OBJECTIVES:To investigate the association between para-tubal cysts, adnexal torsion, and obesity in female adolescents. Para-tubal cysts, often misdiagnosed as ovarian cysts, may be androgen-sensitive and are of growing clinical concern in relation to obesity and adnexal torsion in adolescents. However, their associations remain underexplored. METHODS:Retrospective cohort study of female patients aged 2-18 years who underwent surgery for suspected benign adnexal lesions at a tertiary-level paediatric hospital between 2018 and 2024. Data on demographics, BMI, cyst characteristics, surgical outcomes, and androgen profile were collected. Obesity was defined as a BMI or weight >95th percentile, using weight alone when BMI was unavailable. RESULTS:There were 124 patients included, median age 15 years, of whom 43 (34.7%) had para-tubal cysts. Thirty-seven patients (30%) had obesity. Obesity was significantly associated with para-tubal cysts (P = 0.002), with a relative risk of 2.2 (95% CI 1.4-3.5). In patients with a para-tubal cyst, a positive correlation was found between para-tubal cyst volume and BMI z-score (rho = 0.46, P = 0.007). Para-tubal cysts were also associated with adnexal torsion (P < 0.001), with a relative risk of 2.4 (95% CI 1.6-3.6) compared to ovarian cysts, and this association remained significant even when restricting ovarian cysts to those of dermoid subtype, which are traditionally considered to be the primary cause of adnexal torsion in the paediatric literature. CONCLUSIONS:Para-tubal cysts are more common in adolescents with obesity and are strongly associated with adnexal torsion. This highlights the need for heightened awareness and careful evaluation of para-tubal cysts in patients with obesity to prevent complications like adnexal torsion.

Adolescents have lower rates of breastfeeding (BF) compared to older mothers. BF self-efficacy (SE) has been identified as an important factor influencing BF outcomes. An innovative BF program for young women was co-designed and implemented, which included staff training, a prenatal BF class, and BF peer support. The objective of this prospective pilot cohort study was to evaluate the effectiveness of prenatal education and peer support in improving a young mother’s BF SE. Participants were pregnant adolescents recruited from a large urban non-profit social service outreach centre. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was administered to participants before and after participating in the BF program. BSES-SF scores were summed to determine a composite score and compared descriptively using median score. Un-aggregated, item-by-item, comparison of pre- versus post-BF program scores were also compared to examine improvements in SE. A total of 20 adolescent mothers (mean age = 16.6) attended the program. An increase in the total BSES-SF score was observed based on descriptively comparing the mean pre- versus post-intervention. Participation in tailored prenatal education classes and a peer-support program was associated with increased BSES-SF. Identifying mothers with low BF SE can enable healthcare professionals to implement targeted interventions in this at-risk population.

Only in the last two decades have we started to realize the importance of pediatric and adolescent gynaecology (PAG) care provided by specialists trained in this area. Obstetricians and gynaecologists (Ob/Gyns) have been caring for women for many years; however, the care of young women and children with gynaecological issues has been provided by health care providers from different specialties with no, little, or variable PAG training. The Royal College of Physicians and Surgeons of Canada (RCPSC) has Objectives of Training and one Entrustable Professional Activity for achieving competency in PAG during an Ob/Gyn residency. There is a paucity of data in Canada on who provides care to the PAG population and how these providers are trained. With this letter, our team explored the topics of care provision, health care providers’ self-perceived competence, and desire for and method of delivering PAG training to future and current Canadian Ob/Gyns. Like any budding field, time is required for clinical and educational research to catch up with that of other well-established subspecialties.

Aging-dependent changes of some enzymatic activities related to the glycolytic anaerobic pathway (lactate-dehydrogenase, LDH), to the Krebs's cycle (succinate dehydrogenase, SDH) and to the activity of the respiratory oxidative chain (NADH2 - tetrazolium reductase, NADH-D) were studied in the nephron of 4-(young) and 24- (aged) month-old female Wistar rats. In the renal glomeruli LDH and NADH-D activities were reduced with aging, while SDH did not undergo aging-dependent changes. In both the proximal and the distal convoluted tubules, LDH reactivity slightly increased while NADH-D remarkably decreased in old rats; SDH did not show aging-dependent changes. In the loop of Henle LDH was slightly increased, SDH was unchanged and NADH-D was decreased in aged in comparison to young rats. The three enzyme activities investigated were significantly reduced in the collecting tubules of aged animals. The above results are suggestive of the existence of aging changes in mechanisms related with energy transduction in the rat kidney, affecting at a different extent the cell populations of the nephron.

