GYNECOLOGIC CARE OF MEDICALLY COMPLICATED ADOLESCENTS

Keith Owens; Ann Honebrink

doi:10.1016/S0031-3955(05)70141-3

Puberty and adolescence can be extremely stressful transitions for girls. When the transition is confounded by the addition of a chronic medical illness or disability, it becomes a more challenging situation. Caregivers for pubertal and adolescent young women with chronic illnesses must understand the interactions of the normal endocrinology of development and the pathophysiology of the medical illness. As adolescent medicine continues to evolve, hopefully more attention will be directed to this area because currently only a paucity of information is available. One of the largest obstacles has been the fractional care given by various subspecialists treating patients with medical illnesses, whereas the gynecologic issues have been ignored or delegated to gynecologists who may poorly understand the interaction between a particular disease and the reproductive process. The normal pubertal development and subsequent normal menstrual cycle are a reflection in part of the general health of the individual. The maturation of the hypothalamic-pituitary-ovarian axis requires a given body mass with a certain percentage of body fat. 29 This is illustrated in young athletes who have delayed puberty while they continue strenuous activities, such as gymnastics, at a highly competitive level. 29 The interactions of chronic, severe medical illnesses on the maturation and continuing function of the hypothalamic-pituitary-ovarian axis can be understood when the pathophysiology of the disease process is overlaid on the normal development of the axis. In the same way, the interplay of a given medical illness with fertility and pregnancy outcome requires an understanding of the physiology of fertility and pregnancy, while adding the perturbations occurring as a result of the medical illness. To offer contraceptive advice to chronically ill adolescents, one must understand the relationships of the disease process to the menstrual cycle. The ramifications of contraceptive failure on adolescents, the disease process, and subsequent pregnancy must be considered. The system has multiple points where both negative and positive feedback mechanisms are subject to the metabolic processes throughout the body. Many drugs may also act at various points to disrupt the system. The natural pyschology of adolescents must also be considered. If the contraceptive method is to work, it must be used consistently as long as someone is sexually active. Convincing healthy adolescents that they may become pregnant and therefore must use contraception is often difficult. In developing young women who are already dealing with the stigmata of chronic medical illnesses, the addition of a contraceptive method often perceived as cumbersome, such as usual barrier methods, is frequently unrealistic. Caregivers must understand and be willing to offer alternative methods of contraception to these young women, understanding that health risks secondary to the method must be balanced against the health and psychosocial risks posed by unintended pregnancy. A formula that helps quantify this judgment process has been proposed by Jones and Wild 19 : ▪ This assessment is often hampered by the lack of good prospective data about the risks of different contraceptive methods in chronically ill or disabled women. The risks for pregnancy are a little better studied, although mostly in a retrospective manner. 19 Although chronically ill and disabled adolescents are likely to be sexually active, they are less likely to receive information and guidance about sexual issues from their health care providers and more likely to harbor misinformation regarding sexual issues. 5 In addition to basic information, disabled adolescents need to know the potential impact of their illness on pregnancy. They also need to be told what genetic risk their illness, treatment, and disability pose to unborn children and, in terms of their disability or illness, adolescents need to know what limitations are imposed on both sexual function and fertility. Female fertility, although lower in patients with certain chronic illnesses, such as cystic fibrosis and Crohn disease, should be assumed to exist until proven otherwise. Finally, social isolation is common because, in chronically ill or disabled adolescents, counseling addressing social and judgmental skills is crucial. 33

GYNECOLOGIC CARE OF MEDICALLY COMPLICATED ADOLESCENTS

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GYNECOLOGIC CARE OF MEDICALLY COMPLICATED ADOLESCENTS

Additional Links

Abstract

Metrics

Details

UN Sustainable Development Goals (SDGs)

InCites Highlights

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