Pediatric and Adolescent Gynecology (PAG) is uniquely qualified to meet the Eunice Kennedy Shriver National Institute of Child Health and Human Development mission: to “understand human development, improve reproductive health, enhance the lives of children and adolescents” . PAG is a relatively new subspecialty within the field of Obstetrics and Gynecology and encompasses gynecologic care from the fetal period into adulthood. The American Board of Obstetrics and Gynecology has recently implemented a Focused Practice Designation in Pediatric and Adolescent Gynecology.

Areas in which Pediatric and Adolescent Gynecologists have expertise include:

• CONGENITAL: anomalies of the reproductive tract including disorders of sex development (DSD)
• ONCOLOGY: pelvic masses, pediatric and adolescent cancers of the genital tract as well as risks for adult cancers which begin in childhood and adolescence (such as human papilloma exposure and endocrine exposures)
• FERTILITY/FERTILITY PRESERVATION: Impact of exposures in the adolescent period on fertility such as ovarian torsion, exposure to gonadotoxic therapy and infectious agents which cause infertility (such as Chlamydia), as well as genetic conditions that impact oocytes and follicles in the ovary such as Turner syndrome and Classic Galactosemia. Fertility preservation procedures include ovarian tissue cryopreservation.
• MEDICAL/ENDOCRINE CONDITIONS: evaluation and management of reproductive endocrine conditions such as precocious and delayed puberty, polycystic ovary syndrome, premature ovarian insufficiency, hirsutism and medical management of transgender adolescents
• STRUCTURAL: structural gynecologic conditions including vulvar and vaginal conditions, pre-pubertal bleeding, management of conditions which can cause vaginal stenosis such as radiation, and autoimmune reactions.

Many of the conditions managed by pediatric gynecology are rare diseases and have been poorly studied. In addition, as experts in complex gynecology many pediatric and adolescent gynecologists care for adult women with these and similar conditions. Thus, an emphasis on Pediatric and Adolescent Gynecology fits well within the mission of the Program of Reproductive and Adult Endocrinology, Reproductive Biology and Medicine Branch of NICHD, and offers unique opportunities that align with NICHD research priorities.

Vision

To create a comprehensive and innovative pediatric and adolescent gynecology program within the NICHD which encompasses community clinical and research resources. This program integrates regional clinical care with a post-graduate training program to populate primarily human clinical studies of gynecologic disorders that begin before puberty, to understand both childhood and adult gynecologic disease and fertility.