Objective To identify 1) the current state of pediatric and adolescent gynecology (PAG) provision of care; 2) barriers to practicing PAG; and 3) the need for increased PAG training in residency and continuing medical education (CME). Methods Obstetricians and gynecologists (OB/GYNs) across Canada who currently practice gynecology were asked to complete an anonymous, self-administered, Internet-based survey. Results One-hundred and forty-seven OB/GYNs across Canada responded to the survey, and after applying exclusion criteria (retired gynecologists, medical students, postgraduate trainees, gynecologists who do not currently practice gynecology, PAG specialists, or OB/GYNs seeing predominantly pregnant adolescent women), 135 were included. Seventy-six percent of survey respondents stated that they care for pediatric and adolescent patients in their practice. The pathologies and surgeries they are comfortable managing are those that are similar to the adult population, such as intrauterine device insertion in the office/OR, adnexal detorsion, laparoscopy in patients over 12 years of age, examination under anesthesia, and hymenectomy. Respondents who stated wanting to learn more about PAG preferred either online learning modules (85%) or CME workshops at regional meetings (91%). Conclusion Canadian OB/GYNs provide PAG care with very little training to support their work. Attention must be given to better training for our residents via available curriculums and teaching modalities, as well as increased access to CME for OB/GYNs.

Objectives We conducted a research study to create, disseminate and evaluate a video promoting young mothers breastfeeding in public given that many pregnant and parenting youth identified stigma associated with breastfeeding as a significant concern. The study was designed to determine if a youth-informed breastfeeding video could reduce stigma and increase acceptability of breastfeeding in public. Methods Research ethics board approval was obtained. Focus groups with pregnant and parenting youth (n=9) were conducted. A qualitative analysis identified two key themes: 1) Our breast-obsessed society doesn't always support breastfeeding, and 2) We need to normalize breastfeeding in Canada. A script was written based on focus group findings, and two short evidence-based videos were produced and critically reviewed by participants. An evaluation survey was administered to pregnant and parenting youth and staff at a large urban outreach centre (n=99). Results Participants agreed/strongly agreed with the following statements: the video was informative about a mother's right to breastfeed in public (88%); the video would encourage more mothers to breastfeed in public (90%); and the video would encourage public openness to breastfeeding in public spaces (86%). Social media was identified by the majority of respondents as the best way to share the videos, and there was unanimous support for sharing the videos widely. Conclusions Youth-informed breastfeeding videos featuring young mothers appear to reduce stigma and increase acceptability of breastfeeding in public. Given the frequency of young breastfeeding mothers reporting stigmatization, greater advocacy work is required to protect breastfeeding in public spaces. We conducted a research study to create, disseminate and evaluate a video promoting young mothers breastfeeding in public given that many pregnant and parenting youth identified stigma associated with breastfeeding as a significant concern. The study was designed to determine if a youth-informed breastfeeding video could reduce stigma and increase acceptability of breastfeeding in public. Research ethics board approval was obtained. Focus groups with pregnant and parenting youth (n=9) were conducted. A qualitative analysis identified two key themes: 1) Our breast-obsessed society doesn't always support breastfeeding, and 2) We need to normalize breastfeeding in Canada. A script was written based on focus group findings, and two short evidence-based videos were produced and critically reviewed by participants. An evaluation survey was administered to pregnant and parenting youth and staff at a large urban outreach centre (n=99). Participants agreed/strongly agreed with the following statements: the video was informative about a mother's right to breastfeed in public (88%); the video would encourage more mothers to breastfeed in public (90%); and the video would encourage public openness to breastfeeding in public spaces (86%). Social media was identified by the majority of respondents as the best way to share the videos, and there was unanimous support for sharing the videos widely. Youth-informed breastfeeding videos featuring young mothers appear to reduce stigma and increase acceptability of breastfeeding in public. Given the frequency of young breastfeeding mothers reporting stigmatization, greater advocacy work is required to protect breastfeeding in public spaces.

