Sanfilippo Joseph S, Lara-Torre Eduardo
From the Department of Obstetrics and Gynecology and Reproductive Sciences, Center for Fertility and Reproductive Endocrinology, University of Pittsburgh Physicians, Magee-Womens Hospital, Pittsburgh, Pennsylvania; and Ambulatory Gynecology and Pediatric and Adolescent Gynecology, Carilion Medical Center, Roanoke, Virginia.
Obstet Gynecol. 2009 Apr;113(4):935-947. doi: 10.1097/AOG.0b013e31819b6303.
Given new developments in the field of adolescent reproductive health, this review focuses on highlighting new guidelines and practice patterns in evaluation and management of adolescent gynecologic problems. First, understanding the proper techniques for the initial examination is key to establishing a long-term relationship with this age group. Reservations about the first gynecologic examination are common, and the practitioner's goal is foremost to make the patient as comfortable as possible. Preventive health in this patient population is key, and practitioners should become comfortable with providing education about topics as diverse as sexuality, eating disorders, and dating violence. Furthermore, the frequency with which teenagers report sexual activity and the high unintended pregnancy rate in this age group makes counseling regarding effective contraception essential. Additionally, practitioners are encouraged to take the opportunity to discuss the availability of the human papillomavirus (HPV) vaccine with adolescents. In 2007, adolescents were designated as a special population, given the frequency with which they acquire and clear mild HPV-related cervical dysplasia. More conservative treatment in this population is generally favored. During their transition through puberty, disorders of menstruation become the most common complaint requiring the attention of the gynecologist. Most commonly, anovulation serves as the cause behind such abnormal bleeding. Polycystic ovarian syndrome can develop in early puberty and carry its consequences into adulthood. Infertility, diabetes, and hirsutism mark the most important components of the syndrome and require age-appropriate management. Finally, the consequences of endometriosis on the future fertility of adolescents have brought early intervention to light. Recognition and prompt treatment are advocated to prevent the future implications of this disease.
鉴于青少年生殖健康领域的新进展，本综述着重强调青少年妇科问题评估与管理方面的新指南和实践模式。首先，掌握初次检查的恰当技术是与这个年龄组建立长期关系的关键。对首次妇科检查存在顾虑很常见，从业者的首要目标是让患者尽可能舒适。该患者群体的预防保健至关重要，从业者应自如地就性、饮食失调和约会暴力等各种话题开展教育。此外，青少年报告性活动的频率以及该年龄组意外怀孕率较高，使得关于有效避孕的咨询必不可少。此外，鼓励从业者抓住机会与青少年讨论人乳头瘤病毒（HPV）疫苗的可接种情况。2007年，鉴于青少年感染并清除轻度HPV相关宫颈发育异常的频率，他们被指定为特殊人群。该人群通常更倾向于采用更保守的治疗方法。在青少年经历青春期的过程中，月经紊乱成为最常见的需要妇科医生关注的问题。最常见的是，无排卵是此类异常出血的原因。多囊卵巢综合征可在青春期早期发病，并将其后果延续至成年期。不孕、糖尿病和多毛症是该综合征最重要的组成部分，需要进行适合年龄的管理。最后，子宫内膜异位症对青少年未来生育能力的影响已引起人们对早期干预的关注。提倡早期识别和及时治疗，以预防该疾病的未来影响。
