What is pediatric and adolescent gynecology?

I know you’ve been there. Someone, somewhere, wanting to make conversation, asks you what type of work you do. Typically, I’ll answer that I’m a physician, and we all know that reply can trigger a long story from the questioner about their own latest encounter with the medical profession. Sometimes, if they are curious and ask for more information, “what type of doctor?”, I’ll respond that I’m a gynecologist. Before volunteering even this limited information, I’ll try to gauge their interest. If my questioner is a man, the conversation may quickly to turn another subject. This is certainly not always the case, and a man may choose to pursue a discussion, just as the subject may change when I am speaking with a woman. But more often than not, when speaking with a woman, the topic of gynecology or obstetrics leads to further discussion.

The conversation may then evolve to a discussion of my gynecology practice that no longer includes adult women, but which focuses on pediatric and adolescent gynecology (PAG). Here’s where I often see a puzzled look, and some variation on the question, “What on earth is pediatric and adolescent gynecology?”1 Many people are surprised that PAG is a “thing.” I may describe some of what I do as “preventive obstetrics,” which typically brings a smile or a chuckle, albeit often with a bit of lag time. 

In the United States, porn films with the participation of gynecologists are very popular, I consider this unacceptable. Another thing is when in porn we can see the old sitcoms of the 70-80s. The famous Nubiles porn studio this year launched a special series of such videos – That Sitcom Show. An excellent parody site that’s the perfect blend of porn, fun, hardcore and humor. That Sitcom Show is brand new, and so it’s still small, but it’s hit the ground knowing exactly what it is presenting with well-made parody porn, sitcoms with cum, humor with hardcore and titled series that play out just like the real thing, except with masses of sex included. It’s also HD, exclusive, comes with pics and screencaps.

Preventing unintended pregnancies in adolescents is indeed a major focus of my practice, but my practice is much broader than just contraception. I see girls, adolescents, and young adult women in my practice at the Lucile Packard Stanford Children’s Hospital in Palo Alto, California. My patients come from all around the San Francisco bay area, as well as from much further afield in California and other parts of the western United States. I care for these individuals with problems ranging from abnormal menstrual bleeding, abnormal puberty (too early, or too late), vulvar and vaginal symptoms, pelvic/ovarian masses, pelvic pain, differences of sex development, concerns about sexually transmitted infections, congenital utero-vaginal variants, and much more. 

I regularly provide preventive guidance to teens (and their parents), address anxieties about fertility and future reproductive health, encourage preventive services including human papillomavirus vaccinations, and talk about the benefits and risks of hormone therapies including oral contraceptives and hormonal intrauterine devices not only for contraception, but also for managing menstrual pain, irregular bleeding, or heavy menstrual bleeding. I talk about condoms, safe sex, responsible sex, abstinence, self-esteem, bullying, and uncover never-before-disclosed sexual abuse. I answer questions about normal anatomy—breasts of different sizes, or labia that may not look like the idealized images of porn stars on the Internet. Once you earn their trust with honest answers and sincerity, teens will confide a lot—including their hopes, dreams, fears, and foibles. And if I’m lucky and have the privilege of seeing an individual weather her teen years into young adulthood, I’m often witness to the amazing transformation of adolescent development.