Objectives We designed and implemented an innovative youth-informed breastfeeding (BF) program. The primary objective of this study is to evaluate the impact of this program on BF self-efficacy, intention, initiation and duration in young mothers. The secondary objective includes identifying recommendations to enable future implementation of the program elsewhere. Methods We recruited participants ≤24 years at a large urban youth outreach centre. Participants were enrolled in their 3rd trimester, and followed-up postnatally at 2 weeks, 6 weeks, and 6 months. At the first contact, participants were asked about their feeding intention and prenatal education received. At each follow-up contact, participants were asked about feeding history, BF supports received, or reasons for weaning if applicable. At each time point, participants completed the Breastfeeding Self-Efficacy Scale- Short Form. Interviews were completed with 10 key stakeholders involved in the design and implementation of the program. Results 31 participants enrolled in the study. BF initiation rates were higher, and BF duration rates were longer at time of hospital discharge, 2 weeks postnatal, and 6 weeks postnatal compared with those who did not receive the intervention. None of the results were statistically significant, however, the sample may not have been large enough to detect statistically significant differences. Conclusions The youth-informed program is meeting the needs of pregnant and parenting youth in a responsive and timely manner. The peer support program is adaptable, with expandable content. Essential components of a youth-informed BF program have been identified. Collaboration with community partners was key to the success of this program. We designed and implemented an innovative youth-informed breastfeeding (BF) program. The primary objective of this study is to evaluate the impact of this program on BF self-efficacy, intention, initiation and duration in young mothers. The secondary objective includes identifying recommendations to enable future implementation of the program elsewhere. We recruited participants ≤24 years at a large urban youth outreach centre. Participants were enrolled in their 3rd trimester, and followed-up postnatally at 2 weeks, 6 weeks, and 6 months. At the first contact, participants were asked about their feeding intention and prenatal education received. At each follow-up contact, participants were asked about feeding history, BF supports received, or reasons for weaning if applicable. At each time point, participants completed the Breastfeeding Self-Efficacy Scale- Short Form. Interviews were completed with 10 key stakeholders involved in the design and implementation of the program. 31 participants enrolled in the study. BF initiation rates were higher, and BF duration rates were longer at time of hospital discharge, 2 weeks postnatal, and 6 weeks postnatal compared with those who did not receive the intervention. None of the results were statistically significant, however, the sample may not have been large enough to detect statistically significant differences. The youth-informed program is meeting the needs of pregnant and parenting youth in a responsive and timely manner. The peer support program is adaptable, with expandable content. Essential components of a youth-informed BF program have been identified. Collaboration with community partners was key to the success of this program.

Functional hypothalamic amenorrhea (FHA) is a common cause of amenorrhea in adolescent girls. It is often seen in the setting of stress, weight loss, or excessive exercise. FHA is a diagnosis of exclusion. Patients with primary or secondary amenorrhea should be evaluated for other causes of amenorrhea before a diagnosis of FHA can be made. The evaluation typically consists of a thorough history and physical examination as well as endocrinological and radiological investigations. FHA, if prolonged, can have significant impacts on metabolic, bone, cardiovascular, mental, and reproductive health. Management often involves a multidisciplinary approach, with a focus on lifestyle modification. Depending on the severity, pharmacologic therapy may also be considered. The aim of this paper is to present a review on the pathophysiology, clinical findings, diagnosis, and management approaches of FHA in adolescent girls.

Adolescents (≤19 years of age) have lower rates of breastfeeding (BF) compared to older mothers. BF self-efficacy (SE), defined as a mother’s confidence in her ability to breastfeed her infant, has been identified as an important factor influencing BF outcomes. An innovative youth-informed BF program for young women was designed and implemented, which included staff training, a prenatal BF class and BF peer support. The objective of this cohort study was to evaluate the effectiveness of the program in improving young mother’s BF SE.Participants were pregnant adolescents recruited from a large urban non-profit social service outreach centre. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was administered to participants before and after participating in the BF program. BSES-SF scores were summed to determine a composite score and compared descriptively using mean score. Un-aggregated, item-by-item, comparison of pre-vs post-BF program scores were also compared to examine improvements in SE. A total of 20 adolescent mothers (mean age = 16.6) attended the BF program. An increase in the total BSES-SF score was observed based on descriptively comparing the mean pre vs post intervention.Prenatal education and peer support adapted to the needs of adolescent mothers was associated with increased BSES-SF. These results are promising given that clients attending programs at this agency have low-income, low educational attainment, variable family support, housing instability, and are at-risk for not breastfeeding. Future studies with larger cohort are required to further validate and establish generalizability, as well as to determine the effect on BF duration rates.

The pediatric reproductive organs are optimally imaged with a full bladder. The filling of the bladder, however, often leads to significant delay in diagnosis and can subject the patient to invasive bladder catheterization. As the key imaging feature in ovarian torsion is unilateral ovarian enlargement, we suspected that a torsed ovary is large enough to be visualized even if the bladder is not well distended. The purpose of this study was to retrospectively investigate if clinically suspected adnexal torsion can be excluded based on non-visualization of the ovaries on transabdominal ultrasound (US) with a non-distended bladder in pediatric patients. This retrospective study comprised 349 girls (1–19 years old) between Jan. 1, 2013, and July 30, 2018. Three hundred and forty-one of the girls were referred to transabdominal US to assess for adnexal torsion and/or appendicitis, and the ovaries were initially not visualized on US. Their bladders were subsequently filled and rescanned with a distended bladder showing the ovaries. Ovarian volumes and time between US scans were documented. The ratio of the volume of the larger ovary to the smaller one was calculated. Nine girls had surgically proven adnexal torsion and a preoperative transabdominal US with a non-distended bladder. There was an overlap of one girl between the two groups. The negative predictive value (NPV), positive predictive value (PPV), and sensitivity and specificity for exclusion of adnexal torsion based on non-visualization of the ovaries on US with a non-distended bladder were calculated. One of the girls (1/341) who had a US study done with a non-distended bladder in which the ovaries were not visualized had a positive diagnosis of adnexal torsion. In eight of the nine girls who had surgically proven adnexal torsion, the torted ovary was identified with a non-distended bladder. The NPV and PPV for exclusion of adnexal torsion with a non-distended bladder was 1.0 and 0.8, respectively. The specificity and sensitivity were 99.4% and 88.9%, respectively. The mean and median time difference between the initial scan and the scan after bladder filling was 105.1 min (standard deviation [SD] -65.8) and 89.0 min (interquartile range [IQR]- 59.0, 130.5), respectively. Non-visualization of the ovaries with a non-distended bladder on transabdominal US study can help exclude clinically suspected adnexal torsion, alleviating the need for bladder filling and prolonging the wait time in the emergency department. Inclusion of non-visualization of the ovaries as one of the features in a predictive score for adnexal torsion should be considered.

In the present study, sexual health educators in schools in the catchment area for the Children's Hospital of Eastern Ontario were surveyed to determine whether sexual health education programs were available to youth, whether the structure and content of sexual health education programs followed the guidelines, the instructors' qualifications and level of comfort with the material, and the need for additional resources that could be offered by health care professionals. Survey results showed that only 85% of participating schools had a sexual health education program in place. Only one-third of educators stated they had formal training on the topic of sexual health. Some schools still taught mostly about abstinence or advocated condom use for contraception. The results showed that many of these schools did not follow established Canadian guidelines for sexual health education. Nonetheless, 80% of Canadian adolescents report school as their most valuable source of information on sexuality.

Objectives: Understanding adolescent sexual behaviours and factors associated with contraceptive use/lack of use helps guide programs/policies to reduce adolescent pregnancies and STIs. Our objectives: (1) Characterize adolescent women's contraceptive choices, contraceptive adherence, and barriers to consistent use; (2) Determine trends in contraceptive use and sexual behaviours among Canadian adolescents over the last decade.

The degree of exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology and pediatrics. Nevertheless, these programs are responsible for training residents and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2014 publication with added content, resources, and updated references. Additionally, attention to the needs of learners in pediatrics and adolescent medicine is given greater emphasis in this revised North American Society for Pediatric and Adolescent Gynecology Short Curriculum 2.0.

Background: An 18-month-old female toddler presented with severe vulvar ulcers and pancytopenia with investigations revealing Pseudomonas aeruginosa bacteremia. Case: A previously healthy 18-month-old female toddler presented with 6 days of fevers, vulvar rash, and ulcers. Vulvar cultures showed Staphylococcus aureus and P aeruginosa. Bloodwork showed pancytopenia and P aeruginosa bacteremia. She started receiving broadspectrum antibiotics. Bone marrow aspirate revealed a hypocellular marrow with erythroid dysplasia. Vulvar ulcers progressed rapidly, therefore magnetic resonance imaging was performed to rule out necrotizing fasciitis. She was diagnosed with ecthyma gangrenosum (EG). Three months after initial presentation, she was diagnosed with precursor B-cell acute lymphoblastic leukemia. Summary and Conclusion: This case highlights that health care providers should suspect EG when severe vulvar ulcers are present with P aeruginosa infection and neutropenia. Because EG poses significant morbidity and mortality, its presence should prompt aggressive antimicrobial therapy and mobilization of a multidisciplinary team to initiate workup for an underlying immunodeficiency syndrome or malignancy. This case also illustrates that surgical debridement might be avoided in certain patients with EG as long as meticulous wound care and close monitoring with a multidisciplinary team are in place.

