Transitioning healthy young women from pediatric to adult health care can be a challenge. However, patients who have undergone reproductive surgical procedures during their childhood present added complexity. Adolescents with gynecological anomalies, disorders of sexual development (DSD) and other ovarian conditions can benefit from communication and long-term planning about their care.
- Paige Hertweck, M.D., pediatric and adolescent gynecologist specialist with Norton Children’s Gynecology, published an article about the need for further research on transitional health care for these patients. “Challenges and Opportunities in Adolescent Gynecology Patients with Surgically-Treated Congenital and Acquired Anomalies: Transition of Care from Pediatric to Adult,” was published in the April edition of Journal of Pediatric and Adolescent Gynecology.
The need for transitional care between pediatric and adult care has been recognized for other conditions, including congenital heart disease, cerebral palsy, rheumatologic disorders, cystic fibrosis and diabetes. The American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians have developed transition guidelines for patients with these conditions, but currently none exist for patients with gynecology and reproductive issues.
Care improvements for patients with these conditions have shifted expectations from survival to increased emphasis on long-term sexual and reproductive health. The article asserts that patients with DSD, previous reproductive neoplasms (ovarian tumors), and/or other gynecologic malignancies may have better outcomes and respond better to the transition if pediatric providers caring for the adolescent/young adult and her parents work with them on a transition plan. The article makes recommendations on transition timing, content, and structure of the transition plan for these patients.
Successful transition of adolescents and young adults with chronic illnesses from pediatric to adult health care has been associated with the patient’s ability to function on her own, including scheduling and keeping medical appointments as well as compliance and adherence to medical regimens. As such, the paper asserts that clinicians caring for young adult patients in transition with reproductive health issues should be assessed for successful transition using this information. This may include ensuring patients are able to attend their medical appointments, adhere to medication prescribed and have knowledge of safe sexual practices with appropriate screening and use of contraception as needed.
The paper asserts that transitioning patients with reproductive health care needs is a complex process that should occur over multiple years. Patients report that psychological support is an essential component to the process. While transition models used in caring for adolescent patients with other chronic diseases can provide physicians with valuable protocols, transitioning patients with reproductive conditions needs more research. The paper asserts patients have unique issues regarding timing of disclosure of diagnosis, genital examinations, gonadectomy, vaginal treatments, hormone replacement therapy, use of long-term medication, and potential cancer screening recommendations to consider for ongoing care.