Shapiro M.D.
Director
Department of Reproductive Endocrine Service, University Hospital; Professor, Department of Gynecology and Obstetrics, University of Wisconsin,
Madison, Wisconsin 53792
Joe Leigh Simpson M.D.
Ernst W. Bertner Chairman and Professor
Department of Gynecology and Obstetrics, Baylor College of Medicine, Houston, Texas 77030
Melinda B. Stein M.D.
Francis Scott Key Medical Center, Baltimore, Maryland 21244
Ulun Uluĝ M.D.
Attending Physician
IVF Unit, Department of Gynecology and Obstetrics, German Hospital at Istanbul, Taksim, Istanbul, Turkey
Eric A. Wiebke M.D.
Associate Professor
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202
Michele D. Wilson M.D.
Assistant Physician and Clinical Associate Professor
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104
Dedication
To our families
Preface
This book brings a multidisciplinary approach to the gynecologic care of infants, children, and adolescents. The editors are truly fortunate to have
outstanding contributors from the fields of pediatrics, urology, psychology, surgery, and gynecology, who discuss the recognition and treatment of
medical illness in these specific age groups. The pathophysiology of disease is stressed. Knowledgeable handling of pediatric patients requires a
background in genetics and developmental biology. Genital examination requires forethought and gentleness, particularly in children, so variations
from a standard examination are discussed. Ultrasonography and laparoscopy have enhanced our ability to diagnose routine gynecologic complaints
of children and adolescents, but new norms for their use must be established.
Since the publication of our first edition, the field of pediatric and adolescent gynecology has matured. New contributions to our understanding of
this patient population have been made, clinical experience has grown and been documented, and exciting improvements in preventive care have
occurred. Nonetheless, this population still tends to be underserved. The demands for quality care affect many specialties, including family practice,
pediatrics, urology, pediatric surgery, and pediatric and reproductive endocrinology.
The fertility potential and gynecologic and psychosexual health of our youngest patients must be protected; it is essential that we provide quality
care for a wide variety of complaints. We hope that this book will assist those who are called upon to deliver expert care for gynecologic complaints
in infants, children, and adolescents.
Acknowledgments
We acknowledge the assistance of Glenda Walker in the preparation of this manuscript. We also thank Lisa McAllister and Gina Gerace of Lippincott
Williams & Wilkins. We are especially grateful to the many fine contributors whose experience and research is represented in this book.
Sue Ellen Koehler Carpenter
John A. Rock