Study Objective: The goal was to develop a multispecialty committee to address deficiencies in pediatric and adolescent gynecology (PAG) resident education through curricular development under the auspices of the North American Society for Pediatric and Adolescent Gynecology. Design, Setting, Participants, Interventions, and Main Outcome Measures: A multispecialty North American committee was organized to develop short as well as long curricula in PAG through a combination of conference calls and face-to-face meetings. Content was guided by objectives of national accrediting organizations. The curricula used print as well as interactive electronic resources. Results: After publication of the short and long curricula, a dissemination strategy was developed to present the information at national meetings. A curricular study was performed after introduction of the curriculum to evaluate its efficacy. Long-term plans for further curricular components and expansion of educational tools are ongoing. Conclusion: We gathered a diverse multispecialty group of doctors to collaborate on a unified educational goal. This committee developed and disseminated resident PAG curricula using a variety of learning tools. This curricular development and implementation can occur with a minimal financial burden.

The Canadian Guidelines for Sexual Health Education states that “sexual health is a key aspect of personal health and social welfare that influences individuals across their lifespan”. Multiple studies show that sexual health education programs help to prevent negative sexual health outcomes such as sexually transmitted infections and unplanned pregnancies. The objectives of this study are to determine:(1)If sexual health education programs are available to youth in our region;(2)If the structure and content of sexual health education programs are following Canadian guidelines for sexual health education;(3)The qualification and level of comfort of instructors teaching sexual health education;(4)The need for additional resources for educators and students. An observational, non-interventional study was conducted. School principals of seven different school boards in CHEO’s catchment area were asked to complete an anonymous, self-administered, Internet-based survey. REB approval was granted. The primary outcome assessed was the evaluation of the material being taught for sexual health education in primary and secondary schools in CHEO’s catchment area. Our survey collected data on the structure of sexual health education programs, program content, and instructor qualifications. The secondary outcome assessed the need for additional resources based on the challenges faced by instructors. Seven school boards were contacted to participate in the study. One school board accepted to participate. The school board distributed the survey to their thirty-two schools, of which, 90.6% (29/32) accepted to participate and 84.3% (27/32) completed the survey. The person responsible for sexual health education was the physical education teacher (89%). The majority of schools offer sexual health education programs, formal training for instructors and their instructors are comfortable teaching the subject matter (Table 1). Four of the five schools did not discuss contraception despite their instructors stating being comfortable discussing the topic. Similarly, three of the four respondents whose school did not discuss contraception felt that their instructors were comfortable discussing the topic. It is unclear why these topics are not being taught. Finally, sixty percent of respondents indicated interest in receiving educational workshops for their school.Table 1YesNoUnknownOffered sexual health education programs85.2% (23/27)14.8% (4/27)Formal training for instructors33.3% (9/27)33.3% (9/27)33.3% (9/27)Instructor feels comfortable teaching sexual health education51.9% (14/27)14.8% (4/27)33.3% (9/27) Open table in a new tab Sexual health education programs offered in primary and secondary schools in CHEO’s catchment area are facing many challenges and do not follow the established Canadian guidelines. Further studies are needed to determine barriers and enablers allowing successful integration of sexual education in these schools. Supplementary workshops given by medical health professionals could be beneficial for elementary and secondary school students in order to reduce adverse sexual health outcomes.

Young mothers have lower rates of breastfeeding (BF) compared to adult women. BF self-efficacy (SE), defined as a mother's confidence in her ability to breastfeed her infant, has been identified as an important factor influencing BF outcomes. The majority of the interventions to increase BF rates target adult women and the ideal format for an effective youth program has not been conclusively determined. An innovative youth-informed BF Program for young women was implemented at St. Mary's Home in 2015. This unique and comprehensive program incorporates all of the educational and supportive elements that are known to effectively improve young mothers' BF outcomes. This program consists of staff training in BF best practices, a revision of prenatal BF curriculum to be youth friendly, and a new BF peer support program. The objective of this pilot study is to evaluate BF SE following participation in this innovative BF program. We conducted a research ethics board approved study of young women (15-24 years old) who participated in the BF program between November 2015 and October 2016. The validated BF Self-Efficacy Scale-Short Form (BFSE-SF) was administered before and after exposure to program elements. High BF SE is defined as a BFSE-SF scale score ≥ 52/70. Descriptive statistics were performed. Forty-six participants (mean age 19.5 years) were recruited to prenatal BF class (n=26) and peer support group (n=20). Young women were partnered (65.2%) and had prior BF experience (19.6%). BFSE-SF scale scores increased with both interventions: in prenatal class, pre-post BFSE were 45.7 and 54.8 respectively (Table 1); while in peer support group, pre-post BFSE were 50.0 and 60.0 respectively (Table 2). When analyzing complete pre-post pairs: 81% (13/16) participants in prenatal BF class increased their BF SE scores, with 38% (5/13) moving from low to high SE. In the peer support program, 100% (3/3) participants increased their SE score, with 66.7% (2/3) moved from low to high SE. Prenatal education and peer support adapted to the specific needs of young mothers leads to increased BF SE. These are promising results especially since there is a paucity of effective BF programs for young women. Future studies are required to validate the results in a larger cohort and to determine the effect on BF initiation and duration rates.Table 1Prenatal BF ClassAll (n= 26)Complete Pairs (n= 16)AgeYears (range)19.6 (15-24)20.5 (15-24)Partnered18 (72.0%)11 (68.8%)Parenting6 (24%)4 (25%)BF Experience (Yes)2 (8%)1 (6.3%)BFSE PreMean (range)45.7 (14-70)47.1 (26-70)BFSE PostMean (range)54.8 (34-70)57.9 (34-70) Open table in a new tab Table 2Peer Support ProgramAll (n=20#missing demo data in 3)Complete Pairs (n=3)AgeYears (range)19.3 (16-24)20.6 (17-24)Partnered12 (70.6%)2 (66.7%)Parenting10 (58.8%)2 (66.7%)BF Experience (Yes)7 (41.2%)1 (33.3%)BFSE PreMean (range)50.0 (29-68)42.0 (29-54)BFSE PostMean (range)60.0 (29-70)58.3 (55-64)# missing demo data in 3 Open table in a new tab

Study Objective: To share pregnant and parenting youth's experiences with health care to inform recommendations for promoting youthfriendly medical encounters. DDesign: This exploratory study used a qualitative descriptive approach.Setting: Three urban centers that service pregnant youth and young parents in a large Canadian city.Participants: A convenience sample of 26 participants (mean age of 18.7 years) was recruited across sites. Interventions: Five focus groups were conducted.Main Outcome Measures: Focus groups were audio recorded, transcribed verbatim, and analyzed thematically. Analysis involved the independent, open coding of data by 2 qualitative researchers to identify and compare emerging themes.Results: Three major themes emerged regarding their experiences with health care providers: characteristics of negative health care encounters, the emergence of contemporary stereotypes during these encounters, and characteristics of positive health care encounters. Negative encounters often resulted from perceived judgmental attitudes of providers and were shown to contribute to a general sense of mistrust and fear. Positive health care encounters tended to feature mutual respect, support, open dialogue, and nonjudgmental attitudes.Conclusion: Pregnant and parenting youth in our study have experienced many negative health care encounters that have contributed to disengagement and mistrust of the health care system. To engage this high-risk population in health care, practitioners are encouraged to consider their own biases when servicing this population and work toward fostering positive, nonjudgmental interactions, and supportive environments.

Background We describe an unusual presentation of lichen sclerosus in a postmenarchal, virginal girl. Case A 14-year-old girl first presented with acute urinary retention due to labial agglutination and developed bilateral tubo-ovarian abscesses in 10 days of the conservative management period. Abscesses were treated with antibiotherapy and percutaneous drainage; simple division of the labial agglutination and vulvar biopsies were performed with a preliminary diagnosis of lichen sclerosus. Postoperative follow-up with antibiotherapy and clobetasol propionate 0.05% ointment was uneventful. Summary and Conclusion Lichen sclerosus should be considered in cases of labial agglutination with atypical presentations. Finally, this case reminds us that pelvic inflammatory disease and tubo-ovarian abscess must be kept in mind even in virginal adolescents, especially in the presence of obstructive lesions of the genital tract.