PAG over Pastries

Dr. Susan Kaufman and Dr. Kirsten Das walk through how and why prepubertal vulvar and vaginal symptoms happen so often, then show how small hygiene and toileting changes can resolve many cases without antibiotics. We also cover the high-stakes diagnoses you cannot miss, from lichen sclerosus to painful non-sexually transmitted vulvar ulcers and labial adhesions.

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

Dr. Susan Kaufman and  Dr. Bianca Allison take on contraception for teens whose chronic conditions and medications make standard options unsafe or ineffective. They discuss how we protect confidentiality, apply CDC guidance, and still center teen autonomy.

• assessing pregnancy-related risks tied to chronic disease and treatment
• protecting confidentiality with evolving minor consent laws and careful charting
• using the Guttmacher resource for state-by-state consent rules
• reviewing the full method range including IUDs and implants for adolescents
• counseling lupus patients with and without antiphospholipid syndrome
• addressing epilepsy pregnancy risks plus teratogenic anticonvulsants
• spotting anticonvulsant interactions that can reduce hormonal efficacy
• managing lamotrigine level changes with continuous combined regimens
• defining migraine with aura and why estrogen raises stroke risk
• framing VTE risk with estrogen and when progestin-only is preferred
• taking a family history for possible thrombophilias
• treating heavy menstrual bleeding with continuous regimens and LNG-IUD
• discussing BMI effects on the patch and emergency contraception choices
• counseling on depo-related weight gain and follow-up timing
• contraception considerations for cancer survivors and hormonally sensitive cancers
• managing hypertension categories with MEC-guided method selection
• weighing bone health with depo and combined hormonal contraception

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

We trace the line from “bad cramps” to a careful, compassionate evaluation for endometriosis, showing how physiology, history, and practical treatment choices restore a teen’s daily life. Evidence, empathy, and clear steps help shorten the long road to relief and reduce missed school and stress.

• defining primary and secondary dysmenorrhea and why prostaglandins matter
• prevalence figures and diagnostic uncertainty in adolescents
• first line management with timed NSAIDs and continuous hormonal therapy
• what to ask in the menstrual and symptom history
• when to suspect endometriosis after failed therapy
• broad differential including GI, GU, musculoskeletal and psychological causes
• limits of labs and imaging and the value of diaries
• multimodal care: PT, TENS, CBT, neuropathic agents
• GnRH options with add back and prudent use of surgery
• staging limits and mismatch with pain severity
• mental health, trauma awareness and inclusive care for trans patients

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

We walk through a clear roadmap for evaluating heavy menstrual bleeding in teens, from what counts as normal to when labs and treatment should start. A case of a 15-year-old with 10-day periods and nosebleeds anchors a practical workup and evidence-based care plan.

• Normal adolescent cycle ranges and red flags for heavy bleeding
• Definitions that guide when to test and treat
• Key causes in teens: anovulation and coagulopathy
• Focused history and exam without routine pelvic exams
• Labs that matter: pregnancy, ferritin, thyroid, coagulation, von Willebrand
• When imaging helps and when it delays care
• Iron repletion strategies and when to use IV iron
• Hormonal vs nonhormonal therapy, adherence, and expectations
• Acute management thresholds, IV estrogen, and layering therapy
• Long-term options including levonorgestrel IUD and progestins

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

walk through what a healthy teen menstrual cycle looks like, why early cycles are often irregular, and how to recognize red flags that need care. We share practical ways to track flow, choose products, reduce pain, and support teens with sensitivity and clarity.

• menarche timing, influences, and normal ranges
• early anovulatory cycles and HPO axis maturation
• typical cycle intervals and expected variability
• defining normal flow, duration, and clot size
• dysmenorrhea care with NSAIDs and heat
• assessing heavy bleeding using product charts
• clear red flags for evaluation and amenorrhea criteria
• headaches, fainting, nausea, and quality of life
• cycle tracking options and privacy cautions
• product choices, period poverty, and advocacy
• focused adolescent history, nutrition, and activity
• culturally sensitive education and reassurance

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

Dr. Susan Kaufman, pediatric gynecologist at Virtua Health, is joined by Dr. Tania Dumont, pediatric gynecologist from CHEO and the University of Ottawa, to break down how to perform a pediatric gynecologic exam with empathy, clarity, and evidence, from newborn anatomy to adolescent assessment. We show how language, positioning, and choice reduce fear while improving visualization, diagnosis, and outcomes.

Reference: NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 4

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

Dr. Susan Kaufman, PAG physician at Virtua health in New Jersey, and Dr. Olga Kciuk, PAG physician at Stanford University, walk through laparoscopic care for pediatric and adolescent patients from consent and anatomy to entry, pain control and recovery. The focus stays on safety, physiology, and teen-centered decisions that protect fertility and speed return to life.

Reference: NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 30

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

Venture into the intricate world of complex genitourinary anomalies with pediatric and adolescent gynecologists Drs. Susan Kaufman and Megan Sumida. Their discussion unravels the challenges and approaches to conditions that fundamentally alter the anatomical landscape for young patients.

Reference

NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 25

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

Dr. Susan Kaufman and Dr. Yossie Ahmadieh, an adolescent medicine doctor with Physicians for Reproductive Health, explore the vital topic of gender-affirming care for transgender and gender-diverse adolescents, discussing how appropriate medical interventions can be life-saving for these vulnerable youth.

Outline

• Introduction to Transgender Healthcare Basics
• Barriers and Mental Health Considerations
• Creating Safe Spaces in Clinical Settings
• Puberty Blockers and Treatment Options
• Gender-Affirming Hormone Therapy Approaches
• Monitoring Testosterone Therapy
• Estrogen Therapy and Anti-Androgens
• Surgical Options and Cancer Screening

Reference

NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 3

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content. 

Dr. Vrunda Patel, a PAG physician at Nemours Children's Hospital in Wilmington, Delaware, and Dr. Camille Imbo PGY6 PAG fellow discuss the increasing trend of teenage patients seeking evaluation for labial concerns, often driven by appearance rather than medical issues. Many teens and parents lack understanding about what constitutes normal genital appearance.

Outline

• Normal Vulvar Development in Puberty
• Common Labial Concerns and Influences
• Defining Labial Hypertrophy and Asymmetry
• Psychological Aspects and Assessment
• Treatment Options and Self-Care
• Surgical Considerations and Recovery

Reference

NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 16

Labial Anatomy Concerns in the Adolescent - JPAG 

What is PAG?
Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.

Want to test your knowledge?
PAG WebEd cases are a great way to review our podcast